Mach Care Solutions (Birmingham)

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.

About the service

Mach Care Solutions Birmingham is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection there were 40 people using the service.

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.

People received inconsistent call times. Call records and rota's confirmed that short, late and calls close together were still occurring. Staff attending some people's calls, remained inconsistent which impacted on the support people needed, placing them at risk of harm.

There were systems in place for managing complaints, safeguarding concerns, accidents, and incidents. However, we found these continued to fail to identify the concerns we found during this inspection. Although people and their family members were happier with the call times and length of calls, this still required improvement.

One person and a relative told us some care staff members communication was limited, this was due to language barriers and some staff continued to communicate between themselves in their own language. We also found that language barriers impacted on the responses we received from staff when exploring their knowledge of people’s care needs.

We saw care plans continued to lack information and guidance for staff to follow and some had not been reviewed and updated to reflect people's current support needs. Risks to people had not been assessed consistently. 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.

Some people’s care plans contained conflicting information to guide staff with appropriate support for people with nutritional and hydration needs.

People continued to be placed at risk from abuse because the systems and processes in place were not robust to keep people safe. However, the staff we spoke with were aware of their responsibilities to keep people safe.

The management of medicines still required improvement. Guidance in place was not clear for staff to follow.

Pre-employment checks were not always carried out to make sure newly recruited office support staff were suitable to carry out their role, prior to them commencing work. Staff received induction training. People felt staff members had the appropriate skills and knowledge to support them how they wished.

People and their relatives told us and records demonstrated people were now involved in decision making and creating their care plans to meet their individual needs and wishes. 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.

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).

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 inadequate (published 09 November 2022) and there were breaches of regulation. The provider was in breach of regulations 9 Person centred care, 11 Need for consent, 12 Safe care and treatment, 17 Good governance and 18 Staffing. At this inspection we found improvements had not been made and the provider remained in breach of regulations. We also identified a breach of regulation 19, Fit and proper persons employed. The service has remained 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has remained Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mach Care Solutions (Birmingham) on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified continued breaches in relation to; Regulation 9 - Person centred care, Regulation 11 - Need for consent, Regulation 12 – Safe care and treatment, Regulation 17 – Good governance and Regulation 18 – Staffing at this inspection.

We have identified a new breach in relation to Regulation 19 – Fit and proper persons employed. The provider had failed to follow safe recruitment processes.

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

The overall rating for this service remains 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Mach Care Solutions (Birmingham) is a domiciliary service which provides personal care to adults with a range of support needs in their own houses and flats. At the time of this inspection the service was providing personal care to 66 people.

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

Governance systems were not robust and the provider had not ensured an adequate system of observational spot checks on staff was carried out to monitor performance.

There were not enough staff to support people in a timely way. In recent months some people had experienced late calls. The provider had no plans to increase the number of people they supported until they had enough staff to do so safely.

Improvement was needed to the systems for preventing and controlling infection. Some people raised concerns with us about staff not always wearing the correct personal protective equipment (PPE) when arriving to provide their care. Staff took regular COVID-19 tests to ensure they were free from the virus they could pass on to people they supported.

Staff were trained in administering medicines safely. Competency checks had been completed to ensure staff were following safe practices.

Staff had good knowledge about the people they supported. People's risks were assessed at regular intervals or as their needs changed.

People and their relatives were able to give feedback about their care in a variety of ways. Examples included care reviews and survey forms.

Following the inspection, the provider responded to our feedback and provided an improvement plan detailing the actions they were taking to improve.

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

Rating at last inspection

This service was last inspected on 14 May 2019 and was rated Good.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, infection control arrangements and management of safeguarding incidents.

As a result, we undertook a focused inspection to review the key questions of safe and well led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mach Care Solutions (Birmingham) on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Mach Care Solutions is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection, 70 people were receiving care and support services.

People’s experience of using this service:

People told us they felt safe and staff knew how to protect people from the risk of harm or abuse. People’s risks were assessed, monitored and managed. People were supported by a sufficient number of safely recruited staff. Medicines were given as prescribed. Staff had access to personal protective equipment. Accidents and incidents were monitored and reviewed. The registered manager informed us as require doing so by law.

People were cared for by staff who had the skills and knowledge to meet their needs, Staff understood their role and felt supported by the management team. Staff sought people’s consent before care was provided. People were supported to access healthcare agencies when required.

People told us staff were kind in their approach. People told us their dignity and privacy was maintained and they were involved in the planning and review of their care.

People received care that was responsive to their needs. Care records were reflective and up to date. The provider had a complaints process in place which people were aware of and knew how to access.

The provider had quality auditing and monitoring systems in place which included competency checks on staff practice. People and staff said the provider and management team were approachable and the culture of the organisation open and friendly.

Rating at last inspection:

Requires improvement (report published 27June 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection the service was requires improvement overall (in the key questions of Caring and Well-led). We found the required improvements had been made and the service has met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care and nursing care services to people living in their own homes. It provides a service to people of all ages including children, adults and older adults living with physical, learning and/or mental health conditions, such as dementia. At the time of our inspection Mach Care Solutions (Birmingham) was providing care to 122 people, including two children. They were not providing any nursing care to people at this time.

