21 June 2018
During a routine inspection
Not everyone using Mayfair Biggleswade receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
At the time of this inspection Mayfair Biggleswade were supporting 39 people.
We carried out a comprehensive inspection of this service on 21 June 2018. This was Mayfair Biggleswade’s first inspection following a change to their registration. The overall rating for this service is ‘Requires Improvement’. This is the first time the service has been rated Requires Improvement.
The service had not been monitoring if people had received their care visits. Some people had had missed care visits. This meant that the leadership of the service did not know if people were safe and had received their care visits. Records did not accurately evidence if people had consistently had care visits. As a result of these issues the local authority became involved in the service. Their role was to support the service to make improvements and to check improvements were in fact taking place.
We found that people’s risk assessments were not always complete. The accompanying care plans did not fully outline the support people needed. These plans did not give step by step guidance for staff to follow to ensure that people’s needs were met and people were safe. In some instances, particular risks which people faced were not explored or identified in these plans.
The management of the service did not have a clear knowledge of the most vulnerable people the service supported.
Staff recruitment checks were not complete. For example, staff did not have full employment histories with any gaps explained. These checks are important as a way of checking people are safe in the company of staff.
When something went wrong lessons were not always taken from these situations. The leadership did not consider what went wrong, and what they could do to try and prevent a similar situation happening again. Robust contingency plans were not put in place and there was no system to check these plans were being actioned and if they were effective.
The management and the provider of the service were not completing robust and meaningful audits to test the quality of the service provided. The concerns identified by the local authority had not been identified and addressed by the provider. Some issues had been identified by the provider such as the quality of people’s care records, but no plan was in place with action taken to address this issue.
The culture of the service and how to test this had not been considered by the provider. Systems were not in place to ensure poor practices did not happen again. The provider had not considered how they had contributed to issues which the local authority had identified. What they could do to prevent these from re-occurring.
The management of the service were also not sharing certain events, which they must do by law, with us at the Care Quality Commission (CQC).
These issues constituted breaches in the legal requirements. There were four breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
People spoke positively about the support they received in relation to their medicines. However, the systems the service used to check that people always had their medicines, were not always effective. For example, when errors were identified robust action was not taken to prevent these errors from happening again.
Staff knew how to identify if abuse or harm had occurred. However, staff did not know what they could do if they believed action was not being taken to respond to their concerns. One member of staff did not see this as their role.
We found that staff were not always given the opportunity to fully get to know people’s needs before care visits started. Staff were not given the time and opportunity to look at people’s risk assessments and care plans. The service was not testing if staff were aware about the needs of the people they supported.
Staff competency checks were taking place but these were not well evidenced. The management of the service could not have assurances that these assessments were thorough and that staff had the skills to do their job well.
Staff knowledge was not being routinely checked. Staff training was up to date but staff did not receive training in all the areas which effected all the people they supported. The management of the service had not considered this issue before.
The staff we spoke with told us how they supported people to make decisions and choices about their day to day needs. The people we spoke with confirmed this happened. However, the service was not always checking or assessing some people’s capacity to make certain decisions. Even when there were possible signs that this needed to happen. People were being asked for their consent to share information with professionals and the local authority, but people were not being informed about what kind of information could or would be shared with these professionals.
People spoke positively about how caring and kind staff were towards them. Staff told us that they took practical action when a person needed further support and help.
Despite this, the provider and previous management of the service had taken certain actions which put people at risk. They had not considered people’s needs and wishes. Therefore, the service as a whole was not always caring towards the people they were supporting.
People’s assessments were not always person centred. People had only recently started to have reviews of their care. People’s reviews did not evidence if actions were taken when issues with people’s care were identified. People did not have end of life plans in place even when this was relevant to their needs. The service did not have a system to ensure these needs were captured in some way.
People’s complaints were not always well managed. This had improved recently but there were still areas where the service was not promoting people’s rights when they wanted to make a complaint. Alternatively, people told us that when issues were identified with the office, action to resolve these issues were taken.
People told us that the care they received had improved recently. In terms of seeing regular staff at their agreed times. As a result of this people said that they would recommend the service to others.
There was no registered manager in place at the time of this 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. However, an application had been made when we inspected and there is now a registered manager in place.