Background to this inspection
Updated
3 July 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection was carried out by one inspector, one bank inspector and an assistant inspector.
Service and service type:
Master Quality Healthcare Ltd provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
The inspection was announced. We gave the service 48 hours’ notice of the inspection visit because it is small, and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
The inspection site visit activity started on 19 March 2019 and ended on 20 March 2019. We visited the office location on 19 March 2019 to see the registered manager and office staff; and to review care records and policies and procedures.
What we did:
We reviewed information we had received about the service since the last inspection in May 2016. This included details about incidents the provider must notify us about. We asked the provider to complete a Provider Information Return (PIR) prior to this inspection and they returned this. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also sought feedback from the local authority safeguarding and contracting teams, and healthwatch.
During the inspection we spoke with three people and four relatives to gain their views on the care provided. We spoke with the registered manager, company director and three members of care staff.
We reviewed a range of records. These included five people’s care records and three people’s medication records. We looked at three staff files, meeting minutes, documents relating to the management of medicines and quality monitoring records.
Updated
3 July 2019
About the service:
Master Quality Healthcare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. The service was providing personal care to 16 people in the Leeds, Wakefield and Trafford areas at the time of the inspection. Master Quality Healthcare Services Ltd provides a service to younger and older adults.
People’s experience of using this service:
¿ People spoke positively about the service and were happy with the care provided. One person told us, “I can’t fault them [care staff] one little bit. They treat me as though I’m their mum, you can’t get no better care than that.” Another person said, “The carers are excellent.” One relative told us, “This agency does everything that you’d hope for, in a kind and caring way.”
¿ We found risks to the health and safety of service users were not always fully assessed and the provider was not taking reasonable steps to lessen such risks. People did not have risk assessments in place for catheter care, choking and pressure ulcers.
¿ We found medicines were not always managed safely. There was no allergy information recorded on the Medication Administration Records, there was no information to guide staff on what medicines were being taken, any side effects of the medicines and people's preferences for taking their medicines.
¿ We concluded the above demonstrated a breach of regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014, safe care and treatment.
¿ We checked whether the service was working within the principles of the MCA. We found conflicting and unclear information regarding people’s capacity to make decisions. We concluded this demonstrated a breach of regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014, need for consent.
¿ At the last inspection it was noted there was a limited level of detail within the care plans regarding a person’s background and preferences. At this inspection we found this continued to be the case. There was no information within people’s care records regarding their end of life wishes in relation to their care and support. At the time of inspection no one was receiving end of life care. The provider told us this was because no one was currently receiving end of life care.
¿ There were insufficient systems and processes in place to assess, monitor and improve the quality of the service. Quality audits did not adequately identify areas in need of improvement. The provider did not assess, monitor or mitigate the risks relating to the health, safety and welfare of the service users. The provider had not assessed people’s risks in relation to pressure care, choking or catheter care. We concluded these issues demonstrated a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.
¿ The provider had submitted notifications to the CQC, however we identified instances where matters had not been notified to us as required by regulation. This is a breach of regulation 18 of the CQC (Registration) Regulations 2009.This will be dealt with outside this inspection process.
¿ The provider was considering moving staff supervisions from six monthly to once a year. We made a recommendation that the provider holds supervisions every three months in accordance with best practice guidance.
¿ Complaints were responded to, they identified any issues, actions taken and future learning. However, the provider did not keep an overview to identify any patterns and trends.
¿ The staff we spoke with were complimentary about the management team. Team meetings were held to discuss any issues. The minutes showed the registered manager had a focus on staff well-being and had organised a well-being workshop.
¿ We saw examples of staff promoting people’s independence. One relative told us staff respected their family member and their wishes. They told us they were respectful of their home and responding to their requests.
¿ Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny. References were obtained and Disclosure and Barring Service (DBS) checks completed. The DBS helps employers make safer recruitment decisions and reduces the risk of unsuitable people from working with vulnerable groups.
¿ We saw evidence to demonstrate that staff received appropriate training and induction.
Rating at last inspection:
At the last inspection the service was rated Good (report published 7 July 2016).
Why we inspected:
This was a planned inspection based on the rating awarded at the last inspection.
Enforcement:
Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.
Follow up:
We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk