Archived: Mosaic Care Group Limited

At the last inspection, the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement. This is the first time the service has been rated Requires Improvement under the Care Quality Commissions ‘Next Phase’ methodology.

The service had a manager in place however they had not yet applied to become 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 found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

We looked at how the service was staffed. We reviewed staff rotas and focused on how staff provided care within a geographical area. We looked at how many visits a staff member had completed per day. We did this to make sure there were enough staff on duty at all times to support people in their care. We found one example where a family member was being asked to provide care alongside staff on a double up call. This practice was unsafe as the service could not be sure the family member had the required skills and knowledge. The practice was not risk assessed and there was no plan in place to support the practice. This put the person who used the service, staff and the family member at risk.

The risk management issues around unsafe practice and risk planning identified amounted to a breach of Regulation 12 (safe care and treatment) 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.

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; the policies and systems in the service did not support this practice

This failure to follow the code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.

We saw evidence quarterly quality monitoring was being undertaken, however the audits were not always effective. We found little information surrounding the details of issues found and how these had been rectified and lessons learned. We also noted the audit system had not identified the breaches of regulation and areas of improvement we had noted during this inspection.

These shortfalls in quality assurance amounted to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). You can see what action we told the provider to take at the back of the full version of the report.

People raised concerns about late visits. Two people we spoke with told us the office informed them about late visits. One we spoke with told us they had missed visits. We spoke with the manager about this and they informed us sometimes late visits can happen due to unforeseen circumstances. We have made a recommendation around this.

We looked at the procedures the provider had for the administration of medicines and creams. We found one person’s medicine support plan did not list their prescribed creams. We looked at policies and procedures related to medicines management. We found the medicines policy had not been reviewed to include the most up to date NICE guidance for medicine in a community setting. We have made a recommendation around this.

During the inspection we looked at the care plans for seven people. We found current needs were not always identified. We found care plans did not always have enough detail considering the complex needs of the individual cared for. We have made a recommendation around this.

Staff told us there are always changes in the office and they don’t always know who they are speaking to when they contact. At the time of the inspection not all staff were aware that there was a new manager in post. Staff told us they would like to be more informed about what was happening within the service, such as staff changes. We have made a recommendation around this.

The ratings were not displayed on the website for the service. We spoke with the provider who explained the website had been recently changed and not all of the information had been updated. The ratings were added to the website prior to the end of the inspection visit.

We looked at how people were supported to have sufficient amounts to eat and drink. The few people who said they had food prepared had breakfast or snack lunch prepared. All said they chose what to eat and the food and drinks were hot, nicely prepared and how they liked them. Care plans we looked at guided staff on how people liked their meals prepared.

We asked people about staff who visited their homes and if they had time and treated people with compassion dignity and respect. All the responses were positive. Staff understood how to respect people's privacy, dignity and rights and received training in this area. Staff described how they would ensure people had their privacy protected when undertaking personal care tasks.

People were supported by staff with activities to minimise the risk of becoming socially isolated. An example was seen in one person's care file where the person was being supported to go shopping.

The management team were receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

We undertook this focused inspection on 21 December 2016 to check whether the provider had made the improvements necessary to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Mosaic Community Care Limited on our website at www.cqc.org.uk.

Mosaic Community Care is a domiciliary care agency that provides personal care and support to adults and children with a learning disability living in the community. At the time of our inspection the service was providing support to 23 people.

At the time of our inspection the service did not have 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. There was an acting manager who had been in post for just over two weeks. The managing director of the service had previously been the registered manager but had de-registered on 6 December 2016. The managing director told us she had chosen to de-register as the registered manager of the service, as she felt the service needed a day to day manager who did not also hold the responsibilities of service provider.

During this inspection we found that the provider had made improvements and legal requirements were being met.

Relatives told us that there had been significant improvements at the service since our last inspection. They told us visits were rarely missed and on the infrequent occasions that staff were unable to attend, the service informed them.

We found that concerns and complaints were being addressed appropriately, in line with the service’s complaints policy.

Records showed that relatives were asked for feedback about the care being provided to their family members at care plan reviews and through satisfaction questionnaires. The relatives we spoke with confirmed this to be the case. We found evidence that the feedback received was being used to improve the service.

Staff told us that communication from management had improved. They advised that regular staff meetings took place and they received regular supervision.

