Metropolitan Care Services Limited

Barking Metropolitan Care Services Limited is a domiciliary care agency that was providing personal care to nine people at the time of the inspection.

People’s experience of using this service:

People told us they received safe care. Staff had completed safeguarding training and knew what action they should take and how to report any concerns they had.

Staff had been trained in a variety of areas and were knowledgeable about their roles and responsibilities. Systems were in place to support them and monitor their work.

People had risk assessments in place. Where risks had been identified there were plans to manage them effectively. There was an accident policy and a contingency plan to ensure the service could continue in the event of an emergency.

There were sufficient staff to meet people’s care and support needs. A system was in place to recruit suitable staff.

Staff sought people’s consent before providing support to them. People’s capacity to make decisions had been assessed.

People were supported to maintain nutritional and fluid intake. Staff treated people with dignity and respect and promoted their independence. People made their own decisions and staff were aware of people’s choices and care needs.

Care plans were detailed, specific to the person and reflected people’s choices and preferences. People were involved in planning their care and were supported by external health professionals to maintain their health and wellbeing.

The service had a complaints procedure. People, their relatives and staff knew how to complain. Quality assurance systems were in place to monitor the quality of the service, such as surveys, audits and spot checks.

There was an open and person-centred culture within the service. People, staff and relatives felt able to express their views. Feedback regarding the management of the service was positive.

Rating at last inspection:

Requires Improvement (report published 13 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection on 16 January 2018, the service was rated as requires improvement. We asked the provider to take action to make improvements with regard to time keeping as some people and relatives told us the staff did not always arrive and leave on time. We also asked them to improve the system for recording and monitoring staff visits as it was not working effectively, and this could put people at risk. During this inspection we found the actions have been completed.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

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

Barking Metropolitan Care Services Limited is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection, 15 people were using the service.

There was 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.

People told us they felt safe using the service. Staff understood their responsibilities to protect people from the risk of abuse. Risks to people were assessed to ensure they were safe.

Staff monitored people's health and welfare and made referrals to health care professionals where appropriate. There were systems in place to make sure people received their medicines safely.

Staff received appropriate support to meet the needs of people. They received regular training and one to one meeting with their line manager. New staff underwent an induction programme, which included training courses and shadowing experienced staff.

People were supported by sufficient number of staff. The provider had an effective recruitment process in place to ensure staff were safe to work with people who used the service.

People were involved in decisions relating to the care they received. Their preferences and diverse needs had been recorded and care and support were provided in accordance with their wishes.

People’s capacity to make decisions was considered and recorded during the assessment and care planning process. Staff had received training about the Mental Capacity Act 2005. They encouraged people to maintain their independence as much as possible, in all aspects of life and daily activity.

People’s needs were assessed before they started using the service. They were involved in developing their care plans which were individualised to their needs and preferences.

Staff understood the importance of respecting people’s privacy and dignity. People’s cultural needs were understood and catered for by staff. Information about people were treated confidentially.

The provider took account of complaints and comments to improve the service. The views of people and their relatives had been sought and acted upon. Regular audits were undertaken to monitor the quality of the service provided. However, the system for monitoring staff visits was not working effectively and this could put people at risk.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the back of the report.

Barking Metropolitan Care Services Limited is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection they were providing personal care to 22 people.

There was a registered manager in post. 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.

Relatives did not feel people were safe using the service. Risk assessments lacked information about how risks people faced during care were mitigated. This included risks around people’s health conditions and medicines. Medicines were not managed in a safe way. Staff were not knowledgeable about safeguarding adults from avoidable harm or abuse. Recruitment of staff was not completed in a way that ensured they were suitable to work in a care setting.

Staff did not receive the training or support they needed to perform their roles. Relatives told us they were worried staff did not know how to do their jobs. The service did not involve people or their relatives in the assessment and care planning process and was not recording consent to care in line with legislation and guidance. Care plans did not contain information about people’s dietary needs and preferences and relatives told us people were not supported to eat appropriate meals. Care plans did not contain enough information about people’s health conditions to inform staff how to support people to maintain their health. Some relatives worried they would not be informed if people’s health condition changed.

People's relatives and staff told us the quality of their relationships was affected by frequent changes in care workers. Care plans did not contain sufficient information about people’s preferences or life histories to form the basis of positive, caring relationships. The service did not explore people’s relationship histories or sexuality and what impact that may have on their support preferences. Relatives told us they thought care workers treated people with dignity and respect.

Care plans were brief and were not personalised. They did not contain information about how people wished to receive care and there was no information on people’s preferences. People and relatives told us they did not choose what time care workers visited them and the times were often not in line with their preferences. People and relatives knew how to make complaints and told us when they had made complaints they were happy with how they had been resolved. However, the provider had not recorded any complaints made.

People's relatives told us they did not think the service was well run. The provider had not identified any of the issues with the quality and safety of the service which were found during the inspection. The provider had not completed any audits or checks to monitor the quality of records. The checks they had carried out on people’s experience had not identified the issues found during the inspection.

We have made one recommendation about ensuring the service is accessible to people who identify as lesbian, gay bisexual and transgender. We have identified breaches of six regulations relating to person centre care, consent, safe care and treatment, good governance, staffing and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.