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We are carrying out a review of quality at MiHomecare - Finchley. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 25 June 2018

During a routine inspection

This inspection took place on 25, 26 and 27 June 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service. It provides personal care to people living in their own houses and flats. It provides a service primarily to older adults and people with physical disabilities.

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

Inspection carried out on 4 May 2017

During a routine inspection

The inspection took place on 4 and 11 May 2017. This was an announced inspection. We gave the provider 48 hours’ notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet us. This service was last inspected in October 2016 where the overall rating was ‘Requires Improvement’ with ‘Inadequate’ in one key question. We found a number of breaches of regulations in relation to need for consent, safe care and treatment, receiving and acting on complaints, fit and proper persons employed, lack of staff supervision and good governance. Following concerns raised at the last inspection, the provider agreed to have some conditions placed on their registration. The provider sent us an action plan stating what improvements they were going to make.

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 201

Inspection carried out on 12th May 2015

During a routine inspection

This inspection took place on the 12 May and was announced. At our last inspection in December 2013 the service was meeting the regulations inspected.

MiHomecare-Finchley provides personal care services to people in their own homes and MiHomecareLimited has 40 domiciliary care services across the country. At the time of our inspection approximately 240 people were receiving a personal care service.

The service had a registered manager who had been in post since July 2014. 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.

People’s needs were assessed and care plans were developed to identify what care and support people required. People said they were involved in their care planning and were happy to express their views or raise concerns. When people’s needs changed, this was quickly identified and prompt, appropriate action was taken to ensure people’s well-being was protected. People using the service told us they had a copy of their care plan in their home.

People using the service told us they felt safe. Staff understood how to recognise the signs and symptoms of potential abuse and told us they would report any concerns they may have to their manager.

The registered manager told us that assessments were undertaken to assess any risks to the people using the service and the staff supporting them. This included environmental risks and any risks due to people’s health and support needs. The risk assessments we viewed included information about action to be taken to minimise these risks.

People said they found the staff polite and respectful. Staff were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care, asking people how they would like things done and making enquiries as to their well-being to ensure people were comfortable.

We saw that regular visits and phone calls had been made by the office staff to people using the service and/or their relatives in order to obtain feedback about the staff and the care provided.

People were supported to eat and drink. Staff supported people to take their medicines when required and attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs

Inspection carried out on 19 December 2013

During an inspection to make sure that the improvements required had been made

We did not speak with people who used the service during this visit, as we were checking that actions required from our previous inspections on 1 August 2013 and 20 September 2013 had been completed.

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.

Inspection carried out on 20 September 2013

During an inspection to make sure that the improvements required had been made

We carried out this unannounced inspection to check if the provider had complied with a warning notice from a previous inspection of the service carried out on 1 August 2013.

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.

Inspection carried out on 1 August 2013

During an inspection in response to concerns

We have sent out 60 surveys to people using the service, 17 surveys were returned. Out of the surveys returned the majority of people told us that care workers treat them with respect and they were not discriminated against.

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.

Inspection carried out on 14 January 2013

During a routine inspection

We spoke with six people who use the service and two relatives by phone. They informed us that people had been treated with respect and dignity. Their views can be summarised by the following comment ”I am happy with my carers. They are respectful and do what is agreed.”

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.

Inspection carried out on 5 January 2012

During a routine inspection

People who use the service and their relatives were satisfied with the services provided. They informed us that staff had treated them with respect and dignity.

People who use the service indicated that their carers carried out their duties well and they were on the whole satisfied with the care provided.

The registered manager and her staff were knowledgeable regarding the need to ensure that people who use the service were protected from abuse. There was evidence that safeguarding concerns had been fully responded to appropriate action taken to safeguard people who use the service.

People who use the service indicated that staff were professional and able to meet their needs. The staff records we examined indicated that the required recruitment checks had been carried out.

Quality monitoring checks had been done and people who use the service told us that spot checks had been carried out. The views of people who use the service had been taken into account in the planning of services.