We found evidence that the provider was monitoring and improving the service. A service improvement plan was in place and records showed that some actions had been completed. Further actions were planned and timescales were in place for their completion.

Mosaic Community Care is a domiciliary care agency that provides personal care and support to adults and children with a learning disability living in the community. At the time of our inspection the service was providing support to eight adults and 15 children. The service had previously also supported older people. However, this had changed in May 2016.

At the time of our inspection there was a registered manager at the service who had been in post since 2010. 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.

During our previous inspection on 18, 19 and 24 November 2015, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to failure to ensure risk assessments were always available in people’s homes for staff to access and failure to ensure medicines were being managed safely. There was a failure to ensure care plans were always present in people’s homes to inform staff about how to meet people’s needs, a failure to ensure sufficient staff attended to people as required, and a failure to effectively assess and monitor the quality of the service, to ensure any risk to people using the service was managed appropriately.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to a failure to ensure sufficient staff attended to people as required, a failure to effectively assess, monitor and improve the quality of the service and the management of complaints. You can see what action we told the provider to take at the back of the full version of the report.

One person being supported by the service and most of the relatives we spoke with told us people received safe care. Staff had a good awareness of the different types of abuse and understood how to safeguard vulnerable adults from abusive practices.

We saw evidence that staff had been recruited safely. They received an appropriate induction, effective training and regular supervision.

There were processes in place for the safe administration of medicines. People were supported with their healthcare needs and staff raised any concerns about people’s health and wellbeing with their relatives or referred them to healthcare professionals when appropriate.

Relatives told us they were happy with the care provided by their usual care workers. However, they told us that when their usual care worker was not available, visits were often missed. They told us they had raised concerns about this with the service and we saw evidence of this. We found that there were a lack of clear processes in place at the service for the management of concerns and informal complaints.

Relatives were involved in decisions about people’s care and attended care plan reviews.

Relatives told us that the staff who supported their family members were caring and respected their privacy and dignity when providing care. People were encouraged to be as independent as possible.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and the importance of consulting with people’s relatives when they lacked the capacity to make decisions about their own care.

Relatives were asked to give feedback about the service in annual questionnaires and during care plan reviews. Staff also provided feedback about the service in yearly questionnaires. We found little evidence that the feedback received had been used to improve the service.

Most relatives we spoke with and two members of staff expressed concerns about the way the service was being managed. They felt that communication from management was poor and there were insufficient staff employed at the service to cover annual leave and sickness.

Some staff were unclear about the management structure at the service and felt that their concerns were not always addressed or listened to.

We saw evidence that staff practice was observed regularly and checks were made of care documentation.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We spoke to some people who used the service. They told us they were happy with the care they received. One person said, "Those that provide my care are so helpful and obliging. They always ask if there is anything else they can do to help me." Another person said, "The care I've had has been exceptional. They (staff) are always on time and if I've ever had a problem it's been sorted out."

We saw that improvements had been made around medication administration and the people we spoke to were confident in the abilities of staff. The improvements were not yet in place for everyone who used the service but we saw evidence that this was due to be rolled out in the New Year. We have asked the provider to inform us when this is the case.

Some people said their care preferences were not always accommodated. People did not always receive their care visits at their preferred times. People were not always kept informed of the care staff who would be providing their care.

Care assessments and care plans were in place and these were followed in practice.

Procedures for the safe management of medicines were in place. Care staff had received suitable training. However, we found that care staff did not always have adequate information about medicines to ensure that assistance was provided safely. People who used the service were happy with the support they received with their medicines. One person said, “The care records are completed by staff – they say what they’ve done and how many tablets I have taken. I’m happy with the arrangements, it makes me feel secure”.

People were cared for by suitably qualified, skilled and experienced staff. One person said, “I always have the same carer unless she is on holiday. I am happy with her, she’s brilliant, like a breath of fresh air”.

People who used the service, their representatives and staff were able to give their views about the service. Systems were in place to assess and monitor the quality of some aspects of the service that people received.

We found that there was enough skilled and experienced staff so that people had their care delivered at the right time, usually by the same people and in ways they wanted. One person said “I always have the same people unless they are on holiday.”

We found that relevant information was in place to ensure that safe and appropriate care is provided. A range of relevant training had been provided to staff. One person who uses a special hoist said “I feel safe with the staff using the hoist as they know what they are doing”.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager.