Monarch Home Care Services

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.

Not everyone using [Monarch Care Services] receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

People’s experience of using this service:

¿ Improvements had been made following our previous inspection on 27 October and 02 November 2017 to address the areas we identified as requiring improvement.

¿ People were supported by staff to stay safe and who understood the need to ensure they consented to the care they received. People told us that they received care from regular staff who arrived on time and stayed for the agreed length of time. The provider ensured consistency in staff support so people and staff were able to build positive relationships.

¿ People were well cared for by staff who treated them with respect and dignity and encouraged them to maintain their independence. People received care and support based on their individual assessment, needs and preferences.

¿ Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

¿ Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

¿ The provider had introduced new electronic quality assurance systems which had improved the monitoring of care people received.

¿ Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. People were aware of how to make a complaint should they need to.

¿ People spoke highly of the overall service and the management team positively encouraged feedback.

Rating at last inspection: At our last inspection on 27 October/ 02 November 2017 we rated as Requires Improvement with one Breach of regulation 17 Good Governance.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive 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

Monarch Care Services UK Ltd is registered to provide personal care services to people in their own homes. On the day of the inspection, 78 people were receiving support. There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act (2008) and associated Regulations about how the service is run.

People felt safe in the service. There was sufficient care staff who knew how to keep them safe. Where staff were recruited the provider did not ensure that the recruitment process where being adhered too. People received their medicines as it was prescribed, but care staff needed further guidance to administer medicines ‘as and when required’.

Care staff were not consistently supported to ensure they had all the skills and knowledge necessary to support people by way of regular supervisions. People’s consent was sought and the Mental Capacity Act (2005) was being adhered to, however care staff had not received the appropriate training consistently.

People received caring and compassionate support from care staff. People were able to decide how they were supported and care staff did this by ensuring people’s independence, privacy and dignity was respected at all times. People’s support needs were assessed but the care plan did not always reflect the up to date support people received. Where people had diverse support needs, the provider did not ensure this was captured appropriately so their support was person centred.

Whilst most people knew how to complain where needed, the provider did not ensure people were all given a copy of the complaints process.

People’s views were gathered by way of a provider questionnaire; however care staff were still unable since the last inspection to share their views. The registered manager and provider completed spot checks but these were not effective in identifying areas for improvement or concern. People did not always know who the registered manager was.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an announced comprehensive inspection of this service on 12 and 15 August 2016. A breach of legal requirements were found. These related to there not being sufficient care staff to support people at the times required. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. 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.

The provider had taken the appropriate action to ensure there were enough staff to support people. We found that they had also made improvements to how staff were recruited to improve the levels of staff retained.

The provider had improved the systems they had to ensure care staff were being deployed appropriately. However we found that further improvements were still needed to ensure people received the support they needed at the times requested on a consistent basis.

Monarch Care Services UK Ltd is registered to provide personal care services to older adults in their own homes. On the day of the inspection, 62 people were receiving support. There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act (2008) and associated Regulations about how the service is run.

The registered manager was supported by a new operations director and they were committed to developing the service and making improvements.

There was not always sufficient care staff available to support people in a timely manner in line with their expectations. People did not always feel safe within the service due to not receiving the support in the way that they wanted. People received their medicines as it was prescribed.

We found that care staff received the appropriate training to know how people should be kept safe. There was not always sufficient staff to support people. Care staff received training to ensure they had the skills and knowledge to support people, but they did not always feel consistently supported. The provider ensured the requirements of the mental capacity act were being adhered to and people’s consent was sought and their human rights protected.

While people told us that care staff were kind and caring, they did not always feel they were supported how they wanted. People’s support needs were assessed and a support plan was in place to identify how they would be supported. However reviews were not consistently taking place so where people’s support needs had changed these could be noted and actioned appropriately. People’s dignity, privacy and independence was respected.

People did not consistently feel able to share any concerns. The provider had a complaints process in place but they did not take sufficient steps to ensure complaints were logged and managed appropriately.

People were not all consistently able to share their views by way of completing a questionnaire. The outcomes and actions for improvement from the process was not being made available to people.

We found that a system was in place to ensure the appropriate checks and audits could be carried out on the service quality by the registered manager and provider. However these system were not effective in identifying concerns with the poor quality in areas of the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

You can see what action we told the provider to take at the back of the full version of this report.