You are here

Medstar Domiciliary Care Services Limited Good

Reports


Inspection carried out on 17 May 2017

During a routine inspection

This inspection took place on 17 May 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present to provide the information and documents necessary for the inspection.

During the last inspection on 18 January 2016 we found the service was in breach of two legal requirements and regulations associated with the Health and Social Care Act 2008. We found that there were no medicines audits in place across the service, care staff did not have one to one supervision sessions and annual appraisals were not sufficient to support staff to carry out duties they were employed to perform.

Medstar Domiciliary Care service provides care and support for 11 people. Medstar works with people living with dementia, learning disabilities, people with autistic spectrum disorder, and people with sensory and physical impairment.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Detailed and current risk assessments were in place for people using the service. Risk assessments were reviewed and updated regularly. Risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person whilst supporting them to be independent.

Medicines were now managed safely and effectively and there were regular medication audits in place. Staff had completed medication training and the service had a clear medication policy in place which was accessible to staff.

Staff were now receiving regular documented supervisions and an annual appraisal. We saw evidence of a comprehensive staff induction and on-going training programme. Staff were also safely recruited with necessary pre-employment checks carried out.

We received positive feedback from people and relatives regarding the caring and supportive nature of staff.

Care plans were person centred and reflected what was important to the person. Care needs were regularly reviewed and updated to meet the changing needs of people who used the service.

We saw evidence of a comprehensive and on-going training programme.

All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns with regards to people's mental capacity.

People were supported to maintain good health and had access to healthcare services.

The service regularly requested feedback from people who used the service.

People were encouraged and supported to access the community and engage in activities of their choice.

The management team enabled an open culture that encouraged staff to discuss issues and areas for improvement.

The provider had a quality monitoring system to ensure standards of service were maintained and improved.

Inspection carried out on 18 January 2016

During a routine inspection

This inspection took place on 18 January 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to make sure that the registered manager would be at the head office. Medstar Domiciliary Care service provides care and support for 17 people in their own home. 15 of who receive 24 hour care. The provider also supports nine people in a supported living scheme. The provider works with people living with dementia, learning disabilities, people with autistic spectrum disorder, and people with sensory and physical impairment.

The service was last inspected 12 September 2014 and was meeting all the regulations we inspected. 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.

There were no medicines audits in place across the service. Weekly monitoring visits checked medicines. However, this was not documented in detail and did not allow the provider an overview of medicines.

People had not received Mental capacity Act Assessments (MCA) to determine how they could make decisions around their care. The service did not find out people’s capacity at the point of referral. There were no records that families and healthcare professionals been involved in making best interests decisions on a regular basis.

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. We saw that care plans were regularly reviewed and updated as changes occurred. However, care plans were not signed by anyone and there were no records of who had been involved in creating the care plan.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly. However, risk assessments were not signed by anyone and there was no evidence of people being involved in creating the risk assessments.

Staff did not receive regular, effective one to one supervision or appraisal.

People told us that they felt safe within their homes and felt well supported by staff. We visited one person and saw positive and friendly interactions between staff and the person. People and relatives told us that they were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place. Staff understood what to do and who to report it to if people were at risk of harm. Staff had received training in the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People received a continuity of care. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

Staff received a comprehensive induction. Staff were matched to people according to needs.

Senior staff completed regular monitoring of care staff via monitoring visits. Issues identified were immediately addressed.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

There was an open, supportive culture between management and staff. People and relatives also told us that they thought the service was open and encouraged them to voice their concerns and opinions.

We found that the service breached two regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. Where there were breaches of regulations, you can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 12 September 2014

During a routine inspection

An inspector carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; is the service safe, caring, effective, responsive and well led?

Due to the nature of people�s support needs we were unable to speak with people using the service. The summary is based on our observations during the inspection, discussions with a Medstar service director, speaking with four people�s relatives, five staff supporting people, a local authority care coordinator. We also reviewed at records relating to people�s care and support and the management of the service. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found sufficient staff were available to deliver people�s care and support needs and they received the training required to provide safe, appropriate care and support. Appropriate checks were carried out before staff started working with people to ensure they had the appropriate knowledge, skills and experience to meet people�s care and support needs.

The provider had an effective system in place to analyse any incidents that occurred when providing care and support for people in their homes. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

People�s relatives told us their family members were treated with respect and dignity by the staff. We found people were supported appropriately and sensitively by kind and considerate staff. We spoke with staff who told us about how they provided care and support. Relatives we spoke with were positive about the caring nature of staff members supporting them. One relative told us, �(a care worker) is a lovely, lovely lady; she really is. She is so patient with (my relative) and is very encouraging. All of the staff are very helpful and friendly.� Another relative told us, �They (the staff) are very careful to consider (my relative�s) wishes. They respect them as a person and an individual.� People�s relatives told us their family members felt safe in the service.

Is the service effective?

People�s health and care needs were assessed with them and their relatives and other relevant people and healthcare professionals where appropriate. We saw evidence to show relatives or advocates and had been involved in developing and agreeing their care plans. Specialist dietary and healthcare needs had been identified in care plans where required. People were supported to access activities that were appropriate for them. Relatives we spoke with told us their family members received the support needed. A relative told us, �I am very, very happy with Medstar. They provide more individual care and support.� People�s care was subject to regular review so staff could ensure their needs were being met effectively.

A local authority care coordinator told us, �Staff are clearly up to speed and are skilled at what they do. The progress people make is evidence of that. It compares favourably to larger services. They provide specialist care for people with autistic spectrum disorders.�

Is the service responsive?

Staff we spoke with demonstrated they would report any concerns to the registered manager or other senior staff and were confident these would be addressed. This was confirmed by a relative we spoke with who told us, �Staff are very good at letting me know if there have been any changes. I feel fully informed.� A local authority care coordinator told us, �Staff are clearly up to speed and responsive to people�s needs. The service compares very favourably to larger services I work with.

We saw there was an effective complaints procedure in place. One person told us, �I haven�t had any cause to make a complaint but I am sure they (the staff) would deal with it appropriately. I have been encouraged by staff to raise any issues or concerns with them however small they seem and they have always acted accordingly.�

Is the service well led?

Relatives we spoke with, staff and the local authority care coordinator were very positive about the management of the service. Staff told us they felt supported by the registered manager and other office staff. A relative told us, �The managers make us feel like we�re part of a family. They are very caring. We found monitoring and reviews of the service were carried out regularly with necessary actions identified and completed in a timely manner.

Inspection carried out on 30 August 2013

During a routine inspection

Relatives spoken to were very positive about the care and support provided by Medstar Domiciliary Care Services Limited. Relatives spoke very positively about the care and support they received from the service. They could contact the office when they needed to.

Relatives told us they felt staff understood the needs of the people they supported. They told us that staff had where necessary received particular training in the person's home. They told us that regular checks were carried out by the agency to make sure that people received the quality of care they expected. They were happy with the service and they confirmed they felt consulted.