Archived: Mears Care - Rossendale

Mears Care Rossendale is part of Mears Care Ltd and provides domiciliary care services to people in east Lancashire. The agency office is located in Haslingden. The service provides care and support for people who live independently in the community. At the time of the inspection 102 adults were using the service for personal care and/or domestic support.

The service was managed by a registered manager. 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.

At our last inspection on 29 and 30 June 2016 we found the service to be in breach of four regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of systems and processes in place to effectively investigate and document any allegation of abuse. Not having effective systems for receiving and acting on complaints, not following the provider policy in relation to providing an adequate amount of supervision meetings for all staff and not operating established and effective quality assurance and audit systems to monitor and improve the quality and safety of the services provided. The service received a rating of Requires Improvement. Following the inspection we received an action plan form the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made on these matters.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to a lack of robust recruitment procedures prior to staff working at the service. You can see what action we told the provider to take at the back of the full version of this report.

We found there were management and leadership arrangements in place to promote an efficient day to day running of the service. However there had previously been changes in management and the service had been without a registered manager for over two years. Therefore management and leadership arrangements needed embedding to achieve ongoing continuity and progress.

There were processes to monitor and develop the services provided, in consultation with the people who used them.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff said they had received training on safeguarding and protection.

Arrangements were in place to maintain staffing levels to make sure people received their agreed care and support. There were systems in place to ensure all staff received initial training, ongoing development, supervision and support.

People made positive comments about the staff team including their friendly approach, listening skills and respectful manners. Staff expressed a practical awareness of responding to people as individuals and promoting their rights, privacy and choices.

People told us they had agreed to the support and care provided by the service. We found records were kept of people’s consent /agreement to their care and support package. Arrangements were in place to gather information on people’s backgrounds, their needs and abilities, before they used the service. People were aware of their care plans and said they had been fully involved with them and the ongoing reviews.

Processes were in place to monitor and respond to people’s health care needs. All the staff we spoke with described the action they would take if someone was not well, or if they needed medical attention. Where appropriate people were supported with eating and drinking.

We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

There were effective complaints processes in place. There was a formal system to manage, investigate and respond to people’s complaints and concerns.

Mears Care Rossendale is part of Mears Care Ltd and provides domiciliary care services to people in east Lancashire. In addition to this the provider offers a short term domiciliary crisis service. The office is located in Haslingden. The service provides flexible personalised care and support for people who require additional support to live independently within the community. Additional services are offered such as domestic support and carer support. At the time of the inspection 165 adults were using the service for personal care and or domestic support.

The service was last inspected on 22 May 2014 and was found compliant in all areas inspected.

The registration requirements for the provider stated the home should have a registered manager in place. 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. At the time of the inspection there was a manager in post who had submitted an application with the CQC to become registered which is currently being processed.

We found the service to be in breach of four regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of systems and processes in place to effectively investigate and document any allegation of abuse. Not having effective systems for receiving and acting on complaints, not following the provider policy in relation to providing an adequate amount of supervision meetings for all staff and not operating established and effective quality assurance and audit systems to monitor and improve the quality and safety of the services provided. You can see what action we told the registered provider to take at the back of the full version of the report.

During this inspection people indicated that they were pleased with the service and told us that all staff were punctual, well presented and kind. People told us they felt safe and secure and cared for by staff who knew and understood their support needs. Staff gave suitable examples of how to keep people safe. We saw evidence of risk assessments in people’s care files which considered the person’s home environment and any perceived risks at the property.

We noted the provider had policies and processes around safeguarding and whistleblowing; however these policies and processes were not always being followed.

People told us that staff arrived on time. Staff told us they never felt rushed and were able to stay their allocated time. Staff rotas were prepared in advance to ensure all visits were covered. We noted there was a sufficient number of staff to cover all visits. Appropriate recruitment practices were followed and relevant checks were done, this helped to ensure only suitable staff were employed to care for people.

Staff told us they felt supported in their caring role; however, we noted an absence in staff supervision. Staff had attended appropriate training sessions to help them carry out their role and this was confirmed by people using the service. However, due to the lack of certificates on some topics the manager had requested that a variety of training sessions were to be re done to ensure all correct certification was evident.

Staff spoken with were aware of the principles of the Mental Capacity Act 2005 (MCA) and Court of Protection. These provided legal safeguards for people who may be unable to make their own decisions. The manager also demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who used the service in their best interests.

People received an individualised care and support package which reflected their individual preferences, likes and dislikes and promoted their independence. People told us they were involved in planning and reviewing their care. People felt they were treated with kindness, sensitivity and care and staff gave appropriate examples of ensuring people’s privacy and dignity was maintained. People told us they were involved in making decisions about how they would like to be cared for and were supported to eat and drink in accordance with their care plan. Changes to people’s needs and requirements were communicated well which meant staff were kept up to date with these changes.

People who used the service expressed a confidence that should they raise an issue it would be dealt with appropriately. However, none of the people we spoke with had raised a complaint and therefore they could not offer any positive examples how they were managed?. We noted through complaints received prior to the inspection and lack of evidence around known complaints that the complaints process had not been consistently followed.

This is a summary of what we found:

Is the service safe?

Before people received home care services, they had an assessment of their needs to determine the level and type of help they needed. Arrangements were in place to make sure people continued to receive the correct care.

People told us visits were never missed. The agency had good arrangements in place to respond quickly if there was an unexpected staff absence.

All staff had been trained in safe moving and handling of people and we were told this was up to date. Staff were trained to use equipment such as hoist and always worked in pairs when two people were required to move people

Care plans were detailed to support staff to deliver safe and effective care. Risk assessments had been carried out to make sure staff worked in a safe environment. Risk assessments had also been carried out for people to support staff to care for them safely.

