Mosaic 1898 LTD

Mosaic: Shaping Disability Services provides personal care and support for people in their own homes. At the time of our inspection 10 people were receiving personal care and support from the service.

Not everyone who use this type of service receive 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

The provider did not always complete robust recruitment checks to ensure they employed people who were suitable to work with people who used services. They did not have robust systems in place to record incidents that occurred at the service.

The provider did not maintain records of their assessments of people's needs before the joined the service. People's records did not show the provider had considered the Mental Capacity Act as part of care planning.

The provider had not acted to address the issues identified at our previous inspection. The registered manager did not always demonstrate a good understanding of their regulatory responsibilities such as maintaining robust records of the care people received.

Records of people's risks assessment were not comprehensive. They did not always include information of known risks to people and guidance on how staff would minimise the occurrence of risks.

We made recommendations about risks assessments and end of life care planning.

People felt safe when they received care from staff. The service had protocols in place to protect people from the risk of contamination and infections.

Staff supported people to meet their nutritional needs and stay well. They supported people to access health care services.

Staff were kind and compassionate. They had developed positive relationships with people who used the service and treated them like they mattered. People were treated with great dignity and respect.

The support people received was tailored to their individual needs. Support was holistic and supported their general wellbeing.

The registered manager promoted an enabling culture which supported people to live a full life as possible and achieve their desired outcomes. Staff felt supported in their role.

The registered manager and staff team worked collaboratively with other professionals involved in people’s care to ensure that any transitions were well managed, and the care people received was consistent.

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 did not always support staff practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service promoted choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to become more independent where possible.

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 Good, (published 15 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Mosaic: Shaping Disability Services provides personal care and support for people in their own homes. At the time of our inspection 14 people were receiving personal care and support from the service.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People felt safe with the support they received. Staff understood their responsibilities to help people to remain safe including the reporting of suspicions of or actual abuse. However, one allegation that a person had made had not been alerted to the local authority for their consideration of any action that needed to be taken. A manager made contact with the local authority on the day of our visit so that they were aware of the allegation.

Risks to people’s health and well-being were assessed and staff had guidance on how to support people to remain safe. The provider had a safe system in place for dealing with and managing accidents and incidents and staff knew what action they should take. There were procedures available for staff to follow in the event of an emergency, such as a fire.

The provider’s recruitment procedure was safe and they carried out checks on the suitability of prospective staff. People were satisfied with the number of staff the provider had recruited and they received support when they required it.

People received their prescribed medicines when they required them. Their medicine records were not always competed accurately. The provider told us they would make improvements to their checking processes to address this and they supplied us with evidence of this after our visit. Staff knew their responsibilities to handle people’s medicines safely.

People told us that staff had the required skills and knowledge. We found that staff had received some of the required training. This included assisting people to move position. There were topic areas that staff required additional training or an update in such as first aid and medicines. The provider sent us evidence after our visit detailing that training had been arranged as well as competency checks for staff to make sure they were working safely.

Staff members received an induction when they started to work for the provider as well as on-going guidance from a manager so that they knew their responsibilities. Staff told us they received good support.

People were asked for their consent before support was provided by staff. They were involved in decisions about their care. Staff knew what action to take when there were concerns about a person’s ability to make decisions for themselves. People had support plans that they had contributed to and were reviewed with them. This ensured that staff had up to date information and guidance about people’s specific support requirements.

People received support that was flexible to their requirements and based on their preferences. They received support from staff who were consistent and on time.

People received the support they needed to prepare their meals where this was required. Staff took action where there were concerns about people’s eating and drinking including seeking specialist advice. People received support to make sure their health and well-being was maintained.

People were supported by staff who were kind, listened to them and were compassionate. Their dignity and privacy was protected. Staff knew the people they supported including their preferences and things that mattered to them.

People knew how to make a complaint although had not needed to since we last visited. The provider had given people information about how to make a complaint when they had started to use the service. This included the details of other organisations that could help them to make a complaint.

The provider’s checking of the quality of the service was not always effective. For example, checks on people’s care records were not consistently carried out they had not identified some of the areas that required improvement that we had during our visit. A manager provided us with evidence after our visit to show they were making improvements. We did see that some of the provider’s quality checks were effective. For example, they were making sure that people’s support requirements were reviewed when required and we found that they were.

