Archived: Miracle Agency Limited

Miracle Agency Limited is a domiciliary care agency. It provides personal care to people living in their own homes. The service provides support to older people. At the time of our inspection there was 1 person using the service.

People's experience of using this service and what we found

We found evidence during our inspection of multiple breaches of regulation and the need for this provider to make improvements.

People's risk assessments and medicine management records were not robust to ensure safe care delivery. Care records were not always person- centred, accurate and up to date.

People were not always supported to access information in an appropriate way for their needs. Staff recruitment practices and call monitoring systems were not always effective to ensure safe care delivery. Staff did not receive on- going support on the job to ensure they carried out their role responsibilities as necessary.

Training provided for staff was not meeting their role expectations and some staff's understanding of the Mental Capacity Act (2005) was limited. Systems and processes were not in place to effectively support people in the decision-making process.

Management arrangements in place were not sufficiently meeting the service expectations which resulted in a lack of management oversite. The provider had failed to learn lessons when things went wrong and they failed to demonstrate any improvement made since our last inspection.

Despite this, the provider followed current best practice guidelines to effectively manage risks associated with infection prevention and control (IPC).

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

Rating at last inspection

The last rating for this service was inadequate (published 19 August 2022) and there were breaches of Regulation 12 (safe care and treatment), Regulation 19 (Fit and proper persons employed), Regulation 18 (Staffing), Regulation 17 (Good governance), Regulation 14 (Meeting nutritional and hydration needs), Regulation 9 (Person centred care) and Regulation 16 (Receiving and acting on complaints) . The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection enough improvement had not been made and the provider was still in breach of Regulations12, 19, 18, 17 and 9.

This service has been in Special Measures since 19 August 2022. This meant we kept the service under review and, we re-inspected the service to check for significant improvements.

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

Why we inspected

This was a planned inspection based on previous rating and when the service was last inspected.

Enforcement:

We identified 6 breaches in relation to person centred care, staffing, safe care and treatment, fit and proper persons employed, meeting nutritional and hydration needs, and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than12 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.

Miracle Agency Limited is a domiciliary agency providing personal care. The service provides support to older people. At the time of our inspection there were 10 people using the service.

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. At the time of the inspection there were ten people using the service.

People’s experience of using this service and what we found

People did not receive care from a service that was safe. People’s medicines were not managed in line with good practice. People’s identified risks were not recorded and guidance to mitigate risks was not in place. People received care from staff that did not always attend calls on time nor stay the full duration of the visit. The registered manager failed to ensure robust pre-employment checks were undertaken prior to staff working at the service. The registered manager failed to learn lessons when things went wrong.

People did not receive support from a service that was effective. Staff members were not supported to have one-to-one supervisions with the registered manager to reflect on their working practices. People’s nutritional and hydration needs were not recorded and guidance for staff on how to support them was not documented. The registered manager failed to robustly assess people’s needs prior to them using the service.

People did not receive personalised care that reflected their preferences. Care plans were inadequate and failed to give staff clear guidance on meeting people’s diverse needs. People’s communication needs were not always met. The registered manager failed to document and respond to complaints received, appropriately.

People did not receive care from a service that was well-led. The registered manager had ineffective and inadequate knowledge of their role and responsibilities. There were no systems in place to ensure the governance and monitoring of the service were robustly monitored to drive improvements. The registered manager failed to deliver a service that sought positive outcomes for people in a safe way. The registered manager failed to ensure records were kept in line with legislation and did not have a clear understanding of their responsibilities under the Duty of Candour.

The registered manager had arrangements in place for preventing and controlling infection.

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

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

Rating at last inspection

The last rating for this service was good (published 07 December 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

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 Miracle Agency Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to safe care and treatment, person centred care, fit and proper persons employed, staffing, and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Miracle Agency Limited provides domiciliary care and support to three people living in the Hertfordshire area. This service includes assistance with all personal care, meal preparation, eating, medicines administration and general domestic chores. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by CQC.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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.

The provider had only been delivering services to people for the past four months, but during that time had established good practices and procedures which would help as the service expanded.

People were safe in their homes. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with people’s homes, to help keep people and staff safe. Recruitment practices were safe. Staff were trained in medicine administration and prompted people to take their medicines safely, although families actually administered the medicines from blister packs.

People were supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. Staff were providing support in line with the Mental Capacity Act 2005. When required people were supported to eat and drink sufficient amounts to meet their needs. Staff worked well with the people’s GP and the district nurses, to ensure they stayed well and comfortable.

People and relatives told us staff were caring, kind and efficient and staff respected their privacy and treated them with dignity.

People’s needs were assessed before they started to use the service and care was planned and delivered in response to their needs. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Systems were in place to monitor and improve the quality of the service. The provider had effective quality assurance systems to monitor the scheme’s processes. These systems helped ensure people received the care they needed as detailed in their support plans.