Archived: Mears Care - Richmond

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority. At the time of the inspection there were approximately 250 people were receiving support.

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

People using the service were supported to access the community to reduce the risk of social isolation. The registered manager had developed a system to carry out regular checks on people using to service to identify if they were at risk of social isolation and support them to access community services and groups.

Care workers administered people’s medicines in a safe way and as prescribed. The provider had processes in place for the recording and investigation of incidents and accidents.

People told us they felt safe when receiving care. Risk management plans were in place providing guidance for care workers on how to minimise risks for people using the service.

The provider had a robust recruitment process in place and there were enough care workers deployed to provide support. Care workers received the training and supervision they required to provide them with the knowledge and skills to provide care in a safe and effective way.

Detailed assessments of a person’s needs were completed before they started to receive visits. The care plans described the care and support a person required and how they wanted it to be provided.

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.

People were supported to eat a healthy diet and to access healthcare professionals when required.

The provider had a complaints process in place and relatives told us they knew what to do if they wished to raise any concerns.

There was a range of quality assurance processes in place to identify if any actions were required to improve the service. People using the service and staff felt the service was well-led.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 November 2018). There were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. They also provided short term care and support alongside the treatment and support provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return as far as possible to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority

Until just before the inspection this service also provided care and support for people living within two extra care schemes in the borough as part of their contract with the local authority. These two extra care schemes have been registered as a separate location from 10 August 2018 so the care provided was no longer managed by Mears Care - Richmond. At the time of the inspection the agency was delivering an average of 6500 visits per week of around 2600 hours of support for approximately 469 people. Not everyone using Mears Care - Richmond receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Mears Care - Richmond branch was based in an office with a number of other branches.

We previously inspected the service on 18 July 2017 where we rated it requires improvement in the key questions of ‘is the service safe? ’is the service responsive?’ and ’is the service well-led?’ as well as overall. The key questions of Effective and Caring were rated good.

At the time of the inspection the registered manager had left the service four weeks earlier and a new manager had started at the service the week before the inspection. The new manager was in the process of applying to become registered with the CQC when the inspection was undertaken. 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 were not receiving care which met their assessed needs because the provider was not deploying care workers to ensure that visits took place at the stated times and care workers stayed for the agreed length of time.

The provider had a policy for the management of medicines but care workers were not always provided with guidance on how to administer people’s medicines and records were not always completed clearly.

Risk management plans were not in place where specific issues had been identified to provide care workers with the information to enable them to mitigate these risks when providing care.

We have made a recommendation in relation to the recruitment process which not robust as information had not been recorded and appropriate references were not always in place before assessing applicants’ suitability for the role.

The provider had a procedure to assess a person’s mental capacity to consent and make decisions about their care but this was not always completed in a way that ensured people’s care was provided in line with the principles of the Mental Capacity Act 2005.

People’s care plans did not include the person’s wishes about how they wanted their care provided as they were focused on care tasks. Records did not provide up to date information relating to people’s care needs.

The provider had a range of audits in place but some of them were not effective and did not provide appropriate information to enable them to identify any issues with the service and take action to make improvements.

People using the service told us they felt safe when they received support from care workers in their own home.

Care workers completed training the provider had identified as mandatory and where this was overdue the manager had arranged for the relevant training to be provided. Care workers told us they felt supported by their manager.

People felt the care workers were kind, caring and treated them with respect when providing care.

People told us they knew how to raise a complaint but these were not always responded to in line with the provider’s policy but this was being reviewed by the manager.

People were able to provide feedback on the quality of the care and support they received which was acted on by the provider.

We found six breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person centred care (Regulation 9), need for consent (Regulation 11), safe care and treatment of people using the service (Regulation 12), good governance of the service (Regulation 17) and staffing (Regulation 18). You can see what action we told the provider to take at the back of the full version of this report.

