Archived: Mayfair Homecare - Islington

Mayfair Homecare - Islington is a domiciliary care agency. The provider for the agency is Sevacare (UK) Limited. The agency provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, learning disabilities or autistic spectrum conditions as well as physical disability and sensory impairment. There were approximately 259 people using the service at the time of our inspection. The provision of personal care is regulated by the Care Quality Commission. 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

Some aspects of the service management and provision needed to improve. These included dealing with complaints, care calls scheduling and changes and communication with the agency’s office staff.

The agency needed to improve how they managed people’s PRN (as required) medicines. The agency introduced medicines audits. However, these were not always fully effective in identifying issues with medicines management. Improvements were made in how the agency managed people’s regular medicines.

The agency had not dealt with verbal complaints effectively and action was not always taken by the agency to address issues raised by people. We noted that formal written complaints were dealt with promptly and as required by the provider’s complaints policy.

Further improvements were needed to ensure staff were provided with sufficient and specific guidelines on how to manage and minimise risks to health and wellbeing of people who used the service.

The providers policy on dealing with people’s money had not always been followed and there was no managerial oversight of all monetary transactions carried out on behalf of people. Therefore, people and staff were not always protected from the risk of abuse. The registered manager acted on known safeguarding concerns. Appropriate referrals and notifications on safeguarding had been made to the local authority and the CQC as required.

There were sufficient staff to support people. However, the agency needed to further improve to ensure there was continuity of care and effective communication with people, when care staff or the time of a call visit had changed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Although staff involved people in making decisions about their care, often care was provided assuming that people’s routines were always the same.

General feedback from people showed staff were caring and friendly. Overall people were happy with regular staff supporting them. Some staff’s conduct suggested their understanding of professional boundaries needed to improve. The provider informed us that training in professional boundaries for all staff employed was due shortly.

Information about people’s preferred way of communication had been reflected in their care plans. However, these had not always been taken into consideration when communicating with people about their care.

Managers were provided with information about their roles and responsibilities. However, further work was required to ensure effective quality monitoring systems were in place for all aspects of the service delivery.

There were systems to protect people from harm. Staff were recruited safely, accidents and incidents were reported and analysed, and infection control measures were used by staff to avoid infection.

When people had the capacity, they had signed their care plans to show they consented to care provided by the agency.

People’s needs, and preferences had been assessed before they started using the service.

Staff received induction and mandatory training to help them to support people. Further support was provided in the form of spot checks, supervision and appraisal of staff work.

People were supported to live a healthy life. This included providing people with sufficient food and drink as well as enabling contact with healthcare professionals when required.

People’s privacy and dignity was protected when providing personal care.

Each person using the service had a person centred care plan. These plans included information about people’s care needs, their personal likes and dislikes and information on how people would like the care to be provided.

There were yearly service users and staff surveys carried out. People using the service and staff were encouraged to give their feedback about the service provided by the agency.

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 20 June 2018). This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected: This was a planned inspection based on the previous rating.

We carried out a comprehensive inspection of this service on 7 and 8 March 2018 (published 20 June 2018). and found breaches of regulations. We issued the service with a warning notice in respect of one breach we found. This was in relation to the assessment and management of risks to the health and safety of people using the service, poor management of people’s medicines and management of accidents and incidents. During this comprehensive inspection of the service we checked whether the service had met the warning notice.

We found some improvements had been made and therefore the agency had met the Warning Notice. However, some aspects of the service provision needed further improvements to fully meet the requirements of the Regulations.

We found four breaches of regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made three recommendations about handling people’s money, the Accessible Information Standard and effective quality monitoring of the service provided.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayfair Homecare Islington on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mayfair Homecare - Islington is a domiciliary care agency. The provider for the agency is Sevacare (UK) Limited. The agency provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, learning disabilities or autistic spectrum conditions as well as physical disability and sensory impairment. The age group of people using the service varied from younger adults to older people. There were approximately 258 people using the service at the time of our inspection. The registered manager told us that 241 people were currently receiving personal care. The provision of personal care is regulated by the Care Quality Commission.

There were two registered managers in post at the time of our inspection. 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 and associated Regulations about how the service is run. We found that both registered managers had experience and training to be able to carry out the regulated activity. The registered managers were supported by a team of three team leaders, three care co-ordinators and two administration workers.

During our last inspection, in January 2017, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were related to the lack of sufficient risk assessment to health and wellbeing of people who used the service and person centred care planning. Following the last inspection, the provider had submitted an action plan to show what they would do to improve the service in these areas.

During this inspection, we found the agency had not fully addressed issues around assessment of risks to health and wellbeing of people using the service. Consequently, staff had still not had sufficient information on management of these risks and people could receive support that was not safe.

