Archived: Mears Care Limited

When we last inspected the service in September and October 2017, we found nine breaches of the Health and Social Care Act 2008 and associated regulations. The overall rating for the service was ‘Inadequate’. It was rated inadequate in four domains; Is it safe? Is it effective? Is it responsive? Is it well led? It was rated ‘requires improvement’ for Is it caring? The Care Quality Commission (CQC) took enforcement action against Mears Care Limited and imposed a condition on the provider’s registration. This required the provider to send a monthly progress report on the areas of greatest concern and risk. The service was put in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The provider sent an improvement plan outlining the immediate steps being taken to protect people and improve the service, and continued to send monthly progress reports to CQC which showed ongoing improvements. This comprehensive inspection in June and July 2017 was carried out to check whether the improvements made had been sustained and the service was now providing safe and effective care to people. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is now out of special measures and rated as ‘Requires improvement’.

Following the inspection in September 2016 Mears Torbay developed a joint action plan with the local authority under their ‘Provider of Concern’ process, which was formally reviewed every two weeks. This process was concluded in February 2017 and the service continues to be monitored by the local authority under ‘contract performance management’.

When we last inspected in September 2016 we found that people experienced inconsistent levels of care and support because there was a lack of leadership, managerial oversight of the service and ineffective quality monitoring. While we found significant improvements had been made in the areas identified, we found further improvement was required to auditing systems to ensure consistency in risk assessments, the protection of people’s rights where they lacked the mental capacity to consent to aspects of their care or treatment, and respecting people’s preferences with regard to the provision and timing of their care.

At the last inspection we found people's individual plans of care did not always contain enough information for staff to deliver care safely or in a person centred way, and risks had not been fully assessed or sufficient action taken to minimise them. At this inspection we found that since the last inspection all care plans and risk assessments had been reviewed and all but four rewritten. A new template had been used to ensure they were more detailed and contained the guidance staff needed to support people effectively and in line with their preferences. However, we found these improvements were not consistent, for example one care plan of a person unable to mobilise contained no moving and handling plan or risk assessment to minimise any related risks.

At the last inspection we found the service was not working within the principles of the Mental Capacity Act 2005 (MCA), which meant people’s rights were not protected. At this inspection we found significant improvements had been made. However, some improvement was still required in relation to the protection of people’s rights where they lacked the mental capacity to consent to aspects of their care or treatment. 94% of staff had completed mandatory training on the MCA and had a clear understanding of how the MCA related to their practice. Everybody referred to the service was assessed to determine their ability to understand and participate in the development of their care plan, and any concerns about their capacity to do so acted on. However, the service did not always check whether there was a lasting power of attorney for health and welfare, legally able to make decisions on the person’s behalf, or recognise when a best interest decision might be necessary.

When we last inspected we found the service did not employ enough staff to meet people’s needs. This meant some people had not always received their planned visits, visits were late or cut short, and people were sometimes supported by one member of staff when they required two. At this inspection we found there had been significant improvements and people were no longer at risk due to missed visits or late visits. However, people’s preferences were not always respected with regard to timing of visits and the gender of care staff. There were effective electronic monitoring systems to check on the time keeping of visits, time critical visits were prioritised and people with complex needs had a consistent staff team. The registered manager told us ‘continuity’ remained a challenge for the service and they had been working to improve this by looking at recruitment and retention, organising staff rounds more effectively and decreasing levels of staff sickness. Office staff were being closely monitored and had received customer service training to improve communication and ensure people were kept informed about any changes to the rota, call and care times.

The service has a registered manager who was registered on 12 June 2017. 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 registered manager, with the providers and quality leads had developed systems to facilitate clear monitoring and accountability and provide the support and training the front line and office staff required to meet people’s needs safely and effectively. People told us the service had improved since the last inspection. Comments included, “It’s a huge improvement on what it was”, “I am quite happy with Mears. They have everything sorted out now. They did have teething problems, but I am happy” and, “I do get a sense of striving for improvement and big strides. A big difference from a year ago.”

At the last inspection we found some staff providing care and support did not have the skills and knowledge they required to care for people effectively, or receive adequate support or supervision to enable them to be effective in their role. At this inspection we found a comprehensive induction and training programme was in place, which meant staff were knowledgeable about their roles and responsibilities. This included specialist training from external health professionals. People spoke positively about the skills, knowledge and experience of the staff supporting them. One person described three of their staff as “exceptional” and another said the care staff were “absolutely brilliant” and “fantastic”. Staff told us they were now well supported. They had been allocated a line manager who completed an annual appraisal and three monthly supervisions. Regular staff meetings were in place, and a staff satisfaction survey gave them the opportunity to feedback about their experience of working for the service.

