Archived: MiHomecare - Woodingdean

MiHomecare – Woodingdean is a domiciliary care service based in Brighton and is part of a large corporate provider, MiHomecare. The service supports adults and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. At the time of the inspection 126 people were using the service, 120 of those were in receipt of the regulated activity of personal care.

The service had a 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.

We carried out an announced comprehensive inspection on 16 March 2015. A breach of legal requirements was found and the service received a rating of requires improvement. We found inconsistencies in the systems in place to manage, monitor and improve the care and support provided to people, this included significant concerns in relation to on-going incidents of late and missed calls. Following the inspection the provider wrote to us to say what they would do in relation to the concerns found. On 25 July 2016 we carried out another announced, comprehensive inspection to check that they had followed their plan and to confirm that they were meeting legal requirements. At that inspection there was a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regard to the monitoring, management and improvement of missed and late calls which were found to be frequent and on-going. We found breaches of legal requirements and the service received a rating of requires improvement. Another announced, comprehensive inspection took place on 20 March 2017, it was evident that improvements had been made and the provider was no longer in breach of the Regulations. However, there were areas of practice in need of further improvement and those that had been implemented were required to be sustained and embedded in practice.

Quality assurance processes had improved and there was more oversight of the systems and processes to ensure that people were receiving a service they had a right to expect. However, daily records and medicine records for people had not been audited in a timely manner to assure the registered manager that people were receiving their medicines and care on time and in accordance with their care plan and medication prescribing guidelines.

Improvements had been made since the previous inspection with regard to people being able to choose if they received care form a male or female member of staff. However, peoples’ preferences had not always been respected due to staff sickness and at times people had received care from a male member of staff rather than their preferred female member of staff.

People told us that they felt safe. One person told us, “Oh yes I feel safe with them”. Staff had received induction training and had access to on-going training to ensure their knowledge was current and that they had the relevant skills to meet peoples’ needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns.

There were sufficient staff to meet peoples’ needs and people told us that staff were kind and caring. One person told us, “The carers are very polite and kind. I can’t speak highly enough of them, everyone has been so kind”. People confirmed that they were treated with respect and dignity and their privacy maintained.

Risk assessments had been undertaken and were regularly reviewed. They considered peoples’ physical and cognitive needs as well as hazards in the environment and provided guidance to staff in relation to how to support people safely. People were protected from cross infection. People told us that staff maintained infection control by wearing appropriate personal protective equipment and regular observations by the management team ensured that this was maintained. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice. People received their medicines on time, they were administered by staff that had undertaken relevant training and who had their competence assessed. People had access to relevant healthcare professionals to maintain good health. People were supported with their hydration and nutrition and were offered support according to their needs and preferences.

Staff had undertaken training which the registered manager considered essential as well as training that was specific to peoples’ needs and conditions. People felt that the staff were well trained and felt confident that they had the right skills to meet their needs. One person told us, “They know their business”. A relative told us, “The carers are very professional in how they go about things”. People told us they were asked for their consent before being supported. For example, when being supported with their personal hygiene or to take medicine. The registered manager and staff understood that people should be supported to make their own decisions, and when people had difficulty with this, had involved the relevant people to ensure any decisions made were in the person’s best interests.

People were involved in their care and decisions that related to this. People were asked their preferences when they first joined the service and these were respected and accommodated. There were detailed, comprehensive and person-centred care plans that documented peoples’ needs and abilities. Regular reviews ensured that peoples’ care was current and appropriate for their needs.

A complaints policy was in place and complaints that had been received had been dealt with appropriately and in accordance with the providers’ policy. There was a friendly atmosphere within the service. People were complementary about the leadership and management. One member of staff told us, “I think so. The manager really listens. There’s always support if you need it, especially out of hours”. Another member of staff told us, “I think the manager is one of the best I’ve ever worked with. They’re honest and friendly but firm with it. Nothing gets missed”.

The service was last inspected on 16 March 2015. We found one breach of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 where there were inconsistencies in the systems in place to manage, monitor and improve the quality of support provided to people in their own homes, which included some significant concerns regarding on-going incidents of late or missed calls. This was identified as a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the provider was asked to submit an action plan to address this.

We reviewed the systems in place to monitor, manage and improve the quality of support provided to people as part of this inspection. At this inspection we found that while some improvements had been made to services delivered in the Brighton and Hove area the monitoring and management of missed and late calls was not consistent. We also found that the systems and processes in place for the Eastbourne and Seaford areas were not sufficiently robust and there were significant concerns regarding on-going incidents of missed and late calls in the Eastbourne and Seaford areas.

The service had a 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.’

