MiHomecare - Finchley

Not everyone using MiHomecare – Finchley receives regulated activity; 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 the inspection MiHomecare - Finchley provided domiciliary care and support for 456 people in their own home. Following the inspection, the deputy manager informed us that 381 people received a regulated activity.

At our last inspection on 4 and 11 May 2017 the service was rated ‘Requires Improvement’. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 which related to the safe management of medicines and providing sufficient information on people’s personal risks to ensure that staff were able to minimise the risk and Regulation 17 which related to monitoring and auditing people’s medicines and daily care records. At this inspection we found that the provider had addressed these breaches.

We also made a recommendation around capturing and documenting information on the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) in relation to people using the service. At this inspection we found that the service had addressed this and MCA/DoLS was well documented and managed.

The service is now rated ‘Good’.

There was a manager in post. However, at the time of the inspection the manager was on planned leave. The manager was in the process of applying to CQC to become the registered manager and was registered on 17 July 2018. The inspection was supported by the deputy manager. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider.

People and relatives were positive and felt that they were safe with the staff that visited to provide care.

People had person centred risk assessments based on their individual needs. Risk assessments were detailed and provided staff with guidance on how to minimise known risks.

Staff had received training in safeguarding and understood how to recognise and report any concerns. The company had a dedicated whistleblowing phone number for staff, relatives and people. Staff understood how to whistleblow if they had any concerns.

Medicines were safely managed. Staff had received training in medicines and were competency assessed each year. Medicines auditing was effective and had improved since the last inspection.

Staff were recruited safely. The service completed necessary checks to ensure that staff were safe to work with vulnerable adults.

Staff were aware of infection control and how to keep people safe from the spread of infection. The service provided gloves and aprons for staff when delivering personal care.

People received continuity of care and often had the same care staff visiting them. People and relatives told us that staff were on-time and stayed the correct amount of time.

Accidents and incidents were well managed and any actions or learning documented.

Staff received an induction when starting work. Part of the induction included shadowing more experienced staff. However, whilst staff told us they did shadow during their induction this was not well documented.

Staff received regular supervision, appraisal and training to support them in their role.

People were supported to express their views and were actively involved in making decisions about their care. Where appropriate, relatives had been involved in planning people’s care.

People were supported with their nutrition and hydration where this was an identified need. People were positive about the support they received with meals.

Staff were aware of how to report concerns if they noticed a change in people’s health or well-being. People were referred to healthcare professionals where appropriate.

There was a complaints process in place and people and their relatives knew how to make a complaint. Complaints were investigated and followed up.

People and relatives told us that they felt that staff were kind, caring and treated people with compassion and empathy. Staff understood the importance of communication and building rapport with people and their relatives.

People were encouraged to be as independent as possible.

Staff knew people well and people told us that they were treated with dignity and respect.

People and where appropriate, their relatives were involved in planning their care. This was well-documented in people’s care plans.

Care plans were detailed and provided enough information for staff to support people. Care plans were regularly reviewed and updated immediately if changes occurred.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. Surveys were completed with people who used the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

During this inspection we found the provider had not made adequate improvements in relation to safe care and treatment and good governance. At the time of our inspection MiHomecare – Finchley was providing care to 435 people in their own homes in the London boroughs of Barnet and Camden. MiHomecare – Finchley is a domiciliary care service run by MiHomecare Limited. They support people with dementia, mental health needs, a physical disability, learning disability or autistic spectrum disorder, sensory impairment and older people in their own homes.

The service had a registered manager. 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 provider had made improvements in their auditing systems and processes since they were last inspected. However these had not been sufficient to identify errors, inconsistencies and gaps in daily care records, MCA, medicines administration records (MAR) and risk assessments. Care plans were detailed, person-centred and regularly reviewed and audited. We found that risk assessments had improved and were detailed and individualised. However, the provider did not always include sufficient information on the management of the risks to people with ongoing health conditions. There had been improvements in medicines assessments and information in medication profiles. However we found inconsistencies in the list of medicines recorded on MAR compared to medication profiles. We found there were improvements in the punctuality of care visits and a decline in missed visits. The service met infection control requirements. The service had clear and accurate complaints records and was responding to complainants in a timely manner.

People using the service and their relatives told us they felt safe with staff. People were happy with the support they received around medicines management, and told us their health and care needs were met.

The service followed appropriate safeguarding procedures and the registered manager maintained accurate records of safeguarding concerns. New staff were appropriately checked before allowed to visit people.

Staff received regular training and found it useful. Staff told us they were supported well and received regular supervision. They demonstrated a good understanding of people’s needs, abilities and likes and dislikes. Staff were able to explain their responsibility in spotting and reporting abuse.

People and their relatives told us staff were caring, helpful and friendly. The service maintained staff allocation systems to ensure continuity of care. People confirmed they usually received the same staff which they found helpful.

The service implemented good procedures around Mental Capacity Act 2005 but there were inconsistencies in care files.

The provider worked well with the local authority care quality team to improve the quality of the service.

We found the provider was not meeting all legal requirements and there were two breaches of the Health and Social Care Regulations 2014 in relation to safe care and treatment, and record-keeping and systems and processes to improve the quality of the service.

We have made a recommendation that the service seeks advice and guidance regarding appropriately capturing and recording information on MCA and DoLS, based on current practice.

MiHomecare – Finchley is a domiciliary care service run by MiHomecare Limited. The service was providing personal care to over 400 people at the time of the inspection. They support people with dementia, mental health needs, a physical disability, learning disability or autistic spectrum disorder, sensory impairment and older people in their own homes.