Mach Care Solutions (Birmingham) is required to have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

Some people continued to raise concerns about late, rushed or short care calls particularly when their regular carer [staff] was absent from work. This meant that some people did not always receive the care and support they required when they required it. The provider’s quality assurance practices had not always identified or addressed these issues in a timely manner. They had also failed to recognise or address other shortfalls that we identified during our inspection, including the lack of robust recruitment practices and poor information governance systems. We continued to experience a delay in receiving the information we requested as part of our inspection and some of the records we received could not always be relied upon for their validity. This meant that this inspection was the fourth consecutive inspection whereby improvements were required to the governance of the service and therefore the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we have taken at the end of our report.

People were supported by sufficient numbers of staff who had the skills, knowledge and competencies to keep people safe and to meet their needs. People were protected from the risk of abuse because staff understood their responsibilities and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

Most people were pleased with the consistency of the staff that provided their care and reported staff to be kind and caring. People were treated with dignity and respect and received their care with consent. People were also encouraged to be as independent as possible and staff were mindful of the need to involve people in making choices and decisions about their day to day needs.

People knew how to make a complaint if they were unhappy and felt that any complaints or issues raised were dealt with efficiently. However, further improvements to the management of complaints was required. The management team were compliant with the Duty of Candour regulation and were receptive to the feedback we provided at the time of our inspection.

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care and nursing care services to people in their own homes. At the time of our inspection Mach Care Solutions (Birmingham) were providing care to 155 people. They were not providing any nursing care to people at this time.

Mach Care Solutions (Birmingham) is required to have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

We found a clear leadership structure within the service, however, the leadership style was not always supportive to staff.

People’s safety was not always protected because risks assessments did not always identify risks that were specific to their needs and care plans were not always individualised. Quality monitoring systems had not always identified when people’s needs had changed or where shortfalls in service delivery were evident.

People were supported by sufficient numbers of staff who were kind and caring. Most people were pleased with the consistency of the staff that provided their care.

Most people knew how to make a complaint if they were unhappy; however, not all complaints were identified, recorded or investigated reliably.

People were supported by staff who had the knowledge and skills they required to fulfil their roles and responsibilities effectively. People were protected from the risk of abuse because staff understood their responsibilities and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

People were treated with dignity and respect and received their care with consent. People were also encouraged to be as independent as possible and staff were mindful of the need to involve people in making choices and decisions about their day to day needs.

The management team were compliant with the Duty of Candour regulation and were co-operative throughout the inspection process.

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care services to people in their homes. We were told that since our last inspection improvements had been made and they were now providing personal care services to more people. At the time of our inspection Mach Care Solutions (Birmingham) were providing care and support to 157 people including three children. The provider also offers other services to people such as support with shopping or household tasks that we do not regulate.

Mach Care Solutions (Birmingham) is required to have a register 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

People we spoke with told us they felt they received a safe service. However, we found that the systems and processes in place to monitor people’s safety were not always effective in detecting late or missed calls; leaving people at risk.

People’s safety was not always protected because the provider did not have robust recruitment processes.

People were supported by sufficient numbers of staff who understood their responsibilities to keep people safe from abuse and avoidable harm; they knew how to raise concerns if needed.

People were supported to have their prescribed medication safely.

People were supported by staff that understood their responsibilities to protect people’s rights. However, the provider had not always fulfilled their responsibilities to ensure care was provided with lawful consent.

People were supported by staff who had received the training they needed to do their job effectively.

Staff felt supported in their role and knew who to contact for advice or information should they require it.

People received enough food and drink and were supported to have food that they enjoyed.

People were supported to maintain good health and to have access to other health and social care agencies when required.

People were treated with kindness, dignity and respect by staff that knew them well and knew what was important to them.

People were involved in planning and reviewing their own care.

People were encouraged to maintain their independence.

Care was delivered in a way that met people’s individual needs and preferences.

People knew how to make a complaint if they were unhappy and were confident that their concerns would be acted upon responsively.

We saw improvements had been made to monitor the quality and safety of the service since our last inspection. However some of these were not always effective.

We found a clear leadership structure within the service which was supportive and transparent to staff and to most of the people who used the service.

However, sometimes people found the management team to be inaccessible and other professionals reported them to be un-cooperative and defensive when trying to address service deficiencies.

We spoke with eleven people and their relatives that used the service and asked them about their experiences. We also spoke with four staff members. We made a visit to Mach Care Solutions office and looked at information to help us gather evidence about whether improvement had been made. On the day of our inspection, the registered manager told us that 77 people received care and support from them. We also spoke with the operations manager and training manager during our visit to the office.

Below is a summary of what we found.

The detailed evidence supporting our summary can be read in our full report.

We looked to see if effective recruitment procedures were in place.

We found that improvement had been made to recruitment procedures and most pre-employment checks were completed as required.

We found that a few workers had started work before all required checks were made.

We looked to see if the provider regularly assessed and monitored the quality of the services provided to people.

We found that improvement had been made to monitoring the quality of the services. One person told us, 'I am now asked for my feedback on the quality of the service.' Another person told us, 'I feel my views are listened to.'

We saw that some systems of audit were in place.

We looked to see if accurate records and appropriate information was kept in respect of each person supported by the provider.

Overall we found that it was and that improvement had been made.

Further improvement was planned for detailed medication records to be kept for people supported to take their medicines.