Managing Care Limited

Managing Care Limited is a domiciliary care service providing care and support to people in their own homes, the majority in Wandsworth, Tooting and Battersea. At the time of the inspection there were 35 people receiving personal care support. Not everyone who used the service received personal care. 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

At the last inspection, we found a number of areas that needed addressing. Risks to people were not being managed in a way that kept people safe. Staff supervision were not being done regularly. Some aspects of the quality assurance checks were not thorough enough and in other cases were not being done regularly. The provider had also failed to submit statutory notifications where required. We also made a recommendation about following up when complaints were made. At this inspection, we found improvements had been made in these areas.

People and their relatives were kept safe through appropriate risk management guidelines that were in place, this included the risk of infection and the safe management of medicines. People were supported by care workers who had been safely recruited. People said they felt safe in the presence of care workers. Potential safeguarding allegations were reported and managed appropriately, with any learning from incidents and accidents and complaints shared with relevant organisations.

Staff received appropriate supervision and training which meant they were able to carry out their roles effectively. People were assessed prior to care being delivered and they were fully involved in planning their care. People’s consent to care was taken. Their nutritional and health care needs were being met by the provider.

People told us they were treated with care and respect. They told us that care workers respected their privacy and tried to encourage them to maintain their independence and delivered care in line with their wishes. Care workers cared for people in a person-centred manner and involved them when supporting them, making them feel at ease.

Care plans for people were reviewed regularly which meant they received care that reflected their needs. The provider engaged with people and their relatives, listening when they raised concerns and following up on any actions.

The service was managed well, this was reflected in the feedback we received from people, their relatives and staff. The registered manager was aware of her responsibilities and encouraged an open culture where people’s views were heard and acted upon. Quality assurance checks were in place which helped to maintain a good level of service.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 4 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our previous inspection on 21 and 22 September 2017 we found the provider was not meeting regulations in relation to the outcomes we inspected, we found breaches of regulation in relation to Staffing and Good Governance. The service was rated Requires Improvement.

At this inspection, we found the provider continued to be in breach in relation to both Staffing and Good Governance, we also found new breaches of regulation in relation to Safe care and treatment and notifications.

The service remained Requires Improvement. You can see the action we have told the provider to take about these breaches at the back of the full version of this report.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. There were 60 people using the service at the time of the inspection.

Since the previous inspection, the service had undergone some major changes at management level. There was a new owner and new manager at the service. The manager was in the process of applying to become registered. 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.

Feedback from people and their relatives was positive. They told us that care workers were caring and friendly towards them they told us they felt safe in their presence. They also told us that the continuity of care was much better than previously experienced, although there were still some differences between care that was provided during the week and the weekends. People were happier with the quality of care they received during the week than at the weekends.

Care workers told us that the new manager had made major improvements to their rotas which they were pleased about. They said more thought had gone into allocating their rotas which meant they had reduced travelling time and were able to attend calls on time as compared to before. They also said that where they were required to ‘double-up’ with another care worker, this worked well also.

Although regular training was offered to staff, they did not always receive the same level of consistency with regards to supervision. New staff did not get a probationary review and experienced care workers did not get an opportunity to discuss their role.

Care plans were completed with the consent of people and their relatives. Although they were up to date, they were not always consistent in the level of information they gave to care workers. The provider was using an electronic care planning system; however this was not being utilised correctly. Care workers reported problems accessing the system which meant some records were recorded electronically and some on paper. The manager was aware of the issues with the current system and was looking at alternate solutions.

When complaints were raised, the provider investigated these. However, there were some occasions we found that agreed action points for improvement were not always followed up.

Records indicated that where safeguarding concerns were raised, the provider worked with the local authority to investigate these. However, the provider failed to meet its statutory requirements and did not always notify the Commission of these concerns.

Quality assurance checks were not being done regularly and in other cases were not thorough enough. This included auditing financial and medicine records, monitoring the quality of service through regular spot checks and monitoring the tine keeping of care workers.

The manager had only been in post since June 2018. At this time, the provider was undergoing major changes to its ownership. She had to deal with a number of staff leaving during this period, including the deputy manager and care co-ordinators. Despite this, she had made improvements to the service in relation to visit times and acknowledged that other areas as highlighted in the report needed to be improved.

Managing Care Limited provides personal care for people in their own homes. They offer a variety of care including dementia and palliative care. At the time of our inspection there were approximately 78 people receiving personal care from the service, the majority funded by the local authority and some privately funded.

There was a registered manager at the service. 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 up to date or accurate records were not always maintained. We saw examples of Medicine Administration Record (MAR) charts not being completed correctly, financial transaction logs not being signed by people using the service or their relatives and receipts not always kept. The complaints records were not completed appropriately.

People using the service told us there was inconsistency with care workers and they were not always kept informed of changes in rota. This was reflected in the provider's own feedback surveys and their on-call records. There were instances where for a double up call, the second care worker did not turn up.

Care workers received an induction based on the Care Certificate and thereafter received ongoing refresher training in the same subject areas. They told us they felt well supported by the management team who they said were approachable.

People said that care workers were caring and friendly. They were treated with dignity and respect and were offered a choice with regards to their personal care support needs. People said they received their medicines and care workers supported them appropriately in relation to their nutrition and they felt safe in the presence of care workers.

The provider was moving to new, online care plans which were accessible on smart phones. Not all of the care plans had moved to this new system. The care plans we saw identified people’s support needs and any risk. They also contained person centred information such as their preferences in relation to their personal care.

The provider sought feedback from people using the service and care workers and used this to make improvements.

We found a breach of the regulations in relation to good governance and staffing. You can see what action we have told the provider to take at the back of the full version of this report.