31 October 2019
During a routine inspection
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.