The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Mears Help to Live at Home Wiltshire

Overall: Good read more about inspection ratings

Suite 3 Minton House, Minton Distribution Park, London Road, Amesbury, Salisbury, Wiltshire, SP4 7RT 0845 266 8944

Provided and run by:
Cera Care Operations Limited

Important: This service is now registered at a different address - see new profile
Important: We are carrying out a review of quality at Mears Help to Live at Home Wiltshire. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

9 and 18 December 2015

During a routine inspection

This inspection took place on 9 and 18 December 2015. This was an announced inspection which meant the provider knew two days before we would be visiting. This was because the location provides a domiciliary care service. We wanted to make sure the manager, or someone who could act on their behalf would be available to support our inspection.

Mears Help to Live at Home Wiltshire is a large domiciliary care agency which provides care and support to people in their own homes on a short and long term basis. The agency manages the local authority’s Help to Live at Home contract.

The agency had a register manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present throughout the inspection.

During an inspection in June 2014, significant concerns were identified in relation to people’s care. We issued a warning notice and four compliance actions to ensure the provider made improvements. We undertook an inspection in August 2014, to ensure the shortfalls had been addressed. However, further widespread shortfalls in care provision, such as missed calls and inadequate care planning were noted. The warning notice, which we had issued in June 2014, had not been complied with. Due to the risk of significant harm to people’s safety, we issued a Notice of Decision, which restricted the provider from accepting any new care packages unless with our prior agreement. Another inspection was undertaken in December 2014, to review the restriction and to ensure people’s safety was assured. Improvements had been made but these needed to be further maintained and embedded within the service. We identified additional shortfalls in relation to the safe administration of medicines, consent and risk management. The provider sent us a detailed action plan to show how they would make improvements.

At this inspection, which took place on 9 and 18 December 2015, all shortfalls had been addressed. Improvements had been made to each area of the service. The registered manager told us they now thought Mears Help to Live at Home Wiltshire provided a safe, effective and responsive service. People and staff confirmed this. There were many positive comments about recent improvements and how the agency had “turned the service around”.

People told us they felt safe and were happy with the service they received. There were no longer any concerns about missed visits. People said they were generally supported by a small team of staff who they were getting to know well. This improved consistency of people’s care. Additional staff had been recruited. This meant staff had a manageable amount of visits and did not feel rushed, when travelling from one person to another. People told us the timing of their visits had improved and there was greater understanding about the agency’s “outcome based” approach. This had lessened frustration about inconsistent lengths of people’s visits. People told us they felt listened to and were encouraged to give their views about the service. Whilst people were aware of how to make a complaint, they did not fell they needed to, as they were now happy with the service they received.

Potential risks to people’s safety had been identified and properly addressed. People had been visited to discuss the support they required. People had a plan of their care which was detailed and well written. People told us their care was regularly reviewed to ensure it remained appropriate.

Improvements had been made to the management of people’s medicines. Medicines were now administered safely, in a person centred manner. Staff had undertaken recent training in the safe management of medicines and records had been improved upon.

There were positive comments about the staff and the registered manager. The registered manager provided clear leadership and had introduced systems, which were now embedded and working well. This included a range of audits to assess the safety and quality of the service. Staff told us they were well supported and had received updated training. All staff had been allocated to newly devised teams to aid communication and team building.

3, 4, 11 and 16 December 2014

During a routine inspection

This inspection took place on 3, 4, 11 and 16 December 2014. This was an announced inspection which meant the provider knew two days before we would be visiting. This was because the location provides a domiciliary care service. We wanted to make sure the manager, or someone who could act on their behalf would be available to support our inspection.

Mears Help to Live at Home Wiltshire is a large domiciliary care agency which provides care and support to people in their own homes on a short and long term basis. The agency manages the local authority’s Help to Live at Home contract and had expanded by purchasing three domiciliary care agencies within the local area, earlier in the year.

The agency had a newly appointed manager and at the time of our inspection, they had been in post approximately two months. They are not as yet the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The newly appointed manager told us they were in the process of completing their application to become the registered manager.

