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Proactive Medicare Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 16 November 2018

Proactive Medicare provides personal care to people living in their own houses and flats and specialist housing. This service is a domiciliary care agency and primarily provides a service to older people. The domiciliary care agency office is near to all major bus and train routes.

The inspection was carried out between the 18 September 2018 and 24 September 2018. At the time of the inspection, there were 14 people using the service.

At our last inspection in April 2017 we rated the service as ‘Requires Improvement.’ Breaches of the legal requirements were found in relation to Regulations 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). At this inspection, we found not all improvements had been made and the overall rating of the service remained ‘Requires Improvement’. This is the second time the service has been rated as ‘Requires Improvement’.

The service had a registered manager in post and they were formally registered with us in August 2018. 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.

Our key findings across all the areas we inspected were as follows:

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. The current arrangements had not identified the issues we found during our inspection. Had these arrangements been more effective, it is envisaged that the shortfalls identified would have been addressed sooner. The incidence of ‘missed’ and ‘late’ calls at the service were not being monitored. Audits relating to medicines were not effective as they had not picked up where there were gaps or anomalies. Neither were these analysed month on month, together with people’s support plans to ensure consistency and to monitor trends for future learning.

Improvements were required to the registered provider’s recruitment practices to ensure these were robust and safe. This remained outstanding from our previous inspection to the service in April 2017. Medication practices and procedures required strengthening to ensure these were in line with good practice procedures and guidance. Not all people had received their prescribed medication because of the morning and lunchtime call times were too close together. Where concerns had been raised and the registered manager notified relating to staff’s poor practice, this had not been considered or raised as a safeguarding concern with the Local Authority or Care Quality Commission; and internal investigation arrangements were not as robust as they should be.

People told us they were safe and had no concerns about their safety and wellbeing. Risks to people were identified and managed to prevent people from receiving unsafe care and support. The domiciliary care service was appropriately staffed to meet the needs of people using the service. People were protected by the service’s arrangements for the prevention and control of infection.

Newly employed staff received an induction to carry out their roles and responsibilities effectively. Staff received mandatory training to meet people’s needs, though a review was required to determine the appropriateness of too many training courses completed in one day and the potential impact this may have on staff and people using the service. Suitable arrangements were in place for staff to receive supervision at regular intervals and staff confirmed they were supported by the registered manager. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported by staff as needed with meal preparation and the provision of drinks. People receive

Inspection areas

Safe

Requires improvement

Updated 16 November 2018

The service was not consistently safe.

Recruitment practices and procedures were not being operated effectively to ensure people were safe.

Arrangements in place did not always protect or safeguard people from abuse or harm.

Medication practices and procedures required improvement to ensure people received their prescribed medication as they should.

There were enough staff to support people safely.

Effective

Requires improvement

Updated 16 November 2018

The service was effective.

Staff received training relevant to their roles and responsibilities, although consideration should be given to review the number of training courses studied on one day.

Newly appointed staff had received an induction and appropriate arrangements were in place for staff to receive regular supervision and an annual appraisal.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and put this into practice.

Staff protected people from the risk of poor nutrition and dehydration. People had their health needs met and were referred to other healthcare professionals when needed.

Caring

Good

Updated 16 November 2018

The service was caring.

People were supported by kind and caring staff who knew them well.

People’s independence was encouraged and their rights to privacy and dignity upheld.

People were encouraged to express their views and to make choices.

Responsive

Good

Updated 16 November 2018

The service was responsive.

Although improvements were required, people’s needs were assessed prior to the commencement of the service being agreed. Support plans were in place detailing their care and support needs.

Support was flexible and staff responded to individual needs. People were supported to receive appropriate end of life care.

There was a complaints policy and process in place and these were managed well.

Well-led

Requires improvement

Updated 16 November 2018

The service was not consistently well-led.

Although quality assurance arrangements were in place, required improvements had not been made or sustained to demonstrate the service was always being run in the best interests of people using the service.