Staff promoted people’s independence and treated them with dignity and respect. People were supported to make choices about their day to day lives, for example how they wanted their care to be provided. The service ensured people and their advocates, where appropriate, were fully consulted and involved in all decisions about their lives and support.

At the last inspection we found that poor monitoring and management of people’s eating and drinking put them at risk. At this inspection we saw people who required support with meals had sufficient to eat and drink and received a balanced diet. Care plans had been developed with the input of specialist health professionals and guided staff to provide people with the support they needed.

At the last inspection in September 2016 people told us their complaints had not been taken seriously, explored thoroughly and responded to in good time. At this inspection we found there was now a clear process for reacting to complaints and concerns, which was overseen by a quality lead with responsibility for managing complaints. Complaints were monitored and analysed in order to identify trends and wider areas for improvement, and the outcomes shared with stakeholders. A relative told us the quality lead worked hard to resolve issues and they felt listened to.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff received regular safeguarding training, and were confident they knew how to recognise and report potential abuse. Staff were recruited carefully and appropriate checks had been completed to ensure they were safe to work with vulnerable people.

There were plans to relocate the Mears Torbay office to Kingsteignton, so that both branches would work from same office. The provider will need to monitor closely the impact of this change on the quality of the service.

We found 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 bac

There was a registered manager in post however the provider notified us they were off work for at least 28 days. There was a new branch manager in post who was managing the service. 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.

At our previous focused inspection carried out in June 2016, we found risks to people’s health and safety had not always been assessed. The provider had not done all that they could to minimise the risks to people. The key question for ‘Safe’ was rated ‘Requires Improvement’.

During August and September 2016, we received concerns from Healthwatch Torbay. Healthwatch is the national consumer champion in health and care. They have powers to ensure people’s voices are strengthened and heard by those who commission, deliver and regulate health and care services. We also received concerns from people who use the service and staff in relation to the quality of care being provided. In response to those concerns we undertook this unannounced inspection which commenced on 26 September 2016 and ended on 13 October 2016.

We found significant concerns which meant some people did not always receive their care as planned and were placed at risk of harm.

The service did not employ enough staff to meet people’s needs. This meant some people had not always received their planned visits or visits were late. This resulted in risks to people’s welfare and safety. For example some people missed their medicines, missed their meals, and had to stay in bed. Some people who needed two care staff at each visit had only one staff member arrive. This meant care could not be carried out as required, or safely; or relatives/representatives were supporting the care staff to deliver care. This placed people and staff at risk of injury or harm.

Staff providing care and support did not always have the skills and knowledge they required to care for people safely. When updates in staff training were required these had not been provided. Some staff had not received regular supervision and appraisals and the majority of staff had not had any recent observations of their work. This meant the provider could not be assured staff had the skills and knowledge they needed to meet people’s needs safely and appropriately.

Some people did not receive support in a caring way, particularly when care was delivered by staff they didn’t know well. People told us they were unhappy with the lack of continuity of care staff. This had caused distress, especially for people living with dementia who needed to see familiar faces. People said they had been unable to speak with managers and did not receive a return call when they requested it. Some people told us they were fobbed off and found out that information given to them was untrue. Other people found staff to be caring and had built good relationships. Some people told us they were happy when they did receive care from staff they knew.

People's individual plans of care did not always contain enough information for staff to deliver care safely or in a person centred way. Where risks were identified, these were not fully assessed, or sufficient action was not taken to ensure people received care in a safe way. Some information about people, visits and care needs was sent directly to care staff’s work phones. This information was very brief and meant staff often went into a visit where a person had complex needs without prior or sufficient knowledge of these needs or how to meet them. People received inconsistent levels of care and support that was not provided according to their individual preferences. People told us care staff did not always stay for the allocated time and their care was sometimes rushed.

Information management systems were not used to support the delivery of a safe service. Reports about visits, time critical visits, visits where two carers were needed could not be accessed by staff who had responsibility to plan and monitor visits. This meant the provider was unable to ensure that everyone was receiving a visit, or identify and resolve missed or late calls to people.

People’s complaints had not been taken seriously, explored thoroughly and responded to in good time. We found numerous examples of people making complaints that had not been resolved by the provider.

