We carried out a review of the data available to us about Meadowvale Homecare Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Meadowvale Homecare Ltd, you can give feedback on this service.
Meadowvale Homecare Ltd is a domiciliary care agency providing personal care to people living in their own homes. It provides a service to young adults and older adults, including people living with dementia. At the time of inspection, 39 people were using the service and receiving personal care.
Not everyone who used the service received personal care. The Care Quality Commission (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
Risks to people were appropriately assessed and managed. Guidance was in place to support staff to safely care for people. People told us they felt safe, and staff knew how to safeguard people from the risk of harm. Staff were recruited safely. Medicines were managed safely, and people received their medicines as prescribed. Staff wore PPE correctly and had received training in infection control.
People’s needs and preferences were robustly assessed. People were involved in the planning of their care. Staff were suitably trained to carry out their roles. Staff supported people to access healthcare services. 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.
People were treated with kindness and respect. Staff supported and promoted people’s privacy, dignity and independence. Staff supported people to do things they enjoyed.
People received person-centred care which met their individual needs. Staff were knowledgeable about people’s likes and dislikes. People were supported to communicate effectively, and the provider used easy read documents and pictorial cues to assist with this. People were supported to take part in activities and build and maintain relationships.
The quality of the service had improved since our previous inspection. Regular audits were carried out, and action plans were developed in response to audit findings. The provider was committed to continuous development and improvement. Staff felt supported by management and regular staff meetings took place. People were asked for feedback and actions were taken in response.
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 requires improvement (published 26 February 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Meadowvale Homecare Limited is a domiciliary care agency which provides personal care and support to people who live in Redcar and Cleveland. The service supported adults and older adults living with physical and mental health conditions, including dementia. At the time of inspection 43 people were receiving personal care.
People’s experience of using this service and what we found
The procedures in place to support people at risk of harm needed to be further developed. The recruitment policy had not been consistently followed. This did not support safe recruitment procedures. There were enough staff to support people safely.
The scope of auditing at the service needed to be expanded to support improvement. There were gaps in records used to monitor the quality of the service. Lessons learned analysis was not robust. Oversight of the service had not resulted in improvement.
People and relatives were extremely happy with the care provided. Relatives said, “The care is brilliant. Carers have been reliable, professional and they are a really good team. The carers turn up on time and they get in touch with me if there are any issues” and, “The care has been over and above what I would expect.”
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 requires improvement (published 1 May 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider remained in breach of regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan from the last inspection in March 2020 and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadowvale Homecare Limited on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to quality assurance, recruitment and the fitness of the provider. Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Meadowvale homecare is a domiciliary care agency which provides personal care and support to people who live in Redcar and Cleveland. The service supported adults and older adults living with physical and mental health conditions, including dementia. At the time of inspection 121 people were 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. At the time of inspection 53 people received personal care.
People’s experience of using this service and what we found
People said staff supported them to feel safe and had managed any potential risk of harm. Care records needed continued development to ensure they were accurate and up to date. Systems to support a lesson’s learned approach had been embedded. Staff were proactive in raising concerns.
Quality assurance measures needed further development to increase their scope of review. The level of information within audits was limited in places. Feedback was used to drive development at the service and communication at all levels had improved. People were happy with their care and staff were committed to the service.
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 requires improvement (published 27 November 2019) and there were multiple breaches of regulation. At that inspection we identified breaches in relation to the care which people received, staffing levels, support for staff and the quality of the service. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
The service had remained within a serious concerns protocol with Redcar and Cleveland local authority. As part of this process, the provider shared an action plan each month and met with stakeholders (including the Care Quality Commission) to demonstrate the improvements they had been making.
At this inspection we found continued improvements had been made in areas around the care and support which people received. Continued improvements were needed in record keeping and quality assurance processes. This meant the provider was still in breach of one regulation.
Why we inspected
We undertook a targeted inspection to review the progress made by the service to become compliant with the multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers findings in relation to safe care and treatment and quality assurance. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement
We have identified a breach in relation to the governance of the service at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with Redcar & Cleveland local authority to monitor progress.
Meadowvale homecare is a domiciliary care agency which provides personal care and support to people who live in Redcar and Cleveland. The service supported adults and older adults living with physical and mental health conditions, including dementia. At the time of inspection 105 people were 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. At the time of inspection 52 people received personal care.
People’s experience of using this service and what we found
Improvements were needed to manage the risks of potential harm. Particularly for behaviours which challenge, self-harm and risks associated with drug and alcohol use. Improvements were in place to ensure lessons were learned. These needed to be formally recorded. Continued improvements were taking place to monitor staff travel time. We made a recommendation about this.
