We inspected Managing Care Limited on 24 October 2018 and 1 November 2018. This was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.At our previous inspection on 21 and 22 September 2017 we found the provider was not meeting regulations in relation to the outcomes we inspected, we found breaches of regulation in relation to Staffing and Good Governance. The service was rated Requires Improvement.
At this inspection, we found the provider continued to be in breach in relation to both Staffing and Good Governance, we also found new breaches of regulation in relation to Safe care and treatment and notifications.
The service remained Requires Improvement. You can see the action we have told the provider to take about these breaches at the back of the full version of this report.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. There were 60 people using the service at the time of the inspection.
Since the previous inspection, the service had undergone some major changes at management level. There was a new owner and new manager at the service. The manager was in the process of applying to become registered. 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.
Feedback from people and their relatives was positive. They told us that care workers were caring and friendly towards them they told us they felt safe in their presence. They also told us that the continuity of care was much better than previously experienced, although there were still some differences between care that was provided during the week and the weekends. People were happier with the quality of care they received during the week than at the weekends.
Care workers told us that the new manager had made major improvements to their rotas which they were pleased about. They said more thought had gone into allocating their rotas which meant they had reduced travelling time and were able to attend calls on time as compared to before. They also said that where they were required to ‘double-up’ with another care worker, this worked well also.
Although regular training was offered to staff, they did not always receive the same level of consistency with regards to supervision. New staff did not get a probationary review and experienced care workers did not get an opportunity to discuss their role.
Care plans were completed with the consent of people and their relatives. Although they were up to date, they were not always consistent in the level of information they gave to care workers. The provider was using an electronic care planning system; however this was not being utilised correctly. Care workers reported problems accessing the system which meant some records were recorded electronically and some on paper. The manager was aware of the issues with the current system and was looking at alternate solutions.
When complaints were raised, the provider investigated these. However, there were some occasions we found that agreed action points for improvement were not always followed up.
Records indicated that where safeguarding concerns were raised, the provider worked with the local authority to investigate these. However, the provider failed to meet its statutory requirements and did not always notify the Commission of these concerns.
Quality assurance checks were not being done regularly and in other cases were not thorough enough. This included auditing financial and medicine records, monitoring the quality of service through regular spot checks and monitoring the tine keeping of care workers.
The manager had only been in post since June 2018. At this time, the provider was undergoing major changes to its ownership. She had to deal with a number of staff leaving during this period, including the deputy manager and care co-ordinators. Despite this, she had made improvements to the service in relation to visit times and acknowledged that other areas as highlighted in the report needed to be improved.