There had been a lack of leadership, governance and managerial oversight of the service. Although the provider had identified a number of shortfalls, they had not ensured improvements were made in a timely way to minimise risks to people. The new branch manager told us they were determined to ‘get it right’. They wanted people to feel safe and staff to feel valued. We saw evidence the branch manager and Nominated Individual was taking action to make the required improvements. By the end of our inspection, senior managers had been brought into the location to support the branch manager and staff; reports were now available and were being used to monitor and manage risk, ensuring people received their care as planned; the local authority who commissions the service were working with the provider.

At this inspection we found the service to be in breach of nine regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The services provided include personal care and domestic work in Torbay, Newton Abbot, Teignmouth, Dawlish and surrounding areas. In January 2015, Torbay and Southern Devon NHS Trust awarded Mears Care Limited the contract for provision of domiciliary care in Torbay. The contract started on 1st April 2015 and resulted in the merger of three existing domiciliary care agencies to create the new agency.

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 visited the office on 6 and 8 June 2016. We carried out visits to people’s homes on 10 June and 15 June 2016. We made phone calls to people during the week commencing 13 June 2016. At the time of this announced inspection 404 people were receiving personal care from the service. The service was registered in April 2015 and this was the first inspection.

We carried out this focused inspection as we had received some concerns about the quality of care and the management of medicines. The purpose of this inspection was to check people were receiving safe care.

Risk assessments were not always carried out to ensure people received care in a safe way. We found risks had not been assessed in relation to people who were at risk of harming themselves and others. Some care plans contained a good level of detail for staff to follow. Others were more basic and contained a list of tasks. For example, wash, dry, dress. We found one person did not have a care plan in their home. This meant staff who visited this person had no information to follow in order to meet this person’s complex needs. This placed them at risk of inappropriate care. Following our visit to this person’s home, the registered manager arranged for a care plan to be delivered back to their home. The registered manager was aware care plans and risk assessments needed to be reviewed. They had allocated four senior staff to carry out a review of all care plans. Work on this had commenced and was being done on a priority basis, starting with people with the highest dependency levels.

People told us they received a list of their planned visits each week. People were happy with their regular staff members and told us everything worked well when they visited. However, when the regular staff members were on holiday or off sick, they said there could be a number of different staff. Some of these staff did not have such a good awareness of their needs. We saw lists that contained visits with no staff name against them. People told us someone always came but they didn’t know who was coming. Some people told us they were told about changes, others told us they weren’t contacted. The registered manager told us they planned to move the service to smaller area hubs. This meant people should know the staff who visited them and provide them with the continuity they wanted.

Some people told us staff were often late. There was an alert system in place to ensure people’s visits took place at the right time, and lasted for the allocated time. Further to the phone calls we made, we asked the branch manager about late calls. They were able to provide a report and reason for these. Where issues had been identified about timings of visits, the staff had locked in specific times on the computer system to prevent a re-occurrence. The service’s plan to move staff to working in smaller geographical areas should reduce the travel distance between visits.

People were supported safely with their medicines and told us they were happy with the support they received. Staff completed medication administration record (MAR) sheets after they gave people their medicines. This showed people had received their medicines as prescribed to promote good health. Where there was a gap in one MAR sheet, we checked with the person who told us they had received their medicines. The senior lead told us they would follow this up with the staff member concerned.

People told us they felt safe when staff were in their home and when they received care. Staff had received training in safeguarding vulnerable adults and knew how to recognise signs of potential abuse. They confirmed they would report any concerns in line with the service's safeguarding policy.

Risk assessments had been completed for each person’s home environment. Where risks were identified, action had been taken to minimise the risk of potential harm. For example, staff noticed one person did not have smoke detectors in their home. They discussed this with the person and arranged for the fire prevention officer to fit smoke alarms the following day. The service had a partnership agreement with the Devon & Somerset Fire and Rescue Service.

Recruitment practices were safe. Staff files showed the relevant checks had been completed. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable adults.

There was an 'on call' telephone number for people to ring in the event of an emergency out of office hours. The service had a plan in place to deal with foreseeable emergencies. There was a system in place to ensure visits to vulnerable people were prioritised.

We found a 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.

A further comprehensive inspection will take place to check improvements have been made. We will inspect all five questions relating to this service. These questions ask if a service is safe, effective, caring, responsive and well-led. This will result in the service receiving an overall rating.