Ten people and two relatives told us that they had experienced late or missed calls. One relative told us that their family member had missed meals and medication as a result of missed calls and another two relatives told us how late called had resulted in people taking their medicines later than prescribed. This meant that since the last inspection any improvements to the systems and processes had not consistently improved the experience of people and the provider continued to have a lack of oversight of the incidents of missed and late calls. This was identified as a continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff were trained to give medicines and their competency was checked prior to giving medicines to people in their own homes. However, medication was not always given at the time it had been prescribed due to late or missed calls and this was identified as a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Recruitment practices were not always robust. Two members of staff did not have full employment histories and one member of staff did not have a health declaration on file. In addition agency profiles did not confirm pre-employment checks. This meant that the provider had not ensured that staff were suitable to work with people and this was identified as a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People said they could request a male or female carer but that their preference was not always respected. One relative told us that male care workers were often allocated their family member when they had expressed a preference for female carers only. The relative had complained to the registered manager but the agreed action plan had not been adhered to. This meant that people’s preferences were not always taken into account when staff were allocated to calls and has been identified as breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a complaints process in place but agreed actions were not always followed through. People told us that they found it difficult to contact the office with questions about their care and support. Two people told us that they had left messages and been promised a call back but that no one had got back to them. Nine people said that if they called the office to cancel a call the message did not get through to their care workers who turned up anyway. This meant that people did not always get the information they needed or feedback to the provider and this has been identified as breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was not consistently working within the principles of the Mental Capacity Act 2005 (MCA). There were mental capacity assessments in place with clear guidance to staff on how to support people to make every day decisions however where people lacked capacity it was not clear whether the person consenting to care had the legal right to represent them. One person’s support plan had been signed by a relative to indicate consent to care. The person was assessed as having mental capacity but there was no explanation as to why the relative was giving consent on their behalf. This meant that the service was not seeking consent in line with the MCA and is an area that needs improvement.

Staff told us they were supported and understood their roles and responsibilities. Quality assurance systems were in place but were not employed consistently or effectively to monitor, manage and improve the quality of service and this is an area that needs improvement.

Staff understood their responsibilities in regards to keeping people safe from harm. They had received training in safeguarding adults and children and had access to policies and procedures to guide them if they needed to raise a concern. Staff were comfortable to raise concerns regarding poor practice with the registered manager who acted promptly and effectively to address any practice shortfalls.

Environmental and individual risks had been identified and care plans provided staff with clear guidance on how to manage those risks and meet people’s needs. Staff wore uniforms and took appropriate measures to reduce the risk of cross infection.

New staff experienced a comprehensive induction to include essential training and competency checks in areas such as manual handling and medication practice prior to starting to work with people. There was a training plan in place to ensure that staff had the knowledge and skills to meet people’s needs and four members of staff told us that they had received supervisions and felt supported in their roles.

People were supported to have sufficient to eat and drink. Staff prepared and served meals for some people and encouraged and supported others to maintain adequate hydration. Staff monitored people’s health and wellbeing and any recommendations from health care professionals were incorporated into people’s care plans and referred to by staff.

Positive relationships had developed between people and the staff who supported them.

People told us that their regular care workers were kind, helpful and supportive. Staff treated people as individuals and with respect. People were supported to live independently in their own homes and were encouraged by staff to continue to do as much as they were able. Staff told us that they explained what they were doing and sought consent from people before giving care and support.

Permanent staff knew people well and responded appropriately to people’s changing needs. A member of staff told us how they stayed and chatted with a person who was, ‘Down in the dumps.’ And two members of staff described how they had supported people when they were unwell by contacting their GP.

We identified some 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 back of the full version of the report.

The manager told us that since the previous inspection the service had been taken over by MiHomecare. They told us that despite the previous manager and several office staff leaving, continuity of care had been maintained, individual support had been provided for all staff and the impact on people who used the service had been minimal. This was confirmed through discussions with staff and people who used the service.

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People told us that they received the care and support they required to meet their needs. They also told us that the care they received was generally consistent and met their individual needs. One person said 'They are the best carers, very good people and so kind. If I ask them to do something they will.'

We found that systems and processes were in place to protect people from abuse. Staff knew what constituted abuse and what to do if it was suspected.

We reviewed the recruitment procedures that were in place and found that processes were thorough and well documented. Staff received regular training and supervision and felt valued and supported.

The service had effective systems in place to deal with people's comments and complaints.

People told us they were treated with dignity and respect and they felt safe being cared for by the staff from the agency. They also told us that staff asked permission to provide their care and they had good practical and communication skills to support them.

We spoke with three care workers and one office based employee. They told us how much they loved their job and how everyone worked well as a team. They told us they felt supported in their role through regular access to training, observation and supervision of their work. One care worker told us, 'It's a rewarding job and I feel like I'm making a difference to people's lives.'

We found that the services provided were supported by up-to-date and comprehensive policies and procedures. Records were regularly audited and reviewed. People who used the service were asked for their views annually. All incidents, complaints and commendations about the service were logged and there was a positive culture of learning from feedback.