27 March 2018
During a routine inspection
MiHomecare-Brent is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides a range of domiciliary care services which include domestic support, administration of medicines and food preparation. At the time of inspection the service provided care to approximately 51 people.
There was a registered manager in post. 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.
The previous comprehensive inspection took place on 29 February 2016 and we rated the overall service as Good. We found a breach of regulation in respect of risk assessments and found that under “safe” the service required improvement. Following this, we carried out a focused inspection on 24 March 2017 and found that the service had made necessary improvements in respect of risk assessments and we therefore rated the service as Good under “safe”.
People who used the service spoke positively about the care they received. They told us they felt safe around care workers and were happy with the care provided by care workers and management at the service. Relatives we spoke with confirmed this and said that they were confident that people were well looked after.
Risk assessments were in place which detailed potential risks to people and how to protect people from harm. Risk assessments included detailed information about preventative actions that needed to be taken to minimise risks as well as clear and detailed measures for care workers on how to support people safely. At the end of each person’s risk assessment, there was a “high risk” summary. This provided a quick reference summary of those areas identified as high risk. Care support plans included a contingency plan and this helped establish which people were high risk and detailed what action to take in the event of an emergency.
Systems and processes were in place to help protect people from the risk of harm. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.
We spoke with people and their relatives and asked whether care workers turned up on time and if there were any missed calls. All people told us they had not experienced a care worker not turning up and care workers were usually on time.
There were comprehensive and effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff who were unsuitable.
Appropriate arrangements were in place in respect of medicines management. Records indicated that staff had received training on the administration of medicines and their competency was assessed. We noted that there were some gaps in medicine administration records (MARs) and raised this with management. They confirmed that the medicines had been administered but that MAR had not been completed. We noted that the gaps we found in the MARs had been identified by audits carried out.
Care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers were provided with an induction which provided practical training and shadowing. Care workers also received on-going training. Care workers spoke positively about their experiences working for the service. They told us that they received continuous support from management and morale amongst staff was positive.
Care workers were aware of the importance of treating people with respect and dignity. Feedback from people indicated that positive and close relationships had developed between people using the service and their care worker.
Care plans provided information about people’s life history and medical background. There was a detailed support plan outlining the support people needed with various aspects of their daily life such as personal care, continence, eating and drinking, communication, mobility, medicines, religious and cultural needs. Care plans detailed people’s care preferences, daily routine likes and dislikes and people that were important to them. Records showed when the person’s needs had changed, the person’s care plan had been updated accordingly and measures put in place if additional support was required.
The service had clear procedures for receiving, handling and responding to comments and complaints. Records showed that the registered manager investigated and responded appropriately when complaints were received and resolved matters satisfactorily.
The service carried out a satisfaction survey in September 2017. The results from the survey were mostly positive.
There was a clear management structure in place with a team of care workers, office staff, the registered manager and quality and performance manager. Care workers spoke positively about the management and culture of the service and told us the management were approachable if they needed to raise any concerns.
Systems were in place to monitor and improve the quality of the service. The service had a comprehensive system in place to obtain feedback from people about the quality of the service they received through review meetings, telephone monitoring and home visits.
The service undertook a range of audits of the quality of the service and took action to improve the service as a result. Audits had been carried out in relation to care documentation, staff files, medicines and training.