Archived: Montecare Solutions Ltd Also known as Montecare Solutions Ltd - Harwich

Montecare Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for adults, some of whom may be living with dementia, have a physical disability or a learning disability. The service does not provide nursing care. At the time of our inspection the service was supporting 79 people with personal care. 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.

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

Governance systems in place were not always effective at identifying areas of concern as they had not identified those found at this inspection, and enough improvement had not been made since the previous one in October 2018. At the previous inspection in October 2018 the provider had also failed to make improvements to the service and was also rated requires improvement overall at the inspection in February 2017. This was therefore the third consecutive inspection where the provider had repeatedly failed to improve, and breaches remained in place.

Systems had failed to identify where records were not robustly completed. There was no formal auditing system for monitoring people's care plans, this meant the service had failed to identify when risk assessments were not adequately completed. Risk assessments did not all contain sufficient information to mitigate risks to people and still required further development. Additionally, staff supervision had not been consistently maintained.

Where recommendations had been made at the last inspection, sufficient improvement had not been made. At the last inspection we made a recommendation regarding Improvements in relation to the application of the Mental Capacity Act 2005 (MCA) and the management team not being up to date with best practice.

At this inspection we found improvements had been made in part in relation to training for staff in the application of the of the Mental Capacity Act 2005 (MCA) however people had not always had their consent formally sought and their involvement in care planning was not fully evidenced.

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 this practice. However, we did identify records of best interest decisions were not always in place or fully completed.

People told us they felt safe with the staff that support them. People received their medication as prescribed. Staff had been recruited safely.

Staff were intuitively caring and treated people with respect, and people's privacy and dignity was maintained. Feedback from people said staff were kind and caring. Staff were able to describe how they ensured people's dignity was respected.

Staff felt supported and they received induction, ongoing training and supervisions. People's nutritional needs were met.

People had the opportunity to give feedback on the service. People and their relatives were positive about the management team.

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 requires improvement (published 10 November 2018) and there was a breach of regulation, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made/sustained, and the provider was still in breach of regulations. The service is therefore rated requires improvement at this inspection.

At the previous two consecutive inspections in February 2017 and October 2018, this service has been rated requires improvement. The provider has repeatedly failed to address concerns from previous inspections to improve the rating to at least good. Since being registered under Montecare Solutions Ltd in 2012, the service has fluctuated between good and requires improvement ratings and has not improved at the last three inspections. This demonstrates a lack of understanding of the risks and regulatory requirements and a failure to continuously learn and improve. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to governance systems. Please see the action we have told the provider to take at the end of this report.

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

As this is the third consecutive inspection we have completed where the provider has been rated requires improvement and has made little or no improvements. We will request an action plan for 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 until we return to visit as per our re inspection programme. If we receive any concerning information we may inspect sooner.

It should also be noted that the service was in the process of transitioning to new providers and a change of leadership was anticipated at the time we inspected, and we intend to meet with the provider following this inspection.

At this inspection, we checked that the registered manager had made the required improvements. Since our last inspection of the service, some improvements had been made, however further improvement was still required and the service continues to be rated as ‘Requires Improvement’.

Montecare Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for adults, some of whom may be living with dementia, have a physical disability or a learning disability. The service does not provide nursing care.

This inspection was undertaken on the 11, 12. 13 and 20 September 2018. At the time of the inspection, 63 people were receiving a domiciliary care service from Montecare Solutions. The Care Quality Commission only inspects the service being received by people provided with personal care; such as help with tasks related to personal hygiene and eating, and so did not look at the support being provided to the other people in the service. There were 28 people receiving personal care at the time of our inspection.

The registered provider was also the 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.

Staff knew how to recognise signs of abuse and were confident about what action to take if any concerns arose. Staff were mostly on time to provide people’s support.

People were treated with care, kindness, dignity and respect and received a good level of support that met their needs and preferences. Staff had a good knowledge and understanding of people’s specific care needs and how they wished to be cared for and supported.

Although there was no impact to suggest that people’s care and support needs were not being met, not all risks to people’s health, welfare and safety had been recorded and improvements were required to guide staff in the steps they should take to mitigate risks to ensure people’s safety and wellbeing.

Staff supported people to have enough to eat and drink and to make choices about what they ate and drank. People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance.

The application of the Mental Capacity Act 2005 (MCA) required further development. People received care from skilled staff who were able to meet their needs. Staff received supervision and appraisals to support them in their role and identify any learning needs and opportunities for professional development.

We received mixed feedback regarding the effectiveness of the management team. Although some auditing and monitoring systems were in place to ensure the quality of care was consistently assessed, they had not identified the issues we found during our inspection to ensure the service continuously improved. The management team were not always up to date with best practice.

We have made recommendations about the management of risk and the implementation of the Mental Capacity Act 2005.

You can see what action we told the provider to take at the back of the full version of the report.

Montecare Solutions is a domiciliary care service that provides personal care to people living in their own homes. They predominantly provide a service for older adults, some of whom may be living with dementia or may have a physical disability. The service does not provide nursing care. At the time of our inspection there were approximately 80 people using the service.

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. The director of the company was the registered manager and there was also a general manager.

Procedures for supporting people with medicines were not always followed, so people could not be confident that they would receive their medicines safely. There were sufficient staff to meet people’s needs and to manage risk safely. Whilst we received feedback that staff were not always punctual, senior staff checked staff timekeeping regularly and had made changes to make rotas more manageable. The provider had a robust recruitment process which helped protect people from the risk of avoidable harm.

The service was run by a committed director and manager. There were systems in place to check individual performance but not to monitor themes across the service. There were not sufficient checks to ensure that all senior staff in the service were carrying out their roles effectively. As a result the director and manager had not effectively picked up and resolved the concerns which we had found during our inspection. The director and manager responded positively to address our findings and were pro-active about implementing improvements.

Staff were well supported. They received good quality training which they were enthusiastic about and which enabled them to meet people’s needs effectively. People were given choices about the care they received, and care plans were being updated to clarify that the service was meeting its responsibilities under the Mental Capacity Act. People were supported to consume food and drink of their choice. Staff worked well with people to help them maintain good health and to access health care professionals, where necessary.

People were treated with compassion by staff who knew them well and developed positive relationships with them over time. Staff treated people with respect. Staff communicated well as a team about people’s needs. Care plans were in place which outlined people’s needs and these were being revised so that staff could receive more personalised and clearer information about people’s needs and preferences. People received a detailed response when they made a complaint and their concerns were dealt with effectively.

The staff told us that Montecare was a good company to work for. The management was flexible and approachable and provided good opportunities for training.

At the time of our inspection on 18 June 2013, we saw that monitoring systems for involving and caring for people and managing the service were in place. Effective staff support systems including supervision and annual appraisals were in place.

We noted that there were processes in place for the reporting of safeguarding incidents and that these procedures were followed.

The staff told us that Montecare was a good company to work for. The management was flexible and approachable and provided opportunities for training.

At the time of our inspection on 11 March 2013, we saw that monitoring systems for involving and caring for people and managing the service were in place. Effective staff support systems including supervision and appraisals were in place.

We noted that the reporting of safeguarding incidents and the following of appropriate procedures required improvement.