We carried out an inspection of this service in June 2014 in response to concerning information we had received. We issued a warning notice and four compliance actions to ensure the provider made improvements as we identified widespread non-compliance, in all of the five outcome areas we looked at. There were shortfalls in people’s care, including missed visits and the administration of medicines and inadequate staff support, training and the management of complaints. The significant shortfalls in provision had predominantly been caused by the transfer of the additional agencies, which had not been managed well. The provider sent us a detailed action plan which described how they were going to make improvements.

To ensure improvements had been made, we carried out another inspection of the service in August 2014. We identified further widespread shortfalls in care provision, such as missed calls and inadequate care planning, which placed people at risk of significant harm. The warning notice which we had issued in June 2014 had not been complied with. Due to the risk of significant harm to people’s safety, we issued a Notice of Decision, which restricted the provider from accepting any new care packages unless with our prior agreement.

We undertook this inspection to review the restriction and to ensure people’s safety was assured.

Improvements had been made to the service. However, there was a strong sense that these needed to be embedded and sustained over a period of time. There was concern that the agency would revert back to how it was, in particular when our regulatory work was lessened and seconded managers returned to their previous roles, within the organisation. In addition, people, their relatives and staff were concerned that the potential lifting of the restriction of accepting new care packages would create increased workload, without the capacity to be manageable. Following the inspection we met with the senior management and Wiltshire County Council to discuss these concerns. Discussion took place to ensure that new care packages were offered in a planned way and that there were sufficient staff to meet these new packages.

Whilst improvements had been made to the service, the administration of people’s medicines was not safe. The records were handwritten and had not been signed or countersigned to show that they were accurate. Instructions for the medicines were not written in full. This increased the risk of error. Staff had not consistently signed the record to demonstrate the medicines had been given. Some medicines were left for people to take later but there were no assessments to identify and address the potential risks of this. You can see what action we told the provider to take at the back of the full version of the report.

Assessments regarding potential environmental risks to people had been completed. However, some assessments contained basic information and did not identify specific risks associated with people’s health care conditions. This included the risk of pressure ulceration and the refusal of staff support. The absence of these assessments did not ensure effective risk management, which increased people’s risk of harm. You can see what action we told the provider to take at the back of the full version of the report.

Staff were aware of encouraging people to be involved with making day to day choices and decisions. However, staff’s knowledge about mental capacity and the implications of this within their practice was limited. Most of the staff could not recall having any training about the Mental Capacity Act. The training was not detailed in any records or on the staff training plan. The limitations of staff’s knowledge increased the risk of people being deprived of their liberties. You can see what action we told the provider to take at the back of the full version of the report.

Many care systems had been given a dedicated focus to ensure improvements. However, all were in their infancy and required time to be developed and sustained. For example, within the last three months, manager’s had met with each person who received a service, to undertake an updated assessment of need. This information was then used to develop a plan of care, which accurately reflected the person’s needs, preferences and the support they required. The development of updated care plans meant that staff had access to more information about people, which enabled a more effective service. Time was required to ensure all care plans were updated, as people’s needs changed.

Since our last inspection, the number of missed calls had significantly reduced. An electronic monitoring call system had been installed, which required staff to log in and out when they arrived and left a person’s property. If they did not do this on arrival, within an identified timescale, the office would be alerted to a possible missed call. This enabled action to be taken before the risk of harm. Any missed calls were being monitored and fully investigated with the aim to reduce occurrences further.

People told us the timing of their visits and the consistency of staff supporting them had improved. However, there were some comments that indicated these areas could be further developed. Some people commented they still received support from unfamiliar staff and there was some lateness, which caused anxiety and frustration. People and their relatives were generally positive about the staff. They said their privacy and dignity was maintained unless it was impacted upon by the inconsistency of staff allocated to them. There were some negative comments about individual staff, which some people had raised with the agency.