The service had a registered manager which 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.

Most people using the service and their relatives told us they found staff caring and friendly. They usually received the same staff which they found helpful. Commissioners and the local authority integrated care quality team provided good feedback about the service and its impact on people’s quality of life. However, some people and their relatives told us they were not happy with staff’s punctuality. Staff were not always attending care visits on time and staff working in pairs did not arrive at the same time raising concerns regarding safe care delivery. People did not always receive medicines on time and there were several gaps in the care delivery and medicines administration records (MAR). The service did not fully implement required infection control practices.

Staff were well-trained and able to demonstrate their understanding of the needs and preferences of the people they cared for by giving examples of how they supported people. Staff told us they were supported well. However, records of staff supervision showed not all staff were receiving regular supervision.

Care plans recorded people’s individual needs, likes and dislikes. However, they did not give personalised guidance on how staff were to meet people’s needs and preferences and some sections were not fully completed. Risk assessments were detailed but did not always give sufficient information on the safe management of identified risks.

Most people were happy with the support they received around nutrition and hydration needs.

The service followed appropriate safeguarding procedures and staff demonstrated a good understanding of protecting people against abuse and their role in promptly reporting poor care and abuse.

Appropriate recruitment checks of new staff took place before they worked with people. However, some staff’s criminal record checks were not up-to-date which did not ensure people’s safety.

The service implemented good procedures around Mental Capacity Act 2005 but practice indicated staff did not sufficiently understand the principles to uphold the practice.

The service lacked robust systems and processes to consistently assess, monitor and improve the quality and safety of service provided. Monitoring checks did not effectively pick up on inconsistencies and gaps in the records, practices and care delivery.

The service had a robust complaints procedure but did not always follow it and did not make the complaints processes sufficiently accessible at all stages.

We found that the provider was not meeting legal requirements and there were overall six breaches of the Regulations 2014 in relation to need for consent, safe care and treatment, staff supervision, acting on complaints, safe recruitment practices, record-keeping and systems and processes to improve the quality of the services.

As a result of our findings the provider has agreed to have conditions added to their registration requiring them to carry out specific audits of the service and report back to us actions they are taking to address issues identified. We will use this to check that the required improvements are being made.

During our inspections on 1 August 2013 and 20 September 2013, we found that the provider did not have proper steps in place to protect people who used the service against the risk of receiving care or treatment that was inappropriate or unsafe, by means of the delivery of care in such a way as to meet people's needs and ensured the welfare and safety of people.

Our inspection on 1 August 2013 found that the provider did not make suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse by means of responding appropriately to any allegations of abuse. We also found that the provider did not take appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced care workers employed. We found that there were no suitable arrangements in place, which ensured that care workers received appropriate supervisions and appraisals. We found that the provider did not have effective systems in place to regularly assess and monitor the quality of service provided. We found that complaints were not fully investigated and as far as reasonable practicable, resolved to the satisfaction of the people who used the service or their significant others.

During our inspection on 19 December 2013 we saw that the provider had updated care plans and risk assessments for people who used the service. Systems had been put in place which ensured that missed and late calls were kept to a minimum. Outstanding safeguarding alerts were investigated and resolved in line with the Pan London Multi Agency Safeguarding Procedure 2010. Efforts had been made to recruit additional care co-ordinators and care workers and the system of providing supervision to care workers had been reviewed and regular supervisions were now provided to care workers and office staff. Any outstanding complaints were investigated and complainants were contacted with the outcome of these investigations.

We spoke with the interim manager, three care co-ordinators, viewed records and attended a meeting with the London Borough of Barnet on the 19 September 2013.

We did this to make a judgement as to whether the provider was meeting Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 (Outcome 4 - Care and welfare of people who use the services).

From the interviews with staff and documented evidence, we found that the provider had made substantial improvements and the number of missed and late calls have reduced, however there was still a moderate risk to people using the service and a further compliance action was issued.

Care plans were reviewed and peoples needs were assessed. However, agreed care plans were not followed and the time care workers arrived and spent with clients was erratic. On some occasions care workers were over one hour late and stayed on occasions over 30 minutes less time than agreed in the care plan. This presented a considerable risk to people using the service and resulted that some of the people were not safe at all times.

On a number occasions the provider did not respond appropriately to concerns raised by people using the service or their relatives, which meant that people were not always safe.

There were not always sufficient staff available to care for the number of people under contract to receive care or support, which led to missed or late visits.

Care workers and office staff did not feel supported by senior management, which left them to resolve difficult and complex situations without senior input or advice.

The provider whilst having a quality assurance system in place did not act on concerns raised, which put people using the service under unnecessary risk.

Complaints were not always resolved putting people at risk of poor care.

We are taking action to ensure the provider becomes compliant with the regulations.

Care staff we spoke with were aware of the importance of treating people with respect and dignity. They were able to give us examples of how they maintained the privacy of people while providing care for them. The care provided had been assessed and care plans were signed by people or their representatives. Risk assessments were in place. People said they had been consulted regarding the care provided and their choices had been responded to. Most people who use the service indicated that care staff were reliable and competent.

There were arrangements for staff support. However some staff informed us that their workload had increased significantly and there were times when they felt stressed and under pressure. The manager informed us that additional staff had been recruited to provide support.

Arrangements for quality assurance were in place. Monitoring visits to people and spot checks on staff had been carried out by the agency. There was also documented evidence and confirmation from people that reviews of the care had been carried out.