Archived: MSS Care

This comprehensive inspection took place on 23, 24 and 30 August 2016 and was announced in accordance with our current methodology for domiciliary care inspections. The service was last inspected on 1 August 2014 when it was fully complaint with the regulations.

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.

Everyone who responded to our survey reported they felt safe while receiving care and support and reported that staff always respected their privacy and dignity. People told us, “The carers are very very good”, “The staff are extremely pleasant” and “I’d give them 10 out of 10, they are such a help to me it is unbelievable.”

Visit schedules included appropriate amounts of travel time between consecutive visits. Call monitoring data and daily care records showed that staff normally arrived on time and provided visits of the planned duration. People said, “They do have enough time”, “They do not rush, they have time to chat” and “They are normally on time but you can’t plan for the traffic around here.”

The service used a mobile phone based call monitoring system to ensure all planned care visits were provided each day. This information was monitored by office staff in real time and an alarm system was used to alert office staff if a carer failed to provide their first planned visit each day. People told us, “They never let you down, they always turn up” while staff said, “I don’t know of any missed calls.”

The service operated safe recruitment practices and all staff understood their role in protecting people from abuse and avoidable harm. The service’s safeguarding policy accurately reflected local procedures and had been regularly updated.

All staff received three days of formal induction training when they joined the service. Staff records showed this training was regularly refreshed and appropriate additional training was provided to ensure staff remained sufficiently skilled to meet people individual needs. Staff told us, “The induction was good and well organised” and “They are very hot on training.”

Staff were well supported by their managers and regularly received supervision, spot checks and annual performance appraisals. The service operated an effective on call manager system to provide staff with any necessary guidance outside of office hours. Staff told us, “They [managers] are brilliant actually” and “I can always ask for help from [the registered manager] or [care manager].” The registered manager said, “I do have a lot of confidence in the staff” and “I am really proud of my staff, the way they go the extra mile for the clients. They really do care.”

Care plans were detailed and informative. They provided staff with sufficient guidance to ensure People’s specific care needs were met during each planned visit. Staff told us people’s care plans were; “quite detailed”, “all kept up to date and they are informative” and, “they are actually very helpful.” Risks had been appropriately assessed and staff provided with guidance on how to protect people and themselves from each identified risk.

People and staff were actively encouraged to report accidents, incidents, near misses and compliments via the provider’s safety observation system (SOS). All reported incidents were fully investigated by managers to identify any learning or areas of possible improvement. People understood the service’s complaints procedures and records showed all complaints received had been investigated and appropriately resolved.

The service’s secure information sharing system based on mobile phones allowed staff to effectively share information about changes to people’s care needs with office staff and other carers. This meant prompt action could be taken to address any significant incidents or changes to care needs.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence support our summary please read the full report.

Is the service safe?

We found that the service was safe on the day of our inspection. People who used the service told us they felt safe with their staff and we found that recently recruited members of staff had received appropriate training and necessary pre-employment Disclosure and Barring Service checks had been completed.

All MSS Care staff had completed training on the safeguarding of vulnerable adults and had access to the contact telephone numbers for Cornwall Education, Health and Social Care from their work mobile phones. We saw that recent incidents reported to manager had been resolved in accordance with the providers safeguarding policies.

Is the service responsive?

We found that on the day of our inspection the service was responsive. There were appropriate procedures in place for the reporting of information and concerns to the services management. We saw that all issues reported had been effectively investigated and resolved. This meant the service was able to review its actions and learn from incidents that had been reported.

We found that in the month prior to our inspection there had been two missed care visits. These incidents had been as a result of staff misreading their visit schedules and had been quickly identified by office staff. The individuals whose visits had been missed were contacted by the provider and offered additional support.

Is the service well led?

On the day of our inspection MSS care was well led. People who used the service and staff told us they had notice an improvement in the management and organisation of the service. Their comments included 'it's getting there', 'it is a hell of a lot better', 'most settled I've seen it' and 'things are getting back on track now'.

We saw that the provider had appointed a new care coordinator to assist the registered manager with the leadership of the service. Staff had received regular monthly supervision since our last inspection and told us it was now 'easy' to get hold of managers when necessary.

Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service , relatives, staff and management of MSS Care. Additional information was gathered by visiting three people in their own homes and by reviewing records.

If you want to see the evidence support our summary please read the full report.

Is the service safe?

We found that the service was not safe as staff had not received appropriate training and necessary Disclosure and Barring Service checks had not been completed before staff provided care independently. Staff members were unaware of local safeguarding procedures and told us 'I need training to know what exactly I should be doing' and 'I did some shadowing shifts and then I was out on my own'.

MSS Care had failed to follow it's own policies and procedures in relation to an incident of concern that had been reported to a member of staff. In addition MSS Care failed to inform the Care Quality Commission when a notifiable event had occurred.

Is the service effective?

People's health and care needs had been assessed during face-to-face meetings between senior members of MSS Care staff and the individual in need of care and support. We saw care plans had been developed from information gathered during the assessment process and had been reviewed regularly.

We found risk assessments had been completed and where risks were identified appropriate mitigation measures had been developed.

We found that there were sufficient numbers of staff available to provide all planned care visits with an additional member of staff on call and available to provide care at short notice when required.

Is the service caring?

People who used the service told us they were well cared for. Comments received included 'they are awfully good, I don't think I would be alive without them' 'I am perfectly happy, no complaints whatsoever' and "I've got the perfect agency now, I don't want them to change'.

We saw that the registered manager had a detailed understanding of the care needs of people who used the service and during our visits to people's homes. We saw the manager offered to provide appropriate additional care and support to people during these visits.

People's preferences, interests, and care needs had been recorded during the care assessment process. We found that care and support had been provided in accordance with people's expressed wishes.

Is the service responsive?

Although there were appropriate systems in place for the recording of accidents and complaints these had not been used in relation to a number of recent incidents. This meant the service was unable to learn from adverse incidents as they had not been appropriately investigated.

We found that MSS care had not responded appropriately on occasions where staff had been unable to provide care and that as a result care visits had been missed. Members of MMS care staff told us 'I've had to do double handed visits on my own as no one turned to help' and 'some care visits have been missed because management failed to cover them'.

Is the service well led?

The provider and registered manger accepted that there had been some recent issues with the leadership of MSS Care. The provider stated 'we took our eye off the ball'. People who used the service told us 'since Christmas it has gone downhill a bit but in the last month it has got quite good again' and 'I wouldn't recommend them because of the communications issues but they do have some great carers'.

Staff also reported that there had been problems with the leadership of MMS Care. Staff comments included 'organisation isn't the best' and 'management could be better, things don't always get sorted out'. The provider had identified that staff morale was low and the records of the most recent team meeting showed that these issues had been discussed openly with staff.

A number of new members of staff had been appointed but appropriate training and support for new members of staff had not been supplied. Members of staff told us 'I've not had much training' and 'I did some shadowing shifts and then I was out on my own'.

People's privacy, dignity and independence were respected and care was planned and delivered in a way that was intended to ensure people's safety and welfare.

People's health, safety and welfare was protected when more than one provider was involved in their care because the provider worked in co-operation with others.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Comments from people that used the service included 'No complaints, I am very content and cannot find fault with anything', 'Really excellent care', and 'It is good to be able to stay independent at the same time as being looked after'. One person said care staff were sometimes late for visits, but they usually phoned ahead if this was going to happen.

People's privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection and from unsafe or unsuitable equipment.

People were cared for by sufficient numbers of staff, who were supported to deliver care and treatment safely and to an appropriate standard.