Majestic Care North West Limited

During our previous inspection on 27 and 28 July 2016, we found concerns relating to the recruitment of staff, the management of people’s complaints and lack of effective systems to monitor and develop the service. At that time we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well Led to at least good.

During this inspection visit we found the necessary improvements had been made.

Majestic Care North West Limited is a domiciliary care agency. The service provides personal care and support to people living in their own homes in the Burnley and Pendle area. The range of services provided includes personal care, domestic support, meal preparation and shopping. The agency office is located in the centre of Burnley.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for people supported in their own homes; this inspection looked at people’s personal care and support. At the time of the visit there were 89 people who used the service.

We gave the service 48 hours’ notice of the inspection visit because it is domiciliary care service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

At the time of the inspection, the service did not have a registered manager. Two new managers had been employed from December 2017 and an application to register them with CQC had been forwarded. 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 told us they felt safe and staff were caring and treated them well. They told us staff were like their family and they trusted them implicitly. People said they received care and support from a consistent team of staff with whom they were familiar. They told us staff mainly arrived on time and stayed for the full time allocated. People spoke positively about the staff that supported them and told us they were always treated with care, respect and kindness. Staff had developed good relationships with people and were familiar with their needs, routines and preferences. The management team told us additional work was underway to ensure everyone was provided with a consistent team of staff.

Safeguarding procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and wellbeing had been assessed and managed; further improvements were needed. People told us they received their medicines safely; there were systems in place to monitor safe practice in this area. The recruitment process had improved and additional improvements were made during the inspection to ensure a safe process.

Staff had sufficient knowledge and skills to meet people's needs effectively. New staff completed an induction programme and all staff were provided with regular mandatory training, supervision and support. Staff felt they were supported by the management team and told us they enjoyed working for the agency.

People were involved in the development of their support plans and involved in any discussions and decisions about their care. Staff had clear and up to date information about people’s needs and wishes and there were systems in place to respond when their needs changed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported with their healthcare needs as appropriate and supported with their dietary needs in line with their support plan. Staff supported people to access the local community and to pursue their leisure interests in line with their support plan.

People spoken with had no complaints about the service they received or about the staff that provided their care and support; they were aware of the complaints procedure and processes and were confident they would be listened to should they raise any concerns.

People made positive comments about the leadership and management of the agency. Systems to monitor the quality of the service had been improved and people’s feedback was sought and acted upon in relation to the standard of care and support.

Majestic Care is registered to provide personal care. The agency provides domiciliary care services for adults in the Burnley and Pendle area. The range of services provided includes personal care, domestic support, meal preparation and shopping. The agency office is located in the centre of Burnley and is staffed during the hours of 9:00 am to 5:00 pm.

The service was managed by 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.

At our last inspection on 23 July 2014, the provider was compliant will all of the standards that were reviewed at the time.

During this inspection we found the provider was in breach of four regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to systems for checking and improving the service, staff recruitment checks, staff training and complaints processes. You can see what action we told the provider to take at the back of the full version of this report.

We have also made recommendations about ensuring risks to people’s individual well-being and safety are properly considered and improving practices on safely supporting people with their medicines.

People we spoke with told us they were satisfied with the service provided by Majestic Care, their comments included, “It’s a very good service, “It’s alright” and “I am quite happy with things.”

People we spoke with indicated they felt safe with the service. Staff spoken with were aware of the signs and indicators of abuse. They knew what to do if they had any concerns and were confident in reporting matters. We found safeguarding matters were not been properly recorded and managed, however the registered manger took steps to make improvements.

Arrangements were in place to maintain staffing levels to make sure people received their agreed care and support.

We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

Processes were in place to support and encourage people to make their own decisions and choices. However some staff were not aware of the MCA and had not had training on this topic.

People made positive comments about the staff team including their caring approach and attitude. They told us, “They are caring and really helpful” and “They are friendly, I have made friends with them.”

Staff expressed a practical awareness of responding to people as individuals and promoting their rights, privacy and choices.

People spoken with appreciated the support provided by staff. We received the following comments, “They are very helpful, they do what they have to do” and “They always ask if I am satisfied with what they do.”

Arrangements were in place to gather information on people’s backgrounds, their needs and abilities, before they used the service. People had an awareness of their care plans and said they had been involved with them and reviews.

Processes were in place to monitor and respond to people’s health care needs. Staff spoken with described the action they would take if someone was not well, or if they needed medical attention. People were supported as appropriate with food and drink.

There was written information for people who used the service. This provided details on the service’s contact details, aims and objectives, the range of services available and compliments and complaints procedures.

We found there were management and leadership arrangements in place to support the day to day running of the service. Staff indicated the management team were supportive and approachable.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

Risks to peoples' wellbeing and safety had been identified and managed, taking account of enabling their choices and their right to take risks. However, progress was needed in assessing people's skin condition.

People spoken with during the inspection did not express any concerns about their support with their medicines. There were arrangements in place to manage people's medicines safely. However, we found some records could be better kept to promote safer practices.

There were enough experienced care workers to provide to care and support for people.

Is the service effective?

People were involved in discussions about their care and on-going reviews. Arrangements were in place for people to consent and agree to some aspects of their care. However, progress was needed on assessing people's capacity to make decisions and ensuring staff provide support in people's best interests.

Staffing arrangements were in place to make sure people received consistent care when they needed it. People told us, 'They are always on time', 'I have the same team of people' and 'They don't rush, they have stayed longer if needed'.

Is the service caring?

People spoken with told us they were satisfied with care and support they experienced with Majestic Care. They told us, 'I can't fault them it's a really good care package' and 'I have a care plan I have read it, the carer went through it with me, it details everything that is done'.

People told us they were happy with the care workers. They said, 'Very helpful and respectful', 'They can't do enough to help, it's an immense relief' and 'I think they are brilliant'.

Is the service responsive?

Arrangements were in place to assess and review people's needs and abilities. This meant their individual needs and choices were considered and planned for.

Care workers spoken with were aware of the emergency procedures, including contacting health care services and reporting matters to the management team as needed.

People spoken with were aware of the service's complaints procedures, they were confident in raising concerns. One person said, 'If I had a concern I would speak my mind, I would contact the manager'. However we found progress was needed with properly managing 'informal' concerns.

Is the service well-led?

The service had a registered manager responsible for the day to day management of the service and there were office based care coordinators.

We found people were involved with decisions which affected them informally on a daily basis. People had been invited to complete satisfaction surveys for their views on the service.

There were some systems in place to assess and monitor how care and support was provided, and to monitor the quality of the service. However we found further checking systems were needed.

Staff spoken with had no concerns about the management of the service. They felt they were appropriately supported.