Staff told us they felt better supported and communication systems had improved. Staff were receiving supervision so that issues and work performance could be discussed. This system had enhanced morale although was not available to all staff, such as those in the office. It also required greater time to become established. Records showed what areas had been discussed but action plans were not clear and needed greater clarity. All staff had received updated mandatory training but training specific to people’s needs and their health conditions, was in the process of being developed.

11, 12, 13, 15 August 2014

During an inspection looking at part of the service

We performed this visit to follow-up on our inspection of 20/06/14 to 02/07/14. After that inspection we warned the agency they must make improvements by 08/08/14, to ensure they met people’s care and welfare needs. Following the inspection, we continued to receive information of concern from people, their relatives/advocates and staff.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you would like to see the evidence supporting our summary please read the full report.

Is the service effective?

The agency’s computer records showed the number of missed visits had reduced. We met with one person who had two missed visits after 08/08/14. Their record documented the person had been “upset” and was “thirsty as well as hungry,” following one of their missed visits. Another person needed two people to support them in meeting their needs. Their relative reported on an occasion after 08/08/14 when only one care worker had attended. They told us this meant the person had remained in bed for 36 hours. The person was assessed as being at high risk of pressure ulceration.

We found there were discrepancies between some of the computer records and records held in people’s homes. For example the computer record showed one person’s morning visit as starting at 9:30am but the handwritten record in their home documented it had started at 11:00am. As there were such discrepancies, the agency cannot be assured its systems were accurate and so were not able to verify people’s needs were being met.

We have met with the provider to outline their failure to comply with the requirements of the law. We are issuing them with a revised condition of registration so they cannot provide a service to any additional people for a period of twelve weeks, until they can show us they have completed their action plan for improvements.

Is the service safe?

We met with eight people and/or their relatives/advocates. Two of the people did not have any care plans. Four of the people had care plans from a previous agency. These had not been updated to show how changes in the people’s needs were to be managed. Two of them had a care plan from the agency. These care plans were limited and did not assess or outline delivery of care in a range of areas. People also did not have completed care plans or other records relating to medication.

Care workers told us they often provided care to people they had not met before. They reported they were not informed about people’s care needs prior to going into their homes. One care worker told us “most of the time you are working completely blind.” This meant people were at significant risk of harm, as the agency could not ensure they were receiving consistent support with their care, including taking their medicines.

Is the service caring?

People told us some of the staff were kindly and caring, particularly those care workers who they had got to know, as they visited them regularly. Other people felt because the agency sent different care workers for most of their visits, a caring relationship could not be developed. One person told us their relative was living with dementia and due to this needed care workers they were familiar with. This was not happening.

Some people felt having different care workers who were not familiar with their needs affected how they felt cared for. One person, who was tube fed, told us “the problem for me is those not trained with PEG are quite nervous and syringe quite fast. Giving me stomach ache.”

Is the service responsive?

The agency reported they had tried to respond to people’s concerns by ensuring missed visits did not take place. People told us they did not feel the agency were responsive when they raised concerns about missed visits. One person told us “I’ve given up phoning them when they don’t turn up, they’re very nice but nothing happens.” Another person said “I’ve done it a couple of times, it makes no difference, I’ve given up.”

A person told us they experienced pain and discomfort if they remained in bed too long. They and their advocate said they had told the office about this, however the agency had not responded and they continued to receive late morning visits.

Is the service well led?

We were informed the service manager and other agency managers were currently working their notice. Following our last visit, the agency had allocated several senior managers from their organisation to review and manage the service. These managers told us about new initiatives. These included improved systems for consulting with staff, people who used the service and their advocates.

The senior managers were not able to tell us about day to day management of the agency. We saw the agency continued not to have information on all people they provided a service to, either as computerised or paper records. We asked a care coordinator about a range of different people’s needs. The care coordinator was not able to inform us about specific people’s needs and was not able to locate all relevant records. This meant day to day leadership of the agency was not effective.

20 June and 2 July 2014

During an inspection in response to concerns

Before our inspection, we received some information of concern about service provision from a number of sources. The information indicated a high number of people were not consistently receiving the support they required. Staff were either late in arriving or the call was being missed completely. This meant people were not receiving the required assistance with personal care, eating, drinking or receiving their medicines.