The last inspection took place on 21 March 2017, when we rated the service as Requires Improvement, with an inadequate rating for the key question of Safe. We found breaches of five Regulations in relation to person-centred care, need for consent, safe care and treatment, good governance and staffing. We issued a warning notice for breaches in safe care and treatment telling the provider they must make improvements by 30 April 2017. We issued requirement notices in respect of the other breaches. At the inspection of 18 July 2017 we found that all the breaches had been met. However, some areas of the service still required improvements to make sure people were always cared for in a way which reflected their needs and preferences.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority. At the time of the inspection the agency was delivering approximately 3,000 hours of support a week. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

There was a manager in post. They were registered to manage a different branch of Mears Care Limited. They had changed role to manage this location and were in the process of transferring their registration for the management of Mears Care – Richmond. 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 and associated Regulations about how the service is run.

There had been improvements at the service and the previous requirements and warning notices we issued had been met. Most people using the service, their representatives and the staff told us they had experienced improvements. However, some people still felt the service did not meet their needs. In particular some people were not happy with the times care visits took place because these were not always consistent and did not always reflect when they needed care. Another concern was about the changes in the care workers who visited them. Whilst some people had regular care workers and they were happy with this, others told us they did not always know who would be caring for them and they did not like this. The third main concern people raised with us related to communication with the agency. They told us that they were not informed when changes to their care worker were planned or if care workers were running late. Some people also told us that when they raised concerns they did not always get told what was happening with these.

The manager acknowledged that further improvements were needed to the service. They told us they had focussed improvements on the most urgent and serious concerns relating to risks and medicines management. They had also started to improve the scheduling of care visits; however, they said that this was an area where more improvements were needed.

People using the service and their representatives liked their regular care workers. They told us that care workers were polite, kind, considerate and that they had good relationships with them. Most people told us that the care workers met their needs.

People were involved in planning their own care and had consented to this. Care plans included detailed information about people's individual preferences and how they wanted to be cared for. People were supported to be independent where they were able.

Medicines were managed in a safe way. There had been considerable improvements in the way that the agency monitored and managed medicines. The work undertaken by the branch in this area had also led to changes and an improvement in some of the provider's other branches and the way the provider trained the staff.

The risks people were exposed to had been assessed and planned for. There was clear information for the staff and contingency plans for different emergency scenarios. The provider had a procedure for safeguarding people and the staff had a good understanding of this.

The staff were recruited in a way which made sure they were suitable and appropriately skilled. There were comprehensive systems for inducting, supporting and training new members of staff. The staff we spoke with felt supported and had the information they needed to undertake their jobs.

The branch was being managed in a way which developed an inclusive and open culture. People using the service, other representatives and the staff were asked for their opinions and their feedback was used to help make improvements. The manager had introduced new audits and quality monitoring processes which had identified where improvements were needed. There was evidence action had been and was continuing to be taken to make the required improvements.

The last inspection took place on 15 November 2016 when we found breaches of Regulation in relation to safe care and treatment, person centred care, receiving and acting on complaints, staffing and good governance. We rated the service requires improvement. We found that the service was not safe and rated this domain inadequate.

At the inspection of 21 March 2017 we found the provider had made improvements. In particular there had been improvements in the way in which the service was managed leading to some improvement in all areas. However, we found that the provider was not always keeping people safe. We noted improvements in other areas but these were not always enough to meet the Regulations.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. The number of people who used the service changed regularly because the agency was one of the main providers used by the local authority. At the time of the inspection the agency was delivering approximately 3,000 hours of support a week. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

The registered manager left the organisation in 2016. Since this time three different service managers had been employed to run the service. The current service manager was appointed in February 2017. They had not yet applied to be registered for the Mears Care – Richmond branch, but had previously been the registered manager at another one of the provider's locations. They told us they would be applying to add the Richmond branch to their registration with the Care Quality Commission. 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 and associated Regulations about how the service is run.

People did not always receive their medicines in a safe way and the provider had not taken sufficient steps to ensure medicines were managed safely in the future.

People were sometimes placed at risk of harm and the provider had not taken enough action to minimise this risk.

There had been improvements in the way in which the staff were deployed but there were still instances where people did not receive the care and support they needed because the systems for deploying and organising staff were not always sufficient.

