Meadow Home Care Services Ltd

Meadow Home Care Services Limited is a domiciliary care agency registered to provide personal care to people living in their own home. The service provides support to people under and over 65 years of age and those living with a physical disability. At the time of our inspection there were 87 people using the service.

People’s experience of using this service and what we found

The provider had not ensured all records such as risk assessments were up to date and contained enough detail to reflect the level of support people required. The service had an established staff team who knew people well so this mitigated the risk however new staff joining the service would not have the information they needed to provide care.

The provider had failed to follow the lone worker policy and ensure staff working alone in the community had a risk assessment in place which would support them to know what to do in an emergency or if they felt unsafe.

The provider completed audits but follow up actions from these did not always take place and when they did, they were not recorded in detail. The use of paper records meant audits of medicines were not completed in ‘real time’ so it was difficult for managers to know when medicines had been refused or missed so appropriate action could be taken.

The provider had not followed the processes required when investigating staff disciplinary matters. This had led to safeguarding concerns not being reported to the appropriate authorities. The policy was unclear and did not support managers to fulfil their role in this area of their work.

Staff wore personal protective equipment during visits and people and their relatives said there had been no concerns with this.

Staff were experienced and had recently renewed all mandatory training. They found managers to be supportive and enjoyed working for Meadow Home Care. Managers and staff worked closely with other professionals to ensure care was appropriate and delivered in a timely way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 21 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about recording of information. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. 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 and the actions the provider has already taken to mitigate the risks identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow Home Care Services 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 monitor the service and will take further action if needed.

We have identified breaches in relation to recording of information to keep people and staff safe and staff disciplinary policy and procedures 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last comprehensive inspection in April 2017, we found improvement was required in the key areas of responsive and well led and we rated the service as Requires Improvement. At this inspection we found improvements had been made and the service is now rated as Good.

In May 2017 commissioners stopped referring people funded by the local authority to the service. This was due to concerns about the quality of care identified during a monitoring visit. The provider made the required improvements to the service and in August 2017 the local authority recommenced referrals.

Since our last inspection we have reviewed and refined our assessment framework, which was published in October 2017. For this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The office visit took place on 27 February 2018 and was announced. We told the provider we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager in post at the time of 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.

At our last inspection in April 2017 the provider had revised the management structure to include the role of senior care worker. Senior care staff had specific responsibility for reviewing people’s care service and their role had been developed to include observations of care staff while working in people’s homes. All the managers and the senior member of staff we spoke with were positive about the impact this had on the service. They said it had reduced the number of minor concerns they received as they were able to identify and resolve issues as they arose.

People who used the service felt safe and procedures were in place to keep people safe and manage identified risks to peoples care. Staff completed training in safeguarding adults and understood their responsibilities to protect people from abuse and harm. The provider conducted pre-employment checks prior to staff starting work, to ensure they were suitable to support people who used the service.

People who required support to take medicines received these from staff that had been trained to administer them safely. Staff used protective clothing, such as disposable gloves and aprons when providing personal care, to reduce the risk of infection being passed from one person to another.

People had an assessment completed at the start of their service to make sure staff could meet their care and support needs. There were enough trained staff to allocate all the visits people required and to meet people's needs safely. When needed, arrangements were in place to support people to have enough to eat and drink and remain in good health.

People's right to make their own decisions about their care were supported by managers and staff who understood the principles of the Mental Capacity Act. Staff respected decisions people made about their care and gained permission before they assisted people with care or support.

At the last inspection some people had experienced inconsistency in the time of their calls and with the care staff that visited them. At this inspection we found this had improved, people told us their calls were made by care staff they knew and who arrived around the time expected.

People told us staff were kind and treated them with respect. Staff we spoke with knew the people they visited well, and spoke about people in a caring and considerate manner.

People said staff stayed long enough to provide the care agreed in their care plan and did not rush them. Care plans were personalised and provided information for staff about people’s care needs and the details of what they needed to do on each call. The managers and office staff were in regular contact with people, or their relatives, to check the care provided was what people needed and expected. At the last inspection we found people’s care plans had not always been reviewed and updated when their needs had changed. We found this had improved and people’s care needs were regularly reviewed and plans updated when needed.

People knew how to complain, and information about making a complaint was available for people. People knew who the managers were and felt they listened to them and dealt with any concerns they had.

Staff felt supported to do their work effectively and said the managers were approachable and available. There was an ‘out of hours’ on call system which ensured support and advice was always available for staff. Staff had regular supervision and observations of their practice to make sure they carried out their role safely. The management team and office staff, worked well together and were clear about their roles and responsibilities.

The provider’s quality monitoring system included asking people for their views about the quality of the service. This was through telephone conversations, visits to people to review their care and satisfaction questionnaires. The management team checked people received the care they needed by observing staff during visits to people and through feedback from people and staff.

There was a programme of other checks and audits which the provider used to monitor the service.

Following our last comprehensive inspection of the service in January 2016 we rated the service ‘Requires Improvement’. This was because the provider was not meeting the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the legal requirements for good governance of the service, and improvement was required for the service to be consistently effective and well led. During our comprehensive inspection in March 2017 we found improvements had been made, but continued improvements were required to ensure the service was consistently responsive to people’s needs and was effectively managed.

We visited the office of Meadow Home Care Services on 2 March 2017. We told the provider before the visit we were coming so they could arrange for staff to be available to talk with us about the service. The visit was supported by the office manager.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager in post at the time of 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 and associated Regulations about how the service is run.

People told us they felt safe using the service and staff understood how to protect people from abuse and keep people safe. There were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough staff to deliver the care and support people required. Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. Not all training had been updated in line with the provider’s time scales, however people told us staff had the right skills to provide the care and support they required.

The managers and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions people made about their care and gained people’s consent before they provided personal care.

People had different experiences with the times staff arrived to provide their care. Some people said staff arrived around the time expected; others had experienced late or missed calls. Some people told us the service they received at weekends was not as consistent or reliable as the service they received during the week.

Most people told us staff stayed long enough to provide the care they required and people said they received care from staff they knew. Staff we spoke with visited the same people regularly and knew how people liked their care delivered. Care plans provided guidance for staff about people’s care needs and instructions of what they needed to do on each call.

People told us staff were kind, respected their privacy, and promoted their independence. Staff felt supported by the management team and there was an ‘out of hours’ on call system, which ensured management support and advice was always available for staff.

People knew how to complain if they needed to. People who had raised concerns or issues with the managers said these had been resolved to their satisfaction. Recording of complaints required improvement to ensure all complaints were recorded and investigated in line with the provider’s complaints procedure.

Quality assurance systems to assess and monitor the quality of the service had been improved since the last inspection. These included; an increase in the management team by recruiting senior care workers, implementing observations of staff in people’s homes, and more structure for management procedures. People received visits to review their care and were sent an annual questionnaire to find out their experience of the service.

There was a programme of other checks and audits which the provider used to monitor and improve the service. We found these had not always been implemented consistently, and improvement was required in how some late and missed calls were monitored.