Background to this inspection
Updated
29 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to explore concerns received about the quality and safety of the service, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.
Prior to our inspection we reviewed information we held about the service. This included information received from local health and social care organisations and statutory notifications. A notification is information about important events that the provider is required to send us by law, such as, allegations of abuse and serious injuries. We also contacted commissioners of the service and asked them for their views. We used this information to help us to plan the inspection.
We did not request a Provider Information Return prior to this inspection. This is information we require providers to send us at least once annually to give some key information about the service, what they do well and improvements they plan to make. However, we gave the provider the opportunity to share this information during the inspection.
This comprehensive inspection took place on 8, 9 and 11 May 2018 and was unannounced. The inspection was prompted due to information of concern we received in relation to safeguarding, risk management, staff recruitment and the quality of care.
The inspection was undertaken by two inspectors, a specialist advisor 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. The office inspection took place on 8, 9 and 11 May 2018. On 9 May 2018 the Expert by Experience carried out telephone interviews to gain people’s views in relation to the quality of the service and an inspector made calls to staff employed by the provider.
During our inspection we spoke with seven people who used the service and six people’s relatives on the telephone. We spoke with nine members of care staff on the telephone and the director who was also the nominated individual. The nominated individual is a person who is nominated by the provider to represent the organisation.
To help us assess how people's care needs were being met we reviewed all, or part of, 12 people's care plans and other information, for example their risk assessments. We also looked at the medicines records of four people, ten staff recruitment files, training records and a range of records relating to the running of the service.
Updated
29 June 2018
We carried out an unannounced inspection of Midlands Home Care limited on 8, 9 and 11 May 2018. The service was a domiciliary care agency. It provided personal care to people living in their own homes. Not everyone using Midlands Home Care Limited received a 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. At the time of the inspection, Midlands Home Care Limited supported 61 people with their personal care.
This was the second time the service has been rated as inadequate. Midlands Home Care Limited was also rated as inadequate at our last inspection which was in January 2018. During the course of this inspection, the provider made a decision to close the service. Consequently, we cancelled the registration of the provider, which means the service is no longer registered to provide any regulated activities.
There was a registered manager in post at the time of our inspection visit; however, they were not present during our inspection. 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.
During this inspection we found the service was not safe and people were placed at risk of serious harm. People were not protected from risks associated with their care and support. Risks such as falls, pressure ulcers and moving and handling had not been adequately identified, assessed or planned for. This meant people were exposed to the risk of harm. Accidents and incidents were not investigated, consequently action was not taken to reduce the risk of reoccurrence. Medicines were not managed safely and people did not always receive their medicines as prescribed. Effective infection control and prevention measures were not in place, which exposed people to the risk of infection spreading.
People were not protected from abuse and improper treatment. There had been a failure to conduct thorough and robust investigations of allegations of abuse and people were not safeguarded from harm when allegations had been made against staff. Safe recruitment practices were not followed. Risks associated with previous criminal convictions had not been identified or assessed and pre-employment background checks were not completed for all staff. This meant people were supported by unsuitable staff. Staff were not deployed effectively which meant staff were frequently late for care calls. We were also notified of missed care calls. This had a negative impact upon people who relied upon care staff for support with their personal care.
Staff did not receive regular supervision or appropriate training to enable them to carry out their jobs safely and effectively. A suitably qualified person did not provide training and training was not of sufficient quality or quantity. People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible; the policies and systems in the service did not support this practice. There was a risk people may not receive the support they required with their health as care plans did not contain sufficient information for staff and referrals were not always made to specialist health professionals. Support provided was not in line with current legislation and best practice guidelines. Information was not shared when people moved between services. People were supported with their dietary needs, when required.
People and their relatives told us care staff were friendly and kind, but commented office based staff were not caring in their approach. People were not always introduced to new members of staff before they provided them with care and changes in the staff team had a negative impact upon people. Staff did not always have information about how people communicated. People told us care staff involved them in day to day decisions, but feedback was mixed about involvement in planning care and support. People were not provided with information if they needed the support of an independent advocate to help them express their views.
People were at risk of receiving inconsistent support that did not meet their needs. Care plans were not personalised and did not contain enough information to inform staff how to meet people's needs. Care plans were not always reviewed or kept up to date and some people did not have care plans. There was a risk people’s diverse needs may not be identified or accommodated. The provider did not have a robust process in place to investigate and respond to people’s concerns and complaints. Consequently, action was not taken to address people’s concerns. We were aware of a complaint regarding the quality and safety of care which had been upheld by the Local Government Ombudsman. The provider had not taken action on the recommendations made as a result of this.
The service was not well led. There were a lack of effective systems to monitor and improve the safety and quality of the service. Where there were systems in place these were not robust and did not ensure areas for improvement were addressed. Policies and procedures were not adequate and the provider did not comply with their own policies. People and staff were not involved in the running of the service. People’s feedback was not used to develop and improve the quality of the service. Sensitive personal information was not stored securely. The provider did not willingly share information in an open and honest way.