The provider had not always acted within the principles of the Mental Capacity Act 2005 because they had not assessed people's capacity to make decisions or followed the correct processes for making decisions in people's best interests.

People did not always receive care visits at the time they were planned and expected, or for the amount of time planned, and this resulted in some of their needs not being met.

Records were not always up to date, accurate or well maintained.

The provider's systems for monitoring the quality of the service had improved. But these did not always identify when things had gone wrong or were not being done properly. Therefore improvements had not always been made when they were needed.

We found breaches 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.

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.

There had been improvements in the way in which people were cared for and in all aspects of the service. Whilst we identified problems with the way in which medicines and risks were managed, we also saw that there had been improvements since the last inspection and the provider had systems in place to ensure improvements continued. In particularly they had improved the way in which they monitored how people were being cared for so they could identify and act on any problems swiftly.

People had good relationships with their care workers and felt they were kind, supportive and caring. Their privacy and dignity was maintained. People told us they had seen improvements in the service. People felt the staff met their needs and followed care plans. People felt involved in planning and reviewing their own care and told us the provider had been responsive to requests for change.

The staff told us they felt the service had improved. They felt better supported and told us they had the information and training they needed to help them carry out their roles. The recruitment procedures ensured that checks on the suitability of staff were in place. The staff told us their work was better planned and they were told about who they would be caring for in advance. This was a significant improvement since the last inspection and meant that the care workers were able to meet people's needs better. People were supported by the same regular staff rather than lots of different staff, which had been a problem in the past.

There had been improvements in the way in which the service was managed. This included improvements in team work, systems and processes for monitoring how well the service was working. The provider had demonstrated a commitment to continuous improvements and was acting on problems as they identified these or were made aware of them. They had responded to complaints, accidents and incidents appropriately and were working with the local authority to develop the service.

The overall rating for this provider is 'Requires Improvement' and the key question of safe has been rated ‘Inadequate’ at this inspection and at the previous inspection of the service. This means that it has been placed into ‘Special Measures’ by CQC.

The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The last inspection took place on 17 November 2015 when we found the provider was meeting all the Regulations we inspected.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. As part of the provider's contract with the local authority they provided the care and support to people who lived within two extra care schemes in the borough. They also provided short term care and support alongside the treatment provided by the health authority to people moving back home after an accident, hospital admission or operation. This type of support is known as reablement and is designed to help people to regain skills and confidence so that they can return to the lifestyle they had previously. At the time of the inspection approximately 280 people were using the service, although the number of people changed regularly because the agency was one of the main providers used by the local authority. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with a number of other branches.

The registered manager had left the organisation earlier in 2016. A new manager was in post and they were in the process of applying to be registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

There were not always enough suitably qualified staff deployed to meet the needs of people using the service and keep them safe. The way in which care visits were planned meant that neither the care workers nor the people using the service knew in advance who would be carrying out the visits. People did not always have the same regular care workers and they were sometimes late or visits did not take place.

People did not always feel safe with the agency. In 2016 there had been a high number of allegations of abuse where people had not received their care visits or care had not been delivered in a safe way.

People did not always receive their medicines safely and as prescribed.

People did not always receive care which met their needs or reflected their preferences.

There was a complaints procedure but people using the service and their relatives did not always feel confident that their complaints would be investigated and acted upon.

The service was not always well managed and the communication within the agency was not effective. Records were not always appropriately maintained and the systems for auditing and monitoring the service did not always lead to improvements for people.

We found breaches 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.

Not all of the staff understood their responsibilities under the safeguarding procedures.

The senior staff working at the agency did not always get opportunities for support or training. We have made a recommendation in respect of this.

Not all the staff had a good understanding of the Mental Capacity Act 2005 and we have made a recommendation in respect of this.

