Archived: Mears Homecare Limited - Hillingdon

Mears Homecare Limited – Hillingdon provides a range of services to people in their own home including personal care. At the time of our inspection 300 people were receiving personal care in their home. The majority of people using the service had their care funded by their local authority. People could also pay for their own care.

At the time of the inspection the manager was in the process of being registered with the Care Quality Commission. 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.

At our last comprehensive inspection of this service on 30 November, 1 and 3 December 2015, we found breaches relating to the registration of the manager, need for consent, safe care and treatment, receiving and acting on complaints, good governance and staffing. As a result of these, our concerns were sufficiently serious for us to impose a condition on the provider's registration to restrict admissions to the service based on our concerns in relation to staffing issues and we rated the service as overall inadequate and consequently placed into special measures. At this inspection, we found improvements had been made in this area and we have therefore asked the provider to request that this restriction is now lifted.

We also imposed positive conditions in relation to the provider providing us with regular updates on their progress in addressing the breaches we found with Regulations 12 (safe care and treatment) and Regulation 17 (good governance). At this inspection, we found there were continued breaches of Regulations 12 and 17 and we therefore decided to continue with the positive conditions for these breaches. Because we are continuing previous enforcement action, this has not been reported upon at the back of this report.

At this inspection, we also found a repeated breach of Regulation 11 (need for consent). Because this did not form part of the enforcement action we took after the previous inspection, we have reported on this breach at the back of the report where you can see what action we have told the provider to take.

The provider sent us an action plan identifying the actions they would take to improve the service and we received monthly feedback on the audits that were completed.

There were generic risk assessments in place but these did not identify the possible risks in relation to specific issues for people. Care workers were not provided with guidance on how to reduce these specific risks for example where a person was living with depression or diabetes.

Although people told us they felt safe when they received care in their home, we found that the provider had not always ensured people were protected from the risks of receiving unsafe care. There was a procedure in place for the management of medicines but care workers were not recording the administration of medicines accurately. This meant the provider could not ensure medicines had been administered as prescribed. We have made a recommendation in relation to the administration of medicines.

The provider had a policy in place in relation to the Mental Capacity Act 2005. However, appropriate actions were not taken to assess people’s capacity to make decisions relating to their care and identify the support they required.

Care records relating to people using the service were not completed accurately to provide a current picture of the person’s needs and support provided. This did not provide up to date information for care workers in relation to how and when people’s care should be provided.

Improvements had been made in the recording and investigation of accidents and incidents since the previous inspection. We also found improvements had also been made in the number of care workers available to provide care.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People felt the care workers were caring and treated them with dignity and respect as well as supporting them to maintain their independence while providing care.

There were improvements in the way complaints were investigated and responded to since the previous inspection.

People using the service had been sent a questionnaire asking for feedback on the quality of the service and the comments received had been positive.

Since the previous inspection the provider had introduced a range of systems to monitor the quality of the service provided.

Care workers felt they were supported to carry out their role and the service was now well-led.

Following our last inspection, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

Mears Homecare Limited – Hillingdon provided a range of services to people in their own home including personal care. At the time of our inspection 300 people were receiving personal care in their home. The majority of people using the service had their care funded by their local authority. People could also pay for their own care.

This was the first inspection of the service since Mears Homecare Limited took over the service from Care UK and registered with the CQC on 19 November 2014.

The service did not have a registered manager. 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 provider had a process for the recording of incidents and accidents but the information relating to any actions taken was not recorded on the system.

The records produced relating to the administration of medicines were not accurate. We saw the care workers did not record all the medicines that were administered.

The provider had generic risk assessments in place but they had not identified possible risks in relation to specific issues for people using the service and had not provided care workers with guidance on how to reduce these risks.

People using the service and care workers had concerns regarding the number of care workers available during the weekend, which led to late visits and staff taking on extra calls.

Care workers did not have regular supervision with their manager or an annual appraisal.

There was a policy and training in relation to the Mental Capacity Act 2005. However, the provider did not ensure appropriate actions were taken when a person using the service had been identified as unable to make decisions about their care.

The provider had a complaints policy and procedure in place but complaints were not responded to in an appropriate timeframe.

The provider had limited systems in place to monitor the quality of the care provided. These did not provide appropriate information to identify issues with the quality of the service.

Records relating to care and people using the service were not completed accurately to provide a current picture of the person’s needs and the support provided.

The care plans did not identify how the person wished their care to be provided. We have made a recommendation in relation to person-centred care planning.

People using the service felt the service was not well-led and this was supported by feedback from care workers.

People using the service felt safe when they received care and support. The provider had processes in place to respond to any safeguarding concerns. There were safe practices in place in relation to recruitment of care workers.

Care workers had completed a range of training that had been identified as mandatory by the provider.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider for the breach of the Regulations in relation to need for consent (Regulation 11), the safe care and treatment of people using the service (Regulation 12), receiving and acting on complaints (Regulation 16), the good governance of the service (Regulation 17) and staffing (Regulation 18). We will report on it when our action is completed. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.