We undertook an inspection on the 17 June 2015 and called people who used the service and relatives the following day. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.
Medacs provides personal care to people living in their own homes in the Bristol and North Somerset area. At the time of our inspection the service was providing personal care and support to 198 people.
A registered manager was not in post at the time of 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 2008 and associated Regulations about how the service is run.
People’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. There was a lack of documentation related to a service user’s capacity to make decisions and how to support a service user when there was evidence that they lacked, or had variable capacity to make informed decisions.
Records showed that consent had been obtained by people or their representative regarding the support they received from the agency. In some cases consent forms were signed by their next of kin however, nothing had been recorded as to why this decision had been made, such as having the power of attorney over the person’s care and welfare. Being a person’s next of kin does not give them the automatic right to give consent on the person’s behalf.
The provider did not notify CQC of all incidents that affect the health, safety and welfare of people who use the service as required. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.
Support plans were in place to guide staff in meeting people’s needs. These were regularly reviewed to ensure they were current and amended when a person’s needs changed.
Staff members did not consistently receive on-going or periodic supervisions in their role to ensure their competence level was maintained. However, staff received on-going training to enable them to carry out their roles. Staff spoke positively about the training they received and felt they were able to provide good care as a result of the training.
There were sufficient staff available to meet people’s needs. Staff told us that staffing levels were sufficient and told us they had time to meet people’s needs.
People told us they felt safe when staff visited them and provided their care. A range of checks were carried out on staff to confirm they were suitable for the work. The recruitment process was thorough to ensure people were protected.
Staff knew the people they cared for well and met people’s assessed needs when they visited. One relative commented that the staff were knowledgeable and told us; “They’re very knowledgeable, our two regulars are absolutely brilliant.” People told us that staff were caring and their privacy and dignity was respected and they had a positive relationship with the staff. One person commented, “I feel protected. They are always careful to keep me covered up.”
People were supported to see healthcare professionals when required and records showed that staff responded promptly to peoples changing needs. The service had appropriate systems that ensured referrals to healthcare professionals were made.
There were arrangements in place for obtaining people’s feedback about the service. People who had raised concerns felt they had been listened to and thought the manager was approachable. One person commented, “I wanted some changes to be made so I wrote a letter. They responded immediately and things changed to how I wanted them.”
Since the appointment of the new manager staff told us they felt supported and were kept up to date with any developments.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.