Medacs Homecare - Bristol

Medacs Homecare - Bristol (referred to in report as Medacs) is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 100 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People received good care from staff who were kind and caring. People told us they felt safe and staff treated them with dignity and respect.

People were protected from the risk of abuse because staff were trained and understood the signs to be aware of and report. Where concerns did arise, they were investigated and the registered manager worked with the safeguarding teams in the local authority to ensure people were safe. There were individualised risk assessments in place to guide staff in providing support in areas such as mobility, where there was a risk of harm to the person concerned. There were systems in place to support people with their medicines safely.

There were enough staff to ensure people’s care needs were met. Safe recruitment procedures were in place.

Staff received good training and support to enable them to carry out their roles effectively. Staff told us they were satisfied and that the training gave them the skills they needed. New staff to the organisation received an induction and regular meetings and shadow opportunities with established members of staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was responsive to people’s changing needs and updated people’s care plans accordingly. There was a complaints procedure in place and the registered manager investigated these in accordance with company policy.

The service was well led. Systems were in place to monitor quality and safety and there was a clear management structure supporting the registered manager in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 26 January 2018). The rating for this inspection has remained good.

Why we inspected

We inspected in order to provide an updated rating for the service

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Medacs provides domiciliary care and support to around 200 people living in Bristol and the surrounding area. There were around 200 people receiving personal care when we carried out the inspection. Medacs is a national company that delivers care to people in many areas of the United Kingdom. The services provided at this location included support with personal care such as assistance with bathing and dressing. It also included support with eating and drinking, medicines and home help covering all aspects of day to day housework, this part of the service is not registered by CQC.

There was a registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, they are ‘registered persons’. Registered person have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who needed support with their medicines were supported by staff to receive them safely. This was because the staff had completed training in safe handling and administration of medicines. There were safe systems and processes in place to help to protect people from the risk of harm. For example, new staff were only recruited after an in depth recruitment procedure was completed. When taking on new staff the agency placed an emphasis on the potential new employee’s caring approach. This was to help them try to recruit staff that were suitable to work with people who used the service.

People felt safe and the staff knew what the different types of abuse were and what constituted poor practice. Staff were aware of the correct actions they should follow if they thought someone was at risk of harm or abuse was suspected. Risks to people were being properly managed. Care records contained up to date guidance as well as detailed risk assessments. These were updated regularly when people's needs changed. Accidents and incidents were closely monitored. If actions were required, after an incident these were discussed with staff and the people involved.

People received care and support that met their needs. The staff were led by an experienced registered manager. The team were committed to the values of the organisation they worked for. These included trying to ensure each person had a good quality of life, and were supported to stay independent.

People told us staff were kind and caring and understood how to provide the care and support they needed. People and their relatives were positive about the caring attitude and approach of the staff. Some people told us recently some visits had been very late and on occasions they had not happened at all. The registered manager was in the process of putting in place an action plan to respond to these concerns. Visits plans were being reviewed to ensure that where there was an increase in traffic that was impacting on times then more travel time was given.

The staff knew the people they supported well. People were involved in planning how they were cared for and supported. Care records were person centred and written to meet people's individual needs. Care plans were reviewed regularly with the involvement of the person concerned.

The staff felt they had access to the information they needed to meet people's needs, including receiving regular up to date information. Changes in people's needs were identified and their care packages were updated to meet their changing needs. The service was flexible and responded whenever it could t to people's requests.

The registered manager used IT technology in the form of an electronic rota planning software system. This was to help provide a service that was responsive to the needs of people they supported. This meant it was easier to respond to any changes when they happened. For example, if a staff member was sick at the last minute.

People knew how to make a complaint and were encouraged to share their views and opinions about the service they received.

The views of people who used the service were used as a part of how quality in service was checked and monitored. These were obtained via surveys and telephone calls and some interviews.

There was quality assurance systems in place to monitor the quality of the service provided.

There was a positive culture within the service. The registered manager was positive about how they wished to develop the service through good practice and improvement.

Medacs provides personal care to people living in their own homes in the Bristol and North Somerset area. At the time of our inspection the service was providing personal care and support to approximately 250 people.

