Archived: Mears Care Limited

Updated 8 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15, 16, 21 June and 3 July 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The inspection team comprised of three adult social care inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. We spoke with 14 people by telephone, including four relatives. We visited nine people in their homes with their permission and spoke with a further three relatives during these visits.

The provider completed a Provider Information Return (PIR) on 6 April 2017. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, such as the provider’s action plan, monthly update reports, feedback from health and social care professionals and from statutory notifications. A notification is information about important events which the service is required to send us by law.

We spoke with 19 staff, including the registered manager; senior general manager; operations manager, recruitment and training manager, quality leads for safeguarding and complaints, direct delivery and medicines; ten care staff and the electronic call monitoring administrator. We looked at systems for assessing staffing levels and staff rotas, training and supervision records. We looked at eight staff files, which included recruitment records for new staff, and 13 care plans and risk assessments. We also looked at quality monitoring systems the provider used such as a service improvement plan, audits, spot checks and monthly reports. We sought feedback from Healthwatch Torbay, commissioners and health and social care professionals. We received a response from four of them.

Updated 8 September 2017

This announced comprehensive inspection took place on 15, 16, 21 June and 3 July 2017. Mears Care Torbay is registered to provide personal care to people living in their own homes. At the time of the inspection they were providing care to 269 people in the Torquay, Paignton and Brixham areas. The provider is Mears Care Limited.

When we last inspected the service in September and October 2017, we found nine breaches of the Health and Social Care Act 2008 and associated regulations. The overall rating for the service was ‘Inadequate’. It was rated inadequate in four domains; Is it safe? Is it effective? Is it responsive? Is it well led? It was rated ‘requires improvement’ for Is it caring? The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider’s registration. This required the provider to send a monthly progress report on the areas of greatest concern and risk. The service was put in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The provider sent an improvement plan outlining the immediate steps being taken to protect people and improve the service, and continued to send monthly progress reports to CQC which showed ongoing improvements. This comprehensive inspection in June and July 2017 was carried out to check whether the improvements made had been sustained and the service was now providing safe and effective care to people. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is now out of special measures and rated as ‘Requires improvement’.

Following the inspection in September 2016 Mears Torbay developed a joint action plan with the local authority under their ‘Provider of Concern’ process, which was formally reviewed every two weeks. This process was concluded in February 2017 and the service continues to be monitored by the local authority under ‘contract performance management’.

When we last inspected in September 2016 we found that people experienced inconsistent levels of care and support because there was a lack of leadership, managerial oversight of the service and ineffective quality monitoring. While we found significant improvements had been made in the areas identified, we found further improvement was required to auditing systems to ensure consistency in risk assessments, the protection of people’s rights where they lacked the mental capacity to consent to aspects of their care or treatment, and respecting people’s preferences with regard to the provision and timing of their care.

At the last inspection we found people's individual plans of care did not always contain enough information for staff to deliver care safely or in a person centred way, and risks had not been fully assessed or sufficient action taken to minimise them. At this inspection we found that since the last inspection all care plans and risk assessments had been reviewed and all but four rewritten. A new template had been used to ensure they were more detailed and contained the guidance staff needed to support people effectively and in line with their preferences. However, we found these improvements were not consistent, for example one care plan of a person unable to mobilise contained no moving and handling plan or risk assessment to minimise any related risks.

At the last inspection we found the service was not working within the principles of the Mental Capacity Act 2005 (MCA), which meant people’s rights were not protected. At this inspection we found significant improvements had been made. However, some improvement was still required in relation to the protection of people’s rights where they lacked the mental capacity to consent to aspects of their care or treatment. 94% of staff had completed mandatory training on the MCA and had a clear understanding of how the MCA related to their practice. Everybody referred to the service was assessed to determine their ability to understand and participate in the development of their care plan, and any concerns about their capacity to do so acted on. However, the service did not always check whether there was a lasting power of attorney for health and welfare, legally able to make decisions on the person’s behalf, or recognise when a best interest decision might be necessary.

When we last inspected we found the service did not employ enough staff to meet people’s needs. This meant some people had not always received their planned visits, visits were late or cut short, and people were sometimes supported by one member of staff when they required two. At this inspection we found there had been significant improvements and people were no longer at risk due to missed visits or late visits. However, people’s preferences were not always respected with regard to timing of visits and the gender of care staff. There were effective electronic monitoring systems to check on the time keeping of visits, time critical visits were prioritised and people with complex needs had a consistent staff team. The registered manager told us ‘continuity’ remained a challenge for the service and they had been working to improve this by looking at recruitment and retention, organising staff rounds more effectively and decreasing levels of staff sickness. Office staff were being closely monitored and had received customer service training to improve communication and ensure people were kept informed about any changes to the rota, call and care times.

The service has a registered manager who was registered on 12 June 2017. 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, with the providers and quality leads had developed systems to facilitate clear monitoring and accountability and provide the support and training the front line and office staff required to meet people’s needs safely and effectively. People told us the service had improved since the last inspection. Comments included, “It’s a huge improvement on what it was”, “I am quite happy with Mears. They have everything sorted out now. They did have teething problems, but I am happy” and, “I do get a sense of striving for improvement and big strides. A big difference from a year ago.”

At the last inspection we found some staff providing care and support did not have the skills and knowledge they required to care for people effectively, or receive adequate support or supervision to enable them to be effective in their role. At this inspection we found a comprehensive induction and training programme was in place, which meant staff were knowledgeable about their roles and responsibilities. This included specialist training from external health professionals. People spoke positively about the skills, knowledge and experience of the staff supporting them. One person described three of their staff as “exceptional” and another said the care staff were “absolutely brilliant” and “fantastic”. Staff told us they were now well supported. They had been allocated a line manager who completed an annual appraisal and three monthly supervisions. Regular staff meetings were in place, and a staff satisfaction survey gave them the opportunity to feedback about their experience of working for the service.

Staff promoted people’s independence and treated them with dignity and respect. People were supported to make choices about their day to day lives, for example how they wanted their care to be provided. The service ensured people and their advocates, where appropriate, were fully consulted and involved in all decisions about their lives and support.

At the last inspection we found that poor monitoring and management of people’s eating and drinking put them at risk. At this inspection we saw people who required support with meals had sufficient to eat and drink and received a balanced diet. Care plans had been developed with the input of specialist health professionals and guided staff to provide people with the support they needed.

At the last inspection in September 2016 people told us their complaints had not been taken seriously, explored thoroughly and responded to in good time. At this inspection we found there was now a clear process for reacting to complaints and concerns, which was overseen by a quality lead with responsibility for managing complaints. Complaints were monitored and analysed in order to identify trends and wider areas for improvement, and the outcomes shared with stakeholders. A relative told us the quality lead worked hard to resolve issues and they felt listened to.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff received regular safeguarding training, and were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people.

There were plans to relocate the Mears Torbay office to Kingsteignton, so that both branches would work from same office. The provider will need to monitor closely the impact of this change on the quality of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the bac