Background to this inspection
Updated
7 October 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 was carried out by 1 inspector and an Expert by Experience. 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. This was because the service is small and we wanted to be sure there would be people at home and in the office to speak with us.
Inspection activity started on 20 June 2023 and ended on 23 June 2023. We visited the location’s office on 23 June 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We visited 3 people and spoke with 2 of them and 4 relatives. We spoke to 4 staff including the registered manager. We also spoke with 1 person, 10 relatives, 5 staff and 4 professionals by phone. We reviewed a range of information including 2 people’s care plans and risk assessments, 3 medicines records (MARs) and a range of records relating to the management of the service such as meeting minutes and audits.
Updated
7 October 2023
About the service
Miracle Care is a domiciliary care agency providing personal care to people. The service provides support to older people and some younger people with a learning disability. At the time of our inspection there were 30 people using the service.
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.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
Relatives did not all think their family member was safe whilst receiving support from Miracle Care. Staff did not all understand how to report an accident or incident and the registered manager had not understood when to share safeguarding concerns externally. Risks relating to people’s health and care needs had not aways been recorded in a risk assessment.
Most people received their medicines as prescribed, however medicines management was not always safe.
People did not always receive care form consistent staff members at a consistent time each day. This compromised the quality of their care.
People’s care plans did not always contain sufficient information about people’s needs, preferences and routines. The care people received did not always reflect their preferences and choices. Relatives did not have access to information about what care had been provided to their family member.
People did not always receive food and drink in a way that they preferred.
Assessments of people’s capacity had not been completed in line with the principles of Mental Capacity Act 2005 (MCA).
Staff had completed training but professionals and relatives raised concerns about the training and support staff received.
Staff meeting minutes did not show staff were encouraged to share ideas, raise concerns or discuss people’s support needs.
Staff did not always understood people’s cultural needs and relatives and staff reported that sometimes there was a language barrier which had a negative impact on people’s experiences.
The registered manager had not ensured the service followed best practice. Checks of the service had not identified the failings found during the inspection.
People received care from staff who were calm and kind. Staff and some relatives said the registered manager was approachable.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Right Support:
The model of care did not maximise people’s choice, control and independence. It did not always focus on people’s strengths or promote what they could do. This meant people did not always have a fulfilling and meaningful everyday life.
There was limited guidance available on how to support people who were experiencing periods of distress.
Right Care:
People’s care plans were not holistic. They did not reflect their range of needs and meant staff did not have full information about people when supporting them.
There was little information about people’s aspirations and what they needed to enjoy a good quality of life.
There was no clear plan to ensure people were given the opportunity to actively engage and try new activities.
Right Culture:
The service did not reflect the ethos of Right support, right care, right culture. Staff had not received support or training to understand best practice in learning disability services.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this inspection to provide a rating for this previously unrated service.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, staffing, consent, person centred care, and how the service is managed.
Please see the action we have told the provider to take at the end of this report. We issued a warning notice to the provider telling them the date by which they were required to make improvements.
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.