Although we found a number of concerns, some of which were breaches of Regulation, we also found that improvements had been made at the agency within the four weeks preceding our inspection. People using the service confirmed this and over half the people we spoke with were satisfied with their care at the time of the inspection. The London Borough of Richmond upon Thames had been closely monitoring the service because of the high number of safeguarding incidents which had taken place since April 2016. They told us they had seen significant improvements and that the new manager and provider had taken positive action to improve the service. In addition external professionals who we spoke with told us they had started to see improvements.

Whilst we found problems with some records and evidence of care provided, including administration of medicines, these were records from earlier in 2016. The records of care and medicines provided in the past month were still at the homes of people using the service and therefore could not be inspected. Therefore it was difficult to judge the impact of improvements in these areas. However we saw evidence of the provider's own monitoring and audits in the past month. We saw that the provider had reviewed or planned to review everybody's care by the end of December 2016. We also saw that all staff had taken part in individual supervision meetings or were due to by the end of December 2016. The provider continued to work closely with the local authority in monitoring the service. These included meetings with senior managers each month and weekly meeting between the local authority and branch manager.

People using the service liked their regular care workers and found them kind, caring, polite and trustworthy. The staff liked their work and enjoyed caring for people.

The provider had created comprehensive care plans and risk assessments which were reviewed and updated. These included information about people's preferences.

The staff were appropriately recruited and care staff had access to a range of training which supported them to understand their roles and responsibilities.

The provider had an action plan for continuing improvements and this was regularly monitored and updated. The manager had a good overview of areas which had improved and the work which still needed to be undertaken. This included improving the rostering system to make sure people received care on time from the same regular care workers. The manager had changed the structure of the senior staff team and allocated them geographical areas within the borough which they were starting to familiarise themselves with. This meant they had a better understanding of travel time and how easy it was for the staff to move between people's houses. The impact of this new way of managing the service was starting to show as more care visits were taking place on time and the number of missed calls had significantly reduced. However, further improvements in this area were still required and the manager was aware of this.

The last inspection of the service was on 12 May 2015 when we found no breaches of Regulation.

Mears Care – Richmond is a domiciliary care agency providing personal care and support to people living in their own homes within the London Borough of Richmond upon Thames. The majority of people had their care funded and organised by the local authority. Mears Care Limited is a national organisation and has branches in different counties and London boroughs. The Richmond branch was located in an office with four other branches. There was a manager in post who had worked at the branch since May 2015. He had applied to be registered with the Care Quality Commission. 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 and associated Regulations about how the service is run

The agency had experienced a sudden loss of staff and this had impacted on the care provided meaning some people had received visits later than planned. However, most people felt safe with the agency. The agency had employed additional resources from other branches of Mears Care Limited and had recently recruited new staff to make sure care was delivered to everyone as planned.

People told us their care workers were kind, caring and considerate.

The provider had followed their contingency plans to manage the changes in staffing level and make sure people’s needs were met. They had contacted people using the service, staff and other stakeholders to make sure they were involved in planning how care would be provided and to inform them about how the agency was recovering from the situation.

People who use services said they were treated with dignity and respect. People said carers promoted their independence. People had complained to Mears Care and their complaints had been resolved. People had complained about carers being 'unsuitable'. Once this was reported Mears Care always provided an alternative carer. However, overall people said they were satisfied with the care they received from Mears Care - Richmond.

People we spoke with were satisfied that their care workers treated them kindly and respected their privacy. One person said 'the staff are not too bad, they treat me well'. People confirmed that they could choose the gender of their care workers according to their preferences and that their choices were respected. They also told us staff called them by their preferred names. However we noted that recruitment processes were not robust enough to demonstrate that only suitable applicants were employed to care for people.

We found that staff assessed people's individual needs and prepared appropriate care plans and risk assessments that were reviewed six monthly. People were involved in making decisions about the care and support they needed and had access to their care records.

People had the agency's contact details and said they would speak with the office staff if they had any concerns. Many also said they would involve their relatives if they were worried about their safety. Some said they were sometimes concerned they would not get the care they needed because the agency did not keep them informed when their care workers changed or when they were late for visits. The provider's own quality system had identified these areas for improvement but they had not been able to make the necessary improvements.