In addition to late or missed calls, the information indicated staff were being asked to cover visits at short notice and schedules were not being sent out to people. This meant people were not aware of who would be visiting them and were not receiving consistency of care. The information indicated staff were visiting some people they did not know and there were shortfalls in people’s support plans and medicine administration records. These shortfalls meant staff had limited information about the people they were supporting and the assistance they required.

As part of the inspection to gain feedback about the service, we visited three people accompanied by their relatives in their own homes and spoke with fifteen people, three relatives, one stakeholder and four members of staff on the telephone. In addition, over a period of five weeks between 19/06/2014 and 24/07/2014, we spoke with twenty three people, including people who used the service, their relatives and staff, who had contacted us to raise concerns about the service.

The manager confirmed the service provided had grown significantly in a very short time. They said the provider had purchased two other agencies and were planning to purchase a third. This meant an approximate increase of 2500 to 3000 care hours in addition to the existing service already in place. The manager and two other members of staff told us it had been a very difficult time, which had been very stressful. They said they were doing everything possible to address the shortfalls.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the care staff gave and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service effective?

Those people who had transferred to Mears Help to Live at Home Wiltshire from other agencies were not receiving a service which met their needs. People had experienced late or missed calls. Some people required the support of two staff to support them during their visit but there were occasions when only one member of staff arrived to give assistance.

Some people were receiving visits from a variety of staff which meant there was little consistency of care. Staff said they were visiting some people they had not met before, with minimal or no information about their needs. The manager was not able to confirm that each person had a support plan and medicine administration record in place. This meant staff did not have the required information to meet people’s needs effectively.

Focus was being given to ensuring people’s visits were identified on the agency’s electronic systems so they could be allocated to staff. However, the process of allocating was not consistently effective, which impacted on missed or late visits.

The quality auditing systems in place were not being utilised and therefore deficits in service provision and potential risks were not being effectively identified.

Is the service safe?

Whilst people were happy with the care they received, there were many concerns about the organisation of their visits. Some people were not receiving the service they required. This meant people were at significant risk of harm, as they were not receiving consistent support with their personal care, eating and drinking or taking their medicines.

Due to the lack of information available about some people’s visits, the manager and allocation staff were not fully aware of the support people required. This meant there was potential for additional missed calls, the agency were not aware of. This significantly increased the risk of harm to people.

New staff had received training in a range of topics, as part of their induction. However, staff who had transferred from the purchased agencies had not had the opportunity to discuss or be trained in the new policies and procedures. Not all staff had received formal one to one supervision and appraisal. This increased the risk of inappropriate or unsafe care.

Is the service caring?

People were very complimentary about the staff. They said staff were considerate, caring, respectful and attentive. People told us that when staff did attend, the standard of the care they received, was very good. People’s comments indicated staff showed empathy, a good attitude and commitment to their role.

Staff spoke about people with fondness and concern. They aimed to give a good standard of care and understood people’s vulnerability and the importance of enhancing quality of life.

The manager was concerned about the shortfalls being experienced by the agency. They showed compassion in response to people’s missed calls and the fact the agency was not currently performing how they wanted it to.

Is the service responsive?

The large increase in the size of the agency in a short space of time had negatively impacted upon the service some people received.

The manager and staff were working hard to address the deficits in service provision yet concerns from people, their relatives and staff continue to be raised.

Staff were being recruited to meet the additional demands of the service. A clear induction programme was in place to ensure new staff were fully supported and were equipped to do their job.

Is the service well led?

The manager was experienced, knowledgeable and committed to the service. They were concerned the service was not running how they wanted it to. Senior managers were supporting the manager to ensure improvements to the service.

The manager showed clear leadership skills and had delegated staff to adopt certain roles. They were responding firstly to issues of greatest priority. Other shortfalls with areas such as care planning were scheduled to take place once all information about people’s support and staff allocations had taken place. However, despite these factors, the purchase and transfer of the new services had not been well managed. This significantly impacted on the quality of the service provided and placed some people at risk of harm.