Archived: St. Michael's Home Care Limited

St. Michael's Home Care Limited is a domiciliary care agency providing personal care to 46 older people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Since our last inspection, the provider had made improvements to their systems around the management of people’s medicines and the auditing of people’s care and medicines records.

The manager had a good understanding of their role and had put systems and processes in place to improve quality and safety. People told us the management staff were approachable and listened to their feedback.

There were systems in place to monitor the quality and safety of the care. The provider had used technology to enhance the safe delivery of care.

The provider did not complete the Provider Information Return in the timescale requested by The Care Quality Commission. As this requirement was not met, the rating for the key question well led is requires improvement.

People told us they were happy with their care and that recent changes had given them more consistency in care call times and staffing. People’s care was in line with their preferences and needs.

Staff received appropriate training, induction and ongoing support in their role. They had a good understanding of people’s needs and treated them with respect.

There were systems in place to protect people from the risks of suffering abuse or harm. The provider’s assessment processes identified key risks to people and staff and measures to reduce the risk of harm.

There were appropriate systems in place to gain people’s consent to care.

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 and update

The last rating for this service was requires improvement (published 15 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when they would improve.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Michael’s Home Care is a domiciliary care service that was providing personal and nursing care to 110 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People did not always receive a safe service. The provider’s systems to manage medicines safely and protect people from risks were not always effective as medicine’s administration records were not completed correctly.

Management processes were in place to monitor and improve the quality of the service. However, these were not always effective, as they had failed to address shortfalls in the service.

Staff had respectful caring, relationships with people they supported. They respected people’s dignity and privacy, and promoted their independence.

People received care and support which met their needs and preferences. The provider upheld people’s human rights.

Rating at last inspection:

The rating for the service was Requires Improvement. This was the second consecutive Requires Improvement rating.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the provider’s systems to monitor and improve quality and safety in the service. However, there was insufficient evidence to show these improvements had been effective to address the shortfalls in the service.

Enforcement:

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

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per 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 CQC website at www.cqc.org.uk

This was the first inspection completed for the service. First registered in April 2015, the agency moved location in June 2016.This is the first inspection at the new location.

The service had appointed a new manager in July 2017, who registered in December 2017. 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.

We found that the service was not always safe. The service used some agency staff to assist with delivery of care. People told us that their care and support was not always consistent because they did not have the same carers, or carers that knew them.

Robust recruitment processes were employed by the provision that ensured staff who worked with people were safe to work with vulnerable people. Thorough checks on character including references, disclosure and barring checks were completed prior to staff commencing employment. Staff underwent a comprehensive induction that included completion of mandatory training and shadow shifts prior to being signed off as competent to work independently.

Staff understood how to safeguard people from potential abuse. They reported no hesitation in whistleblowing if the need arose. A large poster was visible in the office that covered the safeguarding protocol, reinforcing the need to report concerns.

Risks to people were recorded and where needed advice on how to manage concerns were provided. We saw that medicines were safely managed, with evidence of when staff had assisted people with medicines.

The staff were reportedly polite, considerate and caring. People and families reported how they maintained people’s dignity when assisting with personal care, speaking to them calmly and advising them what they were going to do next. This meant that people felt involved in their care.

Care plans and reviews were generally completed with people or their families. These were personalised and detailed how people wanted to be supported, although significant time lapses between initial assessments and care plans being written were noted. The service encouraged working in partnership with other agencies to ensure responsive care was delivered.

We found that the service did not always effectively deliver training to assist staff in supporting people. On one occasion it was found that staff had not received specialist training nevertheless continued to deliver support. This put the person at potential risk.

Audits were completed by senior care staff. These did not always illustrate the issues that were prevalent specifically with the time care plans were taking to write. The registered manager was not involved in the audits or action plans when generated. The registered manager was a part of the weekly meeting that were arranged to discuss the audits outcome measures. We found that these were not always comprehensive therefore the registered manager did not have a full understanding of the issues.

Staff reported the service as open and transparent. Staff reported feeling confident that they could visit the office and raise any issues as and when these arose. Similarly, people were confident to raise concerns. The service had a good complaints procedure. We saw evidence of these being appropriately investigated and recorded. People generally provided positive feedback, however felt that the management did not have a thorough overview of the service, as they felt that quality had slipped recently.