Background to this inspection
Updated
13 February 2020
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
This inspection was completed by one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type:
Montecare Solutions Limited is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing. It provides a service predominantly to older adults in Clacton, Harwich and the surrounding areas. At the time of our inspection the service was supporting 79 people and employed 35 members of staff.
At the time of inspection the service had a new manager registered with the Care Quality Commission who had only been in post since August 2019. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of inspection, the service was going through a process of transition and change of leadership the new registered manager was also to be the new provider. The previous provider had de registered as manager but still had regular contact with the service.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection visit because we needed to be sure that someone was available at the office. Inspection site activity took place on 31 October 2019 and 5th November 2019 and telephone calls to people using the service, staff and relatives were made on additional days. We visited the office site location to see the registered manager and office staff and to review care records and policies and procedures.
What we did when preparing for and carrying out this inspection:
Before the inspection, we reviewed information we had received about the service This included details about incidents the provider must notify us about and we sought feedback from the local authority and professionals who work with the service. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection, we spoke with five people and six relatives of people who use the service to ask about their experience of the care provided. We spoke to members of staff including the deputy manager, registered manager, and another prospective director of the company. The previous provider for the service also attended the location on the day of inspection and was spoken to briefly.
We reviewed a range of records. These included eight people's care and medication records. We also looked at six staff files including supervision records, records relating to the management of the service and a variety of policies and procedures developed and implemented by the provider.
Updated
13 February 2020
About the service:
Montecare Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for adults, some of whom may be living with dementia, have a physical disability or a learning disability. The service does not provide nursing care. At the time of our inspection the service was supporting 79 people with personal care. 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
Governance systems in place were not always effective at identifying areas of concern as they had not identified those found at this inspection, and enough improvement had not been made since the previous one in October 2018. At the previous inspection in October 2018 the provider had also failed to make improvements to the service and was also rated requires improvement overall at the inspection in February 2017. This was therefore the third consecutive inspection where the provider had repeatedly failed to improve, and breaches remained in place.
Systems had failed to identify where records were not robustly completed. There was no formal auditing system for monitoring people's care plans, this meant the service had failed to identify when risk assessments were not adequately completed. Risk assessments did not all contain sufficient information to mitigate risks to people and still required further development. Additionally, staff supervision had not been consistently maintained.
Where recommendations had been made at the last inspection, sufficient improvement had not been made. At the last inspection we made a recommendation regarding Improvements in relation to the application of the Mental Capacity Act 2005 (MCA) and the management team not being up to date with best practice.
At this inspection we found improvements had been made in part in relation to training for staff in the application of the of the Mental Capacity Act 2005 (MCA) however people had not always had their consent formally sought and their involvement in care planning was not fully evidenced.
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. However, we did identify records of best interest decisions were not always in place or fully completed.
People told us they felt safe with the staff that support them. People received their medication as prescribed. Staff had been recruited safely.
Staff were intuitively caring and treated people with respect, and people's privacy and dignity was maintained. Feedback from people said staff were kind and caring. Staff were able to describe how they ensured people's dignity was respected.
Staff felt supported and they received induction, ongoing training and supervisions. People's nutritional needs were met.
People had the opportunity to give feedback on the service. People and their relatives were positive about the management team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 10 November 2018) and there was a breach of regulation, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made/sustained, and the provider was still in breach of regulations. The service is therefore rated requires improvement at this inspection.
At the previous two consecutive inspections in February 2017 and October 2018, this service has been rated requires improvement. The provider has repeatedly failed to address concerns from previous inspections to improve the rating to at least good. Since being registered under Montecare Solutions Ltd in 2012, the service has fluctuated between good and requires improvement ratings and has not improved at the last three inspections. This demonstrates a lack of understanding of the risks and regulatory requirements and a failure to continuously learn and improve. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified one breach in relation to governance systems. 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.
Follow up
As this is the third consecutive inspection we have completed where the provider has been rated requires improvement and has made little or no improvements. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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.
It should also be noted that the service was in the process of transitioning to new providers and a change of leadership was anticipated at the time we inspected, and we intend to meet with the provider following this inspection.