People and staff said there had been improvements at the service, however acknowledged that these were ongoing. There were mixed reviews about the visibility of the management team and communication within the service. Continued improvements were needed to the providers quality assurance procedures. Time was needed to ensure improvements were embedded.
Some people experienced good care. Other people felt their care was not individual to them. The quality of care plans had started to improve and supported staff to provide more consistent care. Records to support end of life care were in place, however they needed to be written in line with national guidance. We have made two recommendations in relation to people’s experience of care and records to support end of life care.
Supervision was not in line with supervision contracts. However, staff did receive additional support by way of observations and checks of practice. Staff had started to complete training in behaviours which challenge and end of life care. Records had been more routinely updated when people had been involved with or discharged from healthcare services.
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 27 November 2019) and there were multiple breaches of regulation. At that inspection we identified breaches in relation to the care which people receive, staffing levels, support for staff and the quality of the service. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
The service had remained within a serious concerns protocol with Redcar and Cleveland local authority. As part of this process, the provider shared an action plan each month and met with stakeholders (including the Care Quality Commission) to demonstrate the improvements which they had been making.
At this inspection we found improvements had been made in some areas, such as staffing and personalised care. In other areas further improvements were needed, this included the management of risk, record keeping, leadership and quality assurance processes. This meant the provider was still in breach of regulations in some areas.
Why we inspected
We undertook a targeted inspection to review the progress made by the service to become compliant with the multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers findings in relation to care which people received, safe care and treatment, staffing and quality assurance. The overall rating for the service has not changed following this targeted inspection and remains required improvement.
CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement
We have identified continued breaches in relation to the safety of care provided and the quality assurance of the service.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with Redcar & Cleveland local authority to monitor progress.
Meadowvale homecare is a domiciliary care agency which provides personal care and support to people who live in Redcar and Cleveland. The service supported adults and older adults living with physical and mental health conditions, including dementia. At the time of inspection 98 people were 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. At the time of inspection 50 people received personal care.
People’s experience of using this service and what we found
People said their overall level of care had improved since the last inspection. They were clear that there were still areas for continued improvement, however they had confidence in the service to carry these improvements out.
Quality assurance process remained ineffective. Repeated concerns had been identified. Record keeping in all areas needed to be improved. Full oversight by the provider was required. The culture of the service had improved. The staff team had been working together to raise the standard of care at the service.
Staff were more responsive to risk, however records for risk needed to be improved. Robust processes to ensure lessons were learned needed to be implemented. There were mixed reviews about the timeliness of calls. We made recommendations about medicines records, infection control and systems for ensuring lessons were learned because the right procedures were not always followed.
The quality of which people received had started to improve. Care was more dignified. Continued improvements were needed when communicating with people. People were involved in their care and said staff respected their decisions.
People said they did not experience good care when calls were rushed. Mixed reviews were received about staff knowledge of people. The quality of care records had improved, however not all had been reviewed. Care plans and training in end of life care had not been put in place. Complaints had been investigated appropriately.
Further improvements were needed to the support which staff received. Mixed reviews were received about staff training. People were supported with their health and well-being needs, however records needed to be improved. People were supported with their dietary needs.
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.
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 inadequate (Published 29 June 2019).
There were multiple breaches of regulation.
The service had been placed into a serious concerns protocol with Redcar and Cleveland local authority. As part of this process, the provider shared an action plan each month and met with stakeholders (including the Care Quality Commission) to demonstrate the improvements which they had been making.
At this inspection we found improvements had been made in some areas. In other areas further improvements were needed. This meant the provider was still in breach of regulations in some areas.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadowvale homecare on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to the care which people receive, staffing levels and support for staff and the quality of the service and the support in place for staff at this inspection.
Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
At the last inspection we recognised that the provider had failed to notify the Commission of incidents taking place at the service. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service: During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person-centred care, the privacy and dignity of people, safe care of people, safeguarding people from abuse, effective governance, staffing and fit and proper persons employed.
We received mixed reviews about the quality of care which people received. People and their relatives told us their care was rushed when staff were late for calls. As a result people did not always receive the assistance needed. Staff left calls early because they did not have sufficient travel time. The high turnover of staff and lack of continuity with calls meant staff did not know people and did not have time to review care plans before supporting people. Dignity was not always protected and maintained. Staff were not always professional when carrying out care and support to people. Where people had the same staff team involved, they spoke positively of them.
Staff were not supported to deliver safe care to people. Care plans and risk assessments were not always in place where needed and did not provide staff with sufficient information to support people with the care they needed. People expressed concerns about the recruitment and training of staff. The provider did not have good practices in place to recruit staff safely and ensure they were supported to work at the service. The training programme did not support staff to deliver safe care to people. There were insufficient staff to provide care to people.
