Archived: Merseyside Adult Support Services Limited

At the last inspection of this service on 2 November 2016 we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medication was not well managed, requirements of the Mental Capacity Act were not always followed, records were not always accurate, staff were not always receiving the support they needed and the quality assurance system in place was not effective. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the requirements of the law. At this inspection we found the provider had followed their action plan and they were now meeting the requirements of the law.

This service is a domiciliary care agency. It provides a service to older adults, and to younger adults who have a learning and/ or a physical disability in their own homes. Not everyone using MASS receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 18 people were receiving personal care.

This service provides care and support 24 hours a day to four people living in two ‘supported living’ settings so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

MASS has a registered manager in post. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We found that a safe service was provided by a staff team who were appropriately recruited, trained and supported. Established systems were in place for preventing harm and abuse. Robust arrangements had been made to protect against risks, maintain health and wellbeing, and give medicines safely.

People received effective, personalised care that was thoroughly planned and had been adapted to meet their needs. They directed and agreed to their care and the principles of mental capacity law were applied in upholding their rights.

Staff were supportive, caring and provided dignified care. They understood individual’s preferences and supported their lifestyle and social interests. People were supported to express their views and make choices about their care.

The service had an open, inclusive culture and was well managed. Feedback was sought and there had been no complaints. The governance of the service ensured regular monitoring of standards and the quality of care provided. Where shortfalls were identified action had been taken to make improvements.

The service was last inspected on 21 August 2014 where it was found to be compliant in all the areas that we looked at.

Merseyside Adult Support Services Limited (MASS) is a domiciliary care agency which offers personalised services, including support to reduce social isolation and home support to adults who have a learning and/ or physical disability. The agency office is located in Clubmoor, Liverpool and serves people in local and neighbouring communities. It was established in 1996 and both directors have been in post since the agency was established and have relatives who receive support from the agency.

MASS has a registered manager in post. 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. This inspection focussed on the domiciliary care provided by MASS. The service provided services to people with learning and physical disabilities in their own homes. This service currently provides personal care and support for twenty people within their own homes. At the time of the inspection the service offered support to 71 people, however only twenty people received care and support which involved an activity the provider was registered for with the Care Quality Commission.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

Medication was not well managed and the medication charts that we viewed were not clear and charts did not always identify people’s medication correctly. The manager had taken some steps to improve this during the inspection.

The requirements of the Mental Capacity Act were not always followed. People did not always have mental capacity assessments and best interest decisions where required.

The care files that we looked at contained the detailed relevant information that staff needed to care for the person including their preferences. It was clear through discussions with staff that they knew the people they were supporting very well. People were generally supported by a consistent team of carers that enabled them to build up positive relationships who had worked with them over a number of years. However, we noted that care files were not updated to reflect any changes that had occurred.

Discussions with staff members identified that they felt happy and supported in their roles. They told us that the registered manager was supportive and they felt that they could contact her and approach her at any time. However, we looked at supervision records and could see that staff were not always consistently receiving supervision and appraisals.

The service did not have a comprehensive quality assurance system in place and few checks were made on the quality and safety of the service. The manager sought feedback from the people who used the service in an annual survey.

The people who used the service and their relatives told us that they were treated with respect and kindness by the staff. Comments included, ““They are a great bunch – all friends of mine”, They are respectful and kind” and “They are very good workers and kind”. People told us that the staff were always on time.

There were sufficient staff to complete the visits scheduled for each person and the registered manager did not accept any additional visits if she did not have the staff in place to complete these. Travel time was factored into staff schedules and they had sufficient time to move between visits. Visits were recorded in the daily records and people knew to contact the office with any problems. No concerns had been made to the provider about missed calls.

Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they knew what to do if they suspected that someone was at risk of abuse or they saw signs of abuse. People using the service reported that they felt safe and their relatives told us that they were confident that their relatives were safe and supported by the staff of MASS.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:

Is the service safe?

Relatives told us that staff were knowledgeable and understanding of people's needs, mentally and physically. We saw the way in which staff were recruited was safe and all necessary checks such as Disclosure and Barring Services (DBS) had been completed before the person commenced employment.

We saw evidence that people's needs were assessed and that care plans and risk assessments had been developed with intentions to ensure people's safety. Relatives told us they felt the person who used the service was 'In safe hands'.

Is the service effective?

Merseyside Adult Support Services (MASS) provides visits to assist people with learning and/or physical disabilities integrate into the local community and live a more independent life. People told us that they were asked about their personal preferences and treated as individuals. We saw care files were very person centred and care was catered around the person's daily routines. Relatives told us that staff help them maintain the person's independence and integrate them into the community. People made comments such as 'They go everywhere'clubs, gardening, cinema.'

We spoke to a social worker who told us 'They [the agency staff] monitor people's welfare closely and always act as an advocate for all the people who used the service.' We saw the service was effective in helping people live their lives to their fullest potential.

Is the service caring?

We spoke to one social worker who told us 'MASS gives people quality of life'.

One staff told us that she feels as though she is giving back and gets real job satisfaction for working for the agency.

All seven relatives spoken with made positive comments such as 'The staff are brilliant' and 'We are so grateful such services exists.'

Is the service responsive?

We saw evidence that people, their representatives and staff were asked for their views about their care and they were acted on. The provider also took account of complaints and comments to improve the service.

A comment was made by a relative about office staff not keeping in regular contact of which member of the team was visiting for a person who had daily outings. The manager told us they had resolved this by sending the person a weekly rota of who would be coming from the agency each day. Although, compliant this was not evidenced as being dealt with.

Is the service well-led?

We asked relatives and staff about how the service was managed. They all felt the manager dealt with any issues very promptly and everyone we spoke with gave positive comments about their management style and personality for example, 'She is very approachable', 'Very nice and kind' and 'Good manager.'

All seven relatives we spoke to told us the manager was 'Lovely' 'Supportive', 'Reactive to any concerns' and 'Very accessible and always attended meetings.'

People who use the service told us they were happy with the support they received. One person said, "MASS provides an excellent service. I am very happy with my carers." People told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.