Background to this inspection
Updated
10 August 2021
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 Care Act 2014.
Inspection team
The inspection team consisted of two inspectors and two assistant inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was also a new manager in post who was planning to take over the role of registered manager for the service in the near future.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 06 July 2021 and ended on 08 July 2021. We visited the office location on 06 July 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We sought feedback from Local Authorities, the Clinical Commissioning Group (CCG) and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.
During the inspection
We spoke with 10 people who used the service and five relatives about their experience of the care provided. We spoke with 10 members of staff including the registered manager, manager, compliance officer and seven care workers.
We reviewed a range of records. This included nine people’s care records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, care hours provided and quality assurance records. The provider took immediate steps to address the issues found during the inspection.
Updated
10 August 2021
About the service
Monarch Care Services UK Ltd is a care at home service providing personal care to 150 people at the time of our inspection. The service supports people living in their own homes. The majority of support provided to people was re-enablement packages. This is when people require support for a short period of up to 12 weeks. However, some people received support on a long term basis.
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
Staff were recruited safely, but recruitment records did not always evidence how risks had been addressed or gaps in information had been explored. Systems to learn lessons when things went wrong were not always effective and there were missed opportunities to use learning from incidents to drive improvements.
People and staff did not always feel there was good communication with the service. However, staff enjoyed their role and found the manager approachable if they had a concern.
There were systems in place to audit and monitor the service but these did not always identify the issues we found during the inspection. The provider was in the process of formulating an action plan to address any shortfalls and updated technology was to be implemented to drive improvements.
People told us they received safe care that met their needs. Those who were supported with medication said it was administered safely. Care plans and risk assessments were in place to guide staff about people’s needs. However, records were not always robust when people had specific requirements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 16 March 2019).
Why we inspected
The inspection was prompted in part due to concerns received about recruitment practices, medication errors and poor moving and handling practices. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. The provider took immediate action to address the issues found through their improvement action plan. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Monarch Care Services UK Ltd on our website at www.cqc.org.uk.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified a breach in relation to the governance of the service at this inspection.
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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.