Safeguards were in place to make sure staff were recruited properly. Staff contractual arrangements and a code of conduct and practice helped to protect people.

People got their medicines when they needed them. Measures were in place to deal with shortfalls in standards such as staff failing to sign the Medication Administration Record. These issues were addressed promptly by senior staff.

Spot checks were carried out on staff to ensure they were meeting their obligations when attending people. Staff were trained to deal with emergencies such as first aid, and were able to contact management for support out of hours.

Care had been taken to make sure people were kept safe by good recruitment procedures. Staff contractual arrangements prevented them from gaining financially from people they cared for.

People told us they felt safe in their homes when staff visited. Arrangements were in place for staff to gain entry to their home without placing them at risk.

The manager had been trained and understood principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

Is the service caring?

People told us they were happy with the care they received and the staff team. Surveys carried out showed people considered the service they received was very good.

People we spoke with said, “They make sure I get all the help I need. They will always do that bit extra for you. They always stay the right time and will do little extras.” And, “I love having my bubble bath. I thoroughly enjoy it. The carers run it for me and help me in and out. I have a good soak whilst they get on with other things. I’m a happy bunny.”

“I do a lot for myself and they help me. They have a job to do and they do it well. The standard of work they do is excellent and I’m in my own home. The girls are very polite and caring. They don’t take over and that’s good.”

“It’s nice for people to be in their own home. That’s where you want to be, especially at my age and with this type of service it’s possible. I love the carers visiting. They are very trustworthy and I feel very safe with them”.

“I’m nearly blind. I like having the same carers because I can recognise their voices. They watch out for me and use the key safe to get in and lock my door when they leave.”

People we visited in their home told us staff treated them with respect and kindness. Staff worked to care plans that were person centred and sufficiently detailed on how best to meet individual needs.

Is the service responsive?

People generally felt the agency operated a flexible service and would always try to accommodate their needs. Assessment of people’s needs and care plans were reviewed regularly and adjustments made where needed.

Concerns identified in the last inspection carried out on the 16 September 2013 had been dealt with effectively. Issues around care practice and risk assessment, medication, support for staff and quality monitoring had been addressed.

People using the service and their relatives had completed a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People we spoke with told us carers did what was asked of them and they were flexible in their work. “They make sure I get all the help I need. They will always do that bit extra for you”. “I do a lot for myself and they help me. They have a job to do and they do it well. The standard of work they do is excellent and I’m in my own home. The girls are very polite and caring. They don’t take over and that’s good.”

Staff we spoke with told us they were well trained and were given enough information to know what people required. Work was arranged to let staff visit the same people on a regular basis. Arrangements were made for emergency staff cover In the event of sickness or absence.

People considered the service they received helped them stay in their own home. One person said, “It’s nice for people to be in their own home. That’s where you want to be, especially at my age and with this type of service it’s possible. I love the carers visiting. They are very trustworthy and I feel very safe with them”. Another person told us, “I’m nearly blind. I like having the same carers because I can recognise their voices. They watch out for me and use the key safe to get in and lock my door when they leave.”

Staff had been trained in dealing with health conditions people presented such as diabetes, dementia, and in pressure care.

People told us they were consulted with and listened to. Quality monitoring showed action was taken with regard to comments they received. For example, knowing who is visiting and what time, ‘Better now I’m getting a rota and know what times and who is coming’.

Staff used a tele monitoring system to support managers to know they were meeting their obligations in arriving at people’s homes within the agreed time slot and that they stayed the right length of time. Spot checks on staff ensured staff met their obligation to provide the right standard of care for people.

Is the service well led?

Staff told us the management of the service was good. They considered the manager and senior staff were always available to talk with at any time and they were very supportive.

Staff were clear about their responsibilities and duty of care and were able to raise their views and concerns. Staff were encouraged to develop their skills and knowledge. Training was provided and staff were given opportunity to put their new skills into practice. Supervision of staff was established with spot checks carried out on their performance by team leaders. Meetings were held to keep staff informed of changes within the organisation and provide staff an opportunity to raise issues relating to their work.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service.

However a significant number said there had been problems with frequent changes to their care team because of staff leaving. One person said, "The service is alright as long as I get the same carers; but they haven't got enough staff". Another person said, "There's a core of very good people but we have had a lot of different ones recently". Also two people we spoke with were not satisfied with two of the carers, and some information we received prior to the inspection about five other people indicated their standard of care was unsatisfactory.

People had written care plans in their homes. However some we saw were not up to date so staff didn't have accurate information. The medication records we saw were not completed properly or accurately and indicated poor practices.

We also found staff were not always monitored or supervised properly, and that the agency's quality monitoring systems were not effective in identifying shortfalls.

People also told us they felt they had sufficient choices in the care provided. They had been involved in the setting up of their care, and had been offered some choices in the times of the visits. There was also some flexibility in the support given according to need.

Overall people using the service said they were satisfied with the quality of the service and that the care given met their needs. One person said, "I have no critiscisms; I just can't find anything at all to critiscise". Someone else said, "They go the extra mile". A relative said, "They (the carers) are all brilliant really; they are all so caring".

People also said the service was 'generally' reliable and they had never experienced a 'missed call'. Some said they had good continuity and consistency of care with a group of care workers who were known to them. However most people told us carers could sometimes be significantly late, but they were not always notified of this. Neither were they always notified of changes to the carer group and that sometimes carers they didn't know turned up unannounced.