Background to this inspection
Updated
2 September 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team comprised of three inspectors, one of these inspectors made telephone calls to staff members and two Experts by Experience made telephone calls to people who used the service and their family members. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. Inspection activity started on 06 October 2022 and ended on 17 October 2022. We visited the location's office on 06 October 2022.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also contacted commissioners of care services for their feedback. We used all this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and 14 relatives. We also spoke with 10 care staff, three office staff members and the registered manager who is also the nominated individual for the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We contacted three health professionals but only received feedback from one. We reviewed eight care plans and a selection of call records, daily notes, medicine records, risk assessments, audits and policies and procedures. We also used technology such as electronic file sharing to enable us to review documentation sent to us by the provider, following the site visit.
Updated
2 September 2023
About the service
Mach Care is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection there were 24 people using the service.
At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person.
People’s experience of using this service and what we found
The provider's oversight of the service had not identified some of the shortfalls we found during the inspection process as part of their audits and checks. At our previous inspection in October 2021, the provider was in breach of regulation 17 Good governance. At this inspection we found improvements had not been sustained and the provider remained in breach of this regulation. We also identified new breaches of regulations 9 Person centred care, 11 Consent, 12 Safe care and treatment and 18 Staffing.
There were systems in place for managing complaints, safeguarding concerns, accidents and incidents. However, we found these were not robust and feedback from people and relatives on how the provider managed calls was very poor. The main complaint raised by people and their family members was the lateness, shortness of calls and missed care calls. We found from call records and rota's that short, late and missed calls were occurring. Staff attending people's homes at times were inconsistent which impacted on the support people needed, placing them at risk of harm.
Based on our findings around the continual short, late and missed care calls, staff members were not effectively deployed by the provider to support people.
Two people and their relatives told us some care staff members communication was limited, this was due to language barriers.
Care plans were not fully personalised, and information contained within them had not been reviewed and updated to reflect people's current support needs. Risks to people had not been thoroughly assessed. The assessments themselves did not always clearly reflect what action staff should take in the event of that person becoming unwell or experiencing symptoms of known health conditions.
People’s care and support was not always planned in partnership with them and persons close to them. This meant people were not always supported to have maximum choice and control of their lives as they told us they were not involved in care reviews and when they had raised concerns these had not been thoroughly addressed and resolved.
Where appropriate, staff supported people with nutritional and hydration needs, however care plans contained conflicting information for staff to follow.
People were not consistently protected from abuse because the systems and processes in place were not robust to keep people safe. Staff we spoke with were aware of their responsibilities to keep people safe.
People were not consistently supported by staff to take their medicines, however, guidance in place was not clear for staff to follow. Records demonstrated that medicines were not always given as prescribed.
Overall, people and their relatives told us staff members adhered to current Infection Prevention and Control guidance for the correct and safe use of Personal Protective Equipment (PPE).
Pre-employment checks were in place to make sure newly recruited staff were suitable to carry out their role. Staff received induction training. Many people felt staff members had the appropriate skills and knowledge to support them how they wished.
People told us, staff sought consent prior to supporting them and encouraged people to make their own decisions, in the least restrictive way possible and in their best interests; the provider had policies in place.
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 21 October 2021) and there were breaches of regulation. The service has deteriorated to inadequate. 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 not been made and the provider remained in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns received about people not being supported in a safe way, short call times, staffing levels and poor governance systems. A decision was made for us to inspect and examine those risks.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified new breaches in relation to Regulation 9 - Person centred care, Regulation 11 - Consent, Regulation 12 – Safe care and treatment, Regulation 18 - Staffing and Regulation 17 – Good governance which is a continued breach, at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.