A registered manager was not in post at the time of inspection. 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. A manager has been appointed and they have sent their registered manager’s application to CQC for consideration.

In June 2015 we found that people’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions for themselves. We found insufficient improvements had been made.

In June 2015 the provider did not notify CQC of all relevant incidents that affect the health, safety and welfare of people who use the service, as required. We found sufficient improvements had been made.

The service used the CM2000 system which is a database that allows the service to electronically monitor calls. Between the period of 4 July and 31 July 2016 the service made 9864 calls which represented 100% of their planned calls. 92.92% of calls were made within 30 minutes of the planned time. This meant the service were covering their expected calls and people were in the main receiving their calls at the correct time.

The provider operated safe recruitment procedures and ensured all pre-employment requirements were completed. Staff had received appropriate training to identify and respond to suspected abuse.

Staff received training to enable them to carry out their roles. An induction process was completed by staff newly employed at the service. Staff received supervision, in some cases they needed to be up-dated in line with their supervision policy.

People in the main felt they received good care from staff and that staff were confident and knowledgeable when providing their care. Some concerns were expressed regarding the timeliness of calls and the lack of communication from the office staff.

Records showed that staff liaised with other healthcare professionals when it was appropriate to do so. This helped to ensure that there was good communication and sharing of information about the person’s care needs.

People generally spoke positively about the staff and told us they were caring.

People told us the service was in the main responsive to their needs. Before people commenced a care package with the agency, a full assessment of their needs was carried out by a Service Quality Assessor. This included gathering full information about the person’s needs and their views on the kind of support they wished to receive.

There were systems in place to respond to complaints and this was set out in a written policy. We saw that the concerns outlined in the complaints had been responded to comprehensively and with openness and transparency, with apologies made where appropriate when the service had not performed as expected.

There were systems in place to monitor the quality of the service provided by the agency. This included a system to check that calls to people were being made as scheduled; and having a system of spot checks in place to monitor the quality of the service provided by staff.

Although some staff raised concerns regarding travelling times and their rotas being changed with limited notice they felt well supported by their managers.

People were given the opportunity to feedback their experience of the service through care planning reviews and surveys.

We found one breach 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.

During this inspection we found the agency had made improvements to the training and support mechanisms that were in place.

People could be confident that staff supporting them, had received annual training and that their skills and knowledge were kept under review. This was because staff were receiving regular supervision and spot checks were carried out on their work.

We conducted telephone interviews with four care staff, five people who received a service and two relatives. This was to enable us to make a judgement about the care that was being provided to people receiving a service from Medacs.

As part of this planned review we followed up non compliance from our last inspection in December 2012. This related to the training of staff, monitoring the quality of the service and record keeping.

The agency has demonstrated compliance however, the training and support of staff was still non compliant. Although systems had been put in place to address this.

People could be confident that their needs were assessed and care and treatment was planned.

Comments from people who used the service included 'I look forward to the girls coming, they always ask me if there is anything I need doing', 'all the staff are superb cannot fault them', 'sometimes they are a bit late but it cannot be helped if the traffic is bad or if they have had to attend to an emergency, the care staff will let me know if that is the case so I do not worry'.

Some people told us that communication from the office could be improved for example when the care staff were running late or receiving a weekly rota.

We conducted telephone interviews with five care staff, seven people who receive a service and two relatives. This was to enable us to make a judgement about the care that was being provided to people receiving a service from Medacs.

People told us they had a care plan and that they had been involved in making decisions about how they wanted to be supported.

People told us they were confident that they received their medication. However; the record keeping in relation to administration was not being consistently completed by care staff.

Staff were not receiving training at regular intervals to ensure they had the skills and knowledge to safely support people.

People were asked for their views in respect of the service they were receiving.

Everyone we spoke with receiving a care service told us they were happy with the care staff that supported them. Comments included 'I look forward to the girls coming in, they are friendly and kind'. A relative said 'I am happy with the care staff, I like particular care staff as they go the extra mile and give more than 100%, but on the whole all the staff are really good