We found that the agency had made improvement in relation to person centred care planning. People’s care plans included personalised information of their life histories and backgrounds, health needs and personal likes and dislikes. Further improvements were needed to reflect how people would like to receive their personal care.

We found other shortfalls in the provision of the service. We found numerous issues related to medicines management. The agency’s systems for the management of accidents and incidents were not always followed and there was a risk that the same accidents and incidents could happen again. The agency did not always work within the principles of the Mental Capacity Act 2005 (MCA) and there was a risk that decisions related to people’s everyday care were not made in their best interest or with their consent.

Quality monitoring systems used by the agency were carried our regularly. However, they had not been effective in identifying issues found by us during this inspection.

We found that some areas of the service provision were managed adequately, however, they would benefit from further improvements. For example, staff received regular supervision and appraisal of their skills. However, not all staff understood the purpose of supervision and the documentation relevant to staff yearly appraisals was not always available in staff file for review of staff progress and audit purposes. In another example, the agency had dealt with complaints received from people and people said it was done to their satisfaction. However, some improvements were needed to ensure all members of the management team had good awareness of the agency’s complaints procedures.

We also found many positive things about the service provided by the agency. There were safeguarding procedures in place and staff understood their role and responsibility around protecting people from abuse. The provider had appropriate recruitment procedures in place to ensure only suitable staff were appointed to work with people who used the service. People told us they felt safe with staff who supported them.

The majority of people thought the agency was well managed. They spoke positively about staff who supported them and they were satisfied with care provided. People described staff as kind and caring and they said staff knew and understood people’s individual needs and preferences. People and their relatives thought staff were well trained and they knew what they were doing.

Staff supported people to have enough food and drink and have a diet that suited their nutritional needs and personal preferences. People were supported to have access to appropriate external health services when required. People trusted that staff would take action if they felt unwell. Staff asked people for their permission before providing any support and people felt involved in decisions about their day-to-day care.

When possible, people were supported by the same staff to allow continuity of care and development of positive relationships between people and staff who cared for them. People felt involved in their care planning and they thought staff provided care and support that reflected their needs.

There was good communication between care staff and the management team. Staff were encouraged to attend team meetings and newsletters and memos were produced by the management team to ensure staff were up to date with developments within the service and best care practice. Staff felt supported by their managers.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the warning notice about the Regulation 12.

We made four recommendations that were related to providing supervision and appraisal to staff, managing the service provision during the regular staff absence, person centred care and managing complaints.

Sevacare - Islington provide support and personal care to people living at home. There were approximately 322 people using the service at the time of our inspection. The registered manager told us that 257 people were currently receiving personal care. The provision of personal care is regulated by the Care Quality Commission.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People told us they liked the staff who supported them on a regular basis and that they were treated with warmth and kindness.

However, some people we spoke with had concerns about staff that worked at the weekend or who were a replacement to their usual, allocated staff member. These concerns included timekeeping, following care plans appropriately and the provision of meals.

People’s care plans were not always focused on the individual and some contained inaccurate and inconsistent information about people’s care requirements.

People told us they were generally satisfied with the support they received with eating and drinking and staff were aware of people’s dietary requirements and preferences. However, some people we spoke with told us they felt staff were not always competent around meal preparation.

Where risks to people’s safety had been identified, ways to mitigate these risks had been recorded so staff knew how to support the person safely. However, there were inconsistences with the assessment and recording of risks. The registered manager had identified these shortfalls in the risk assessment process and had provided further training in order to improve the generic nature of assessments.

The agency had a number of quality monitoring systems including yearly surveys for people using the service and their relatives. However, these systems were not always effective in identifying people’s concerns about the quality of service provision.

Staff could explain how they would recognise and report abuse and they understood their responsibilities in keeping people safe.

The service was following appropriate recruitment procedures to make sure that proper checks were carried out before staff were employed at the agency.

Staff we spoke with had a good knowledge of the medicines that people they visited were taking. People told us they were satisfied with the way their medicines were managed.

Staff told us and records confirmed that they were provided with a good level of training in the areas they needed in order to support people effectively.

Staff offered choices to people as they were supporting them and people told us they felt involved in making decisions about their care.

People confirmed that they were involved as much as they wanted to be in the planning of their care and support. Care plans included the views of people using the service and their relatives. People told us they had no complaints about the service but said they felt able to raise any concerns without worry.

The registered manager was working hard to drive improvements in service delivery through the use of a continuous improvement plan and by demonstrating an open and supportive management approach. Staff were very positive about the registered manager and the support they received by the management of the service.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to risk assessments and appropriate and accurate care planning. You can see what action we told the provider to take at the back of the full version of the report.