Archived: Midlands Home Care Limited

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.

Midlands Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to adults of all ages and children between the ages of 13 and 18 years. It can also care for people who need assistance due to living with dementia, mental health needs, a learning disability and/or physical adaptive needs. At the time of our inspection the service was providing care for 75 people most of whom were older people. The service’s administrative office was in Nottingham and the service delivered care calls to people living in the city of Nottingham and surrounding villages.

The service was run by a company who was the registered provider. The chief executive of the company was also the nominated individual. This is a legal role that means the chief executive was responsible for assuring us that the service was well run. There was also 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. In this report when we speak both about the company (as represented by the nominated individual) and the registered manager we refer to them as being, ‘the registered persons’.

We carried out an announced comprehensive inspection on 10 and 11 August 2017. This was the first inspection we had completed since the service was registered with us on 24 July 2017. At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

One of these breaches was because the registered persons had not reliably ensured that sufficient care staff were deployed in the right way to ensure that care calls were carried out as planned. In particular, some care calls had not started at the right time and others had not lasted long enough. This had resulted in some people not always promptly being given all of the assistance they needed to receive in order to be safe and comfortable at home. Another breach was due to the registered persons not making suitable provision to ensure that care was always provided in a lawful way. This is a necessary safeguard when people are considered to be at risk due to not having the mental capacity to make decisions about the care they receive. The third breach was because the registered persons had not told us about some of the significant events that had happened in the service. This oversight had reduced our ability to quickly make sure that people were kept safe.

After the inspection the registered persons wrote to us to say what actions they intended to take to rectify the breaches we had identified. They said that all of the necessary improvements would be completed by 31 December 2017.

At the present inspection we found that sufficient progress had still not been made to meet the breach of the regulations relating to staffing. This was because suitable arrangements had not been made to deploy staff to reliably ensure that care calls were completed in the right way. This shortfall had resulted in a number of care calls not being completed at the right time and/or not lasting for the correct amount of time. This had resulted in the people concerned not promptly receiving important parts of the care they needed.

We also found that the registered persons had continued to not always tell us about significant events that had occurred in the service. However, the third breach had been resolved. This was because suitable arrangements had been made to protect people’s legal rights by obtaining consent to care and treatment in line with legislation and guidance.

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At the present inspection, we also identified three additional breaches of the regulations. One of these related to the registered persons’ failure to consistently deliver safe care and treatment. Another breach involved shortfalls in the arrangements that had been made to safeguard people who used the service from the risk of abuse and improper treatment. The third breach was because the registered persons had failed to ensure that the service had all of the systems and processes it needed to learn, innovate and ensure its sustainability. In particular, there were oversights in the systems used to assess, monitor and improve the quality and safety of the service. This included not having suitable arrangements to enable people and their relatives to be consulted about making improvements in the service.

Full information about CQC’s regulatory response to the breaches of regulations described above will be added to our report after any representations and appeals have been concluded.

As a result of these breaches of regulations the overall rating for this service is ‘Inadequate’ and the service is therefore in, ‘special measures’. Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the registered persons’ registration of the service, will inspect again within six months. The expectation is that registered persons found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. When necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of ‘Inadequate’ for any key question or overall, we will take action to prevent the registered persons from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Our other findings at the present inspection were as follows. Background checks had been completed before new care staff had been appointed. Care staff had not always been fully supported to deliver care in line with current best practice guidance. However, people were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. Also, people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. In addition people had been supported to maintain their accommodation so that it met their needs and wishes.

Suitable arrangements had not been made to support care staff to consistently deliver the caring and respectful service they wanted to provide. However, there were arrangements to give people extra support if this was needed for them to be actively involved in making decisions about the care they received. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

People had not been fully supported to receive personalised care and information was not always presented to them in an accessible manner. Some people were not confident that their complaints and concerns had been managed in the right way so that lessons could be learned to improve the quality of care. However, the registered persons recognised the importance of promoting equality and diversity. This included but was not limited to supporting people who were gay, lesbian, bisexual and transgender. Furthermore, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager. However, most of the care staff with whom we spoke said that the service did not have a positive culture that fully supported them to focus upon achieving good outcomes for people. Care staff had not been fully supported to understand their responsibilities to develop good team work and to speak out if they had any concerns. However, the registered persons had taken a number of steps that were intended to enable the service to work in partnership with other agencies to develop the provision of joined-up care.

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 did not always receive their agreed levels of support, and did not always know who would be visiting them. Risks to people were not consistently managed, and improvements were needed to ensure that people received their medicines as prescribed.

Staff gained people’s consent before supporting them. However, when people were not able to make decisions about their care, the provider had not assessed their capacity. They were also not able to show how decisions made on their behalf were in their best interests. People were supported to have their meals when needed, but some people did not have easy access to drinks.

The registered manager understood their responsibilities, but had not notified us of incident they should have done. The audits that were completed were not used to identify issues and were not effective at driving improvements. People’s care records were not always kept up to date.

Staff were recruited safely and they received an induction and further training to develop their skills. Staff knew how to recognise and report potential abuse.

People were supported in a kind and caring manner, and they had developed positive relationships with the staff that visited them. People were involved in making decisions about their day-to-day care, and staff promoted their independence. People’s privacy was respected and their dignity promoted. They were supported to access health care services.

People and their relatives were involved with the assessment, planning and review of their care. The provider sought feedback from people to understand their experiences. People knew how to raise issues and make a complaint. These were responded to in line with the policy in place.

Staff felt supported and people knew who managed the service.

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