Link Medical Staffing Solutions Ltd Haverhill Branch

Link Medical Care Staffing Solutions Ltd Haverhill Branch is a domiciliary care service providing support to people in their own homes. 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 our visit there were 18 people in receipt of the regulated activity of 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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

The provider did not have adequate knowledge of the ‘Right Support, Right Care, Right Culture’ guidance. In addition, in July 2022 the Health and Care Act 2022 introduced a requirement that regulated service providers ensure their staff receive training on learning disability and autism which is appropriate to the person’s role. The Oliver McGowan Mandatory Training on Learning Disability and Autism is the standardised training that was developed for this purpose and is the government's preferred and recommended training for health and social care staff to undertake.¿The provider had not heard about this training and staff working for Link Medical Staffing Solutions had not undertaken it.

The provider was not able to demonstrate how they would meet the underpinning principles of Right Support, Right Care, Right Culture’. We signposted the provider to relevant information.

People shared that they did not always receive their care and support visits from staff they knew. They told us where changes occurred, these were not always communicated in a timely manner.

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 did not always support this practice.

Mechanisms for auditing were in place, but they needed to be strengthened and clear records of outcome and actions needed maintained. People and their relatives required increased formal opportunities to feedback about the care they received, and the provider needed to improve how they evidenced actions in response to feedback. Many members of staff spoke of a lack of communