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Inspection carried out on 29 March 2019

During a routine inspection

About the service:

Metro Homecare Ltd is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Children, older adults and younger disabled adults use the service. At the time of this inspection on 29 March 2019, 133 people were using the service.

People's experience of using this service:

People had an assessment of their care and support needs and their views were taken into account.

People went to activities of their choice and staff supported them with this when required.

The registered manager followed established safeguarding processes to protect people and report allegations of abuse.

Staff assessed risks to people's health and wellbeing. Plans to manage and mitigate these risks were developed and implemented to keep people safe.

People were supported with taking medicines. The records used for the management of medicines were audited and completed accurately.

The registered manager employed suitably experienced staff by following the provider’s recruitment processes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives gave positive feedback about the service. People said they were happy about the level of care and support they received.

People said staff showed them kindness and were respectful when delivering care and support while protecting their dignity and privacy


People and their relatives contributed to their care assessments and reviews of their needs.

People and relatives said the management of the service was well-led and staff were responsive to their care needs.

There were systems in place for monitoring and reviewing the quality of the service. Actions were implemented where improvements were needed.

Staff were happy working for the service and were complimentary about the registered manager who supported them in their jobs.

Rating at last inspection: At the last inspection on 1 and 3 November 2017, the service was rated overall Requires Improvement. (Report published on 19 March 2018). We asked the provider to send us a plan to describe how they would improve each key question of Effective, Caring and Well-led to at least Good. At this inspection action had been taken to improve the ratings to Good.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 1 November 2017

During a routine inspection

This comprehensive inspection took place on 1 and 6 November 2017 and was announced. Metro Homecare is a domiciliary care service that provides care to people in their homes. The service supports people who live with mental ill health and young adults living with a learning disability. Older adults who are frail and have dementia receive care and support from care workers. At the time of the inspection, 400 people were using the service.

The service had 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.

This was the first inspection at this service since they registered with the Care Quality Commission (CQC) in December 2016. At this inspection, we found the service was not meeting all the regulations we inspected. Two breaches of regulations were found. The breaches were in relation to good governance and notifications. The overall rating for this service is requires improvement. You can see what action we had told the provider to take at the back of the full version of this report.

Staff did not always act in a way that demonstrated dignity and respect. People told us they found care workers were kind, compassionate and helpful to them. However staff did not always treat people respectfully. This was because some staff engaged in their own private activities and spoke in a language people did not understand while delivering care, which meant people did not receive all aspects of their care as planned.

Staff prepared meals and completed shopping tasks so people had enough food and drinks for their needs. However people told us that staff sometimes refused to prepare the food that they preferred to eat.

The registered manager provided us with a list of people using the service as requested. However, we found the information provided to us was not accurate because there were a number of incorrect contact details for people.

The registered manager had not notified CQC of significant incidents that occurred at the service. We were made aware of two safeguarding incidents by the local authority that occurred within the last year that had not been reported to us. The registered manager had told us that there had not been any safeguarding allegations at the service.

The registered provider had safeguarding processes to protect people from abuse. The registered manager and staff understood what action to take to protect people from the risk of abuse.

Assessments recorded risks to people’s health and well-being and the support required. Each person had a risk management plan that identified potential risks and the actions staff should take to mitigate those risks and keep people safe.

There were enough staff deployed to meet people’s needs. The staff rota showed the names of people using the service and the allocated care worker who was scheduled to deliver their care. There were systems in place to monitor missed and late visits. Staff learnt from incidents that occurred at the service. Any incidents of missed and late calls were reviewed and the actions taken to resolve these concerns were recorded. The registered manager implemented an electronic tracking system that care workers used that identified whether people had received their planned care.

People’s medicines were managed in a safe way. We found that people had their medicines as prescribed. When people required support to take their medicines this was provided to them by staff.

People were protected from the risk of infection. The registered manager supplied personal protective equipment (PPE). Gloves, aprons and foot covers were made available for staff to use. Staff used PPE to reduce the risk of infection for people.

People had an assessment of their care and support needs. Assessments were completed before they received a service. The assessments provided staff with sufficient information to enable people to receive safe and appropriate care.

Staff were supported by their line manager. Staff took part in training to increase their knowledge and support them in their role. Staff had regular supervision and an appraisal. An induction programme was in place for new staff to help them understand the organisation they worked in and people they provided care to. However, staff required further support to improve their skills to enable them to be effective in their roles.

The principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. The registered manager and training provider organised MCA training for all care staff. People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible for people. The policies and systems in the service supported this practice.

Consent to care and support was provided to staff by people. Decisions about care and support needs were made by people and their relatives. Staff understood and respected people’s individual needs regarding their care decisions.

Health care support was provided to people when required. Care workers reported any concerns about people’s welfare and office based staff contacted health care services for support and advice on behalf of people. The service, worked in a co-ordinated manner with health and social care services to meet people’s needs.

Staff supported people to maintain their privacy and dignity during care visits. People were mindful when carrying out personal care tasks to help maintain their privacy. People commented that staff supported them in a way that helped them to maintain some independence in their lives.

Care assessments and care plans were developed in accordance with people’s views. People had regular reviews of their care and support needs. Care records we viewed placed people at the centre of them.

The registered manager had a system in place for people to make a complaint about the care they received. People were provided with details of how to make a complaint about the service if they chose.

Staff provided individualised care for people nearing the end of their lives. People were encouraged to discuss the care they wished to receive at the end of their lives and these were recorded in their plan of care.

The registered provider demonstrated a clear vision within the service. We observed a positive work culture and the registered manager valued staff that worked at the service. Staff were positive about working for the service and commented positively about both their line manager and the registered manager. Each member of staff had their designated role within the service. There were systems in place to monitor, review and improve the quality of care.

The registered manager gathered people’s views of the service. People were encouraged to give their views on the service and staff that provided care and support to them. The service engaged with local community groups and local health and social care services to improve the quality of care.