Majesty Healthcare Ltd

People’s experience of using this service: The registered manager displayed a commitment to providing high quality person-centred care. However, they had not implemented effective management systems to achieve this. People told us they liked the registered manager but they felt their service was not always as reliable as they would like.

Despite some improvements management systems were not yet fully established or working effectively. The registered manager could not demonstrate the service was being managed with sufficient skill to consistently safeguard people and promote their wellbeing.

Risks had been mitigated to some extent because the registered manager also provided care hours. However, arrangements regarding the sale and transfer of the ownership and management of the service (which happened during our inspection) were poorly managed. This left people without a care service at very little notice and placed people at potential risk of harm.

The new owner had informed CQC of their intention to be the nominated individual and registered manager. They had updated the organisation’s website but they were not displaying their CQC rating as legally required. They informed us they were not intending to provide a care service until they had recruited and trained staff appropriately.

We found breaches of the Care Quality Commission (Regulations) 2009 Regulation 18 (2)(g) and the Health the Social Care Act 2008 (Regulated Activities) 2014 (Regulation 20A). These related to a failure to keep CQC notified about significant events and to display their rating.

We are following this up with the new owner outside the inspection process.

Rating at last inspection: Requires improvement (report published August 2018). Following the last inspection, we asked the registered manager to complete an action plan to show what they would do and by when to improve to at least Good. At this inspection we found they had failed to demonstrate sufficient improvement in their systems. The service remains rated Requires Improvement for the third consecutive time.

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

Follow up: We will meet with the new owner following this report being published to understand their plans for the service and how they will make changes to ensure the service improves their rating to at least Good. We will continue to monitor intelligence we receive about the service until we return to visit in line with 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.

The service also operates as an employment business, which is subject to regulation under the Employment Agency Standards (EAS) Inspectorate. 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 this inspection the service was providing a personal care service to one person.

The inspection of Majesty Healthcare Limited took place between 30 November and 6 December 2017. This is the second time the service has been rated Requires Improvement

At the last inspection on 15 March 2017, the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 18, Staffing and Regulation 17, Good governance.

After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection, we found the provider was no longer in breach of the previously identified regulations and had started to make improvement to the service.

There was 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 registered manager was also the sole director of Majesty Healthcare Ltd, which is registered as the provider.

The registered manager had completed retrospective recruitment checks for staff and we saw improved record keeping and staff training had been completed. Further planned improvements included staff supervisions, appraisals and meetings.

Feedback from the person who received care was positive. They reported staff were experienced and knew how to meet their needs including their nutritional needs. The care we observed was kind, compassionate and dignified.

Care plans had been reviewed to ensure they were relevant and up to date with sufficient information to ensure the person’s needs were met. Reasonable actions were taken to minimise risks; these included measures to reduce identified risks and were documented in care plans.

The person was supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The person who used the service knew how to raise any concerns should they need to do so.

New policies and procedures had been purchased and staff were working their way through these. Their on-going impact on maintaining safety and quality needs to be monitored over time as the service grows.

Further information is in the detailed findings below.

Harrogate is registered to provide personal care and support to people living in their own homes in Harrogate town and the surrounding area. The service also operates as a business agency supplying care staff to registered care homes. This inspection focused on the regulated activity of personal care that is registered with the Care Quality Commission (CQC). At the time of this inspection the service was providing a personal care service to one person.

There was 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 registered manager was also the sole director of the registered provider, which is Majesty Healthcare Ltd.

Feedback from the person who received care was positive and the registered manager who provided the majority of their care was described as caring and knowledgeable with regard to their care needs and preferences.

Improvements were required to ensure that there was a clear audit trail regarding management processes. These processes were at an early stage of development and did not ensure that all reasonable actions were taken to minimise risks to people using the service. For example; staff recruitment, medicines management and staff support and development. Accurate staffing records were not maintained making it difficult to check whether criminal record checks and appropriate references were in place. This did not ensure people's safety.

Not all incidents had been reported to the CQC as the law requires. We have dealt with this issue outside the inspection process.

While care plans and risk assessments were in place these had not always been set up by the agency and arrangements were not in place to keep these under constant review and to ensure staff provided consistent, safe care.

There were few recorded governance systems in place, and we identified shortfalls in the service, which the registered manager had not recognised or addressed. We have made recommendations about medicines, and staff training and development, including the use of the Mental Capacity Act 2005.

While the size and activity of the service at this inspection was acknowledged it was a concern to find that so many systems and safety procedures were not in place and fit for purpose one year after registration.

We identified 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.