People and staff spoke highly of the service. They had opportunities to give feedback about the quality of the service. The feedback the provider received was mainly positive Some people had made suggestions for how the service could be improved. The provider told us they had not offered feedback to people about any changes they had made. They told us they would make improvements to this.

The provider had aims and objectives for the service that were known by staff. These included supporting people to remain independent. We found that staff were working to these.

The registered manager was mainly aware of their registration requirements including notifying CQC of significant incidents that occurred. One statutory notification that they were required to send to us had not been submitted. They took action on the day of our visit to complete this.

Mosaic: Shaping Disability Services is a domiciliary care agency that provides personal care support in people's homes. At the time of our inspection 19 people were receiving care and support.

The service had a registered manager. It is a requirement that the service has 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.

People felt safe. Where required, staff had assessed any risks to people’s health and well-being to ensure that they supported them safely. Staff had checked that people’s equipment and their homes were safe.

Staff knew how to protect people from the risk of abuse and avoidable harm. Staff knew how to report concerns and had received training to protect people from abuse. The provider had plans to keep people safe during emergencies.

People were generally satisfied with the punctuality of staff providing their care and support and staffing arrangements. There were enough staff to keep people safe and they had been checked for their suitability prior to working for the provider.

Where staff supported people with their medicines, this was completed in a safe way. Some staff required an update to their medication training. We found that the medicines records of two people required a review.

People did not always receive care and support from staff who had the necessary skills and knowledge. This was because staff had not always received regular and appropriate training. For example, half of the staff team required first aid training.

Staff had received an induction when they had become employed by the provider but had not met regularly with their supervisor. Staff did not have regular opportunities to receive guidance and support about their work in order to provide effective support to people.

People received support from a staff team that knew their responsibilities under the MCA. Staff were able to explain how to gain people’s consent and how to offer choices to people who may have required additional support to do this.

People received support to stay healthy. Staff knew how to do this and sought extra support from healthcare professionals where this had been required. Staff followed the provider’s guidelines when they supported people’s specific health needs.

People were receiving support from staff who cared. Their privacy and dignity had been respected and their personal care records were being stored safely.

Staff knew about people’s support requirements and they supported them to remain as independent as possible. Where people required support to make choices, information on how people could access this had been made available.

People had contributed and were involved in planning and reviewing their care and support where they could. There was a risk that people did not receive the support that met their current needs. This was because reviews had not taken place every three months as detailed in the provider’s procedures. This meant that staff did not have up to date information about people’s care and support requirements.

People’s support plans were not always person centred and individual to each person. This meant that staff did not always have detailed information on people’s preferences.

People knew to make a complaint and the provider had a procedure to deal with any received. The provider sought people’s feedback about the quality of the service. However, the provider had not taken action to address any concerns or suggestions for improvements made.

People and their relatives felt that the service was well-led. There were opportunities for them to give ideas about how the service could improve.

There was a shared vision of what the service strove to achieve that included the promotion of people’s independence. This was understood by the registered manager and staff. Staff had been made aware of their responsibilities but this was not being regularly monitored. This was because regular meetings had not occurred with them to discuss their performance or quality of their work. Staff did not always feel that they received the support that they required from their supervisor.

There was a registered manager in place who mainly understood the requirements of their role. However, they had not always checked the service to make sure quality standards were being met.

People told us they were satisfied with the care received and said that staff always sought consent before they were helped. One person said: 'For me this support is very good. People living here all have a disability and can live independently because of support we get from staff.' A relative said: 'It's good that '. gets to enjoy things that every young person does, like socialising, going bowling or to the cinema' and 'The staff that supports '.. understands her and there's trust.'

At the time of our inspection visit the majority of people managed their own medicines. There were policies and procedures in place and staff were trained to ensure they supported people to manage their own medicines.

People told us that they received care and support from regular staff that stayed for the right length of time. One person said: 'The staff and the manager are wonderful people.' People received a copy of the staff rota in advance so that they knew which staff member would be supporting them. Training records showed staff were appropriately trained. This enabled staff to provide the tailored care and support to people using the service.

People's personal confidential information, staff records and other records relating to the management of the service were kept secure and up to date.

We followed up the area of non-compliance identified at the last inspection of the service. We reviewed the evidence the provider had sent to us that demonstrated compliance. We found staff were properly supported, supervised and trained to deliver care and support to people safely.