People were not safe using the service. The provider’s lack of oversight and staff’s failure to comply with the providers policies and procedures meant that some people had suffered abuse and current practices placed people at risk of potential harm. Quality assurance procedures were ineffective. There was no evidence to show that lessons had been learned since the last inspection by CQC. Many of the concerns identified during this inspection had been identified at the previous inspection. The provider had not addressed the action plans which they had shared with us following the last inspection.
Staff failed to understand and mitigate the risks to people. Incidents were not dealt with effectively which had led to, in some cases a delay in seeking assistance. The provider had not taken appropriate action to deal with incidents and did not have effective measures in place to minimise the risk of reoccurrence. People’s personal information was not protected.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Staff did not have any working knowledge of the Mental Capacity Act (2008) and deemed people not to have capacity because of their health condition.
Recommendations from health professionals were not always followed and timely action to seek support when people needed medical assistance was not always carried out. Care records were not reviewed and updated when people’s needs changed.
Some improvements had been identified with the management of medicines since the service had been placed into serious concerns protocol with the local authority, however continued improvements were needed to record keeping to minimise the risk of harm.
Staff had access to personal protective equipment. Some people had been supported to go into their local community to undertake social activities.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: The service was rated as requires improvement (Report published 9 October 2018).
Why we inspected: This was a planned comprehensive inspection based on the previous rating.
At the last inspection we identified breaches in relation to managing the risks to people, medicines and recruitment. Staff were not supported by way of induction, supervision, appraisal and training. Staff were not working in line with the principles of the Mental Capacity Act and lacked understanding of it. Quality assurance systems were not in place; policies and procedures required review and the provider did not have the required oversight of the service. We issued requirement notices.
We issued a fixed penalty notice to the provider for failing to submit statutory notifications when required. They paid this in full.
Following the last inspection, the provider sent us action plans outlining how they intended to improve the service. We carried out this inspection to monitor the improvements.
Enforcement action: The service met the characteristics of inadequate in three key questions of safe, effective and well-led and requires improvement in caring and responsive. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up: We will continue to monitor the service through the information we receive and discussions with partner agencies. We will continue to attend serious concerns protocol meetings with Redcar and Cleveland local authority.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
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 vary the terms of their registration within six months if they do not improve.
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.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger adults, working age adults and older adults living with a physical disability, mental health condition or learning disability.
At the last inspection of the service on 22 December 2016, we rated the service as Good.
At the time of this inspection, 105 people with physical and mental health conditions including people living with a dementia and learning disabilities were receiving care and support. One person received 24 hour support from a small team of staff and everyone else received a range of planned calls which included personal care, domestic care and social support.
The registered manager has been registered with the Care Quality Commission since 2 September 2016. 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 this inspection we found that improvements were needed to improve the quality of the service.
Core risk assessments were in place for people, such as for the environment and for falls however they had not been reviewed regularly. Risks outside of these core risk assessments such as alcohol abuse, safeguarding concerns and behaviours which challenge had not been appropriately risk assessed and information relating to these kind of risks had not been included into people’s care plans. This meant we did not know how the risks to people and to staff were safely managed. We found these risks put staff and people at increased risk of potential harm.
Risks to people and staff were not appropriately assessed when candidates were recruited with previous criminal convictions. We found there was a lack of information about these convictions because accurate information had not always been shared or appropriately investigated. One criminal conviction had not been accurately recorded on an application form. Records did not show that all criminal convictions had been fully discussed during interview and no risk assessment had been carried out before an offer of employment was made.
Medicines were not managed safely. People had not always received their medicines as prescribed and records of medicines had not been kept up to date. The medicines policy did not reflect current practices in place at the service.
Staff knowledge of the Mental Capacity Act 2005 was limited. Staff assumed that people who were living with dementia did not have capacity and were not able to consent to their own care. Care records wrongly stated that people did not have capacity and relatives had been asked to sign consent records and care plans even though people had the capacity to sign these records themselves. This action meant that people were not always supported to have maximum choice and control in their lives.
Staff did not receive appropriate support to carry out their roles by way of regular reviews during induction, supervision and training. The provider and registered manager did not have robust oversight of the service. An ineffective auditing system was in place which had not identified the concerns raised during this inspection. The provider had not submitted a statutory notification when required to do so.
Staff understood their role in protecting people from abuse and safeguarding notifications had been submitted when needed. Accidents and incidents had been reported and recorded and there was evidence that lessons had been learned to minimise the risk of reoccurrence. There were sufficient staff on duty and people spoke positively about the small team of staff involved in their care. Staff had access to and followed infection prevention and control procedures.
Staff supported people with their nutritional needs and ensured people had access to snacks and drinks outside of planned calls. Staff prompted people to make healthcare appointments if they became unwell and supported people to attend their healthcare appointments.
People and their relatives told us they were happy with the care and support which they received from staff. They told us they were involved in making decisions about their care. People told us their privacy and dignity was respected and maintained.
Detailed care plans were in place which demonstrated the care and support which people needed and what people could do for themselves. Daily notes were detailed and demonstrated the kindness of staff. The provider was in the process of setting up activities groups for people to attend and had supported people to access activities in their local community. Complaints had been responded to and dealt with appropriately.
Staff worked together as a team and were supported by the provider and registered manager. All worked in line with the vision and values of the service. The service was transparent and worked alongside health and social care professionals. Feedback had been sought and was used to improve the quality of the service. The service had good links with the local community and worked in partnership with local colleges, employment support services and housing services.
We found multiple breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding people from abuse, good governance and staffing. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009 for failing to submit a notification.
This is the first time the service has been rated Requires Improvement.
You can see what action we told the provider to take at the back of the full version of the report.
Meadowvale Healthcare Ltd provided domiciliary care services for people living in Redcar and Cleveland. The registered provider’s office was located in Boosbeck, a small village in the Redcar and Cleveland area. At the time of our inspection there were 15 people using the service. The registered provider employed an operations manager, registered manager and eight staff.
Meadowvale Healthcare Ltd had been running for less than one year. This meant all of the staff and the management team were fairly new in post. Because of the demands for the service, the registered provider was currently advertising for staff. The registered manager had been in place since the registered provider had set up 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.
All staff had received up to date safeguarding training. Staff had a good understanding of the signs and symptoms of abuse which people using their service could display. They were able to provide detailed information about the procedures which they needed to follow if they suspected abuse. Safeguarding procedures had been followed and appropriately recorded. All staff told us they would whistle blow [tell someone] if they needed to.
The service did not provide care or support to anyone who had a Deprivation of Liberties (DoLS) Safeguard in place. All staff had received training in DoLS and understood about the procedure they needed to follow if they suspected that someone may not be able to make decisions about their own health and well-being.
Risk assessments for people’s needs and the day to day running of the service had been carried out. People did not have a personal emergency evacuation plan in place; however the registered provider told us they would action this straight away. When action was needed to respond to people’s health conditions, we could see staff acted appropriately.
There were enough staff employed to provide care and support to people using the service. People we spoke with told us that staff attended their homes on time, were not rushed and stayed for the agreed length of time. The registered provider was in the process of recruiting further staff to meet increased demand for their service. They told us that they would not take on new people until suitable staff had been recruited. We could see that people had been recruited safely and two references had been checked and a disclosure and barring services check had been applied for before starting work at the service.
Medicines were managed appropriately and staff were trained to dispense medicines. Each staff member had been observed supporting people to receive their medicines. This meant the service could be sure that staff were competent to manage medicines safely following their training.
People had the equipment they needed to help them stay in their own homes. This meant the service was not responsible for the monitoring of wheelchairs or hoists for example, however they told us they would report any fault with them to the appropriate service. Safety certificates for the day to day running of the service were up to date, where they had expired, we could see appointments had been made with the appropriate professionals.
All staff undertook a thorough induction programme when they joined the service. Staff had all received a range of up to date training which was refreshed during staff meetings. Staff had received regular supervision.
Staff supported people to eat and drink and provided prompts when needed. Staff followed the instructions of dieticians when needed. Monitoring processes were in place for people at risk dehydration or malnutrition.
The service worked closely with a range of health and social care professionals.
People and their relatives were very complimentary about the care and support they received from the service. People told us they were involved in making decisions about their own care and could make changes when they needed to. Regular reviews of care had been carried out and feedback sought.
People received care when and how they wanted it. People had regular staff which meant that people and staff could get to know each other and the more specific details of how people liked to be cared for. From speaking with people, we were told that privacy and dignity was always respected and maintained.
At the time of our inspection no one we spoke to had any complaints to make about the service, however everyone knew how to make a complaint and staff knew the procedure they needed to follow if they received a complaint.
People, relatives and staff spoke positively about the service and the management team in place. We could see that people were happy with the service they received and staff were happy working for the service. Everyone spoken to as part of our inspection felt able to approach the management team about any concerns which they had.
The service carried out a number of audits to monitor the quality of the service, and the types of audits were planned to increase as the service grew. We could see that monitoring was in place for accidents and incidents. Regular feedback was sought from people and their relatives and staff attended regular meetings. The registered provider attended a provider forum and kept up to date with the legal requirements of providing a domiciliary care service.
The registered provider had an operations manager and a registered manager in place. This management team was always on hand to address any concerns which arose and an on-call system was in place to deal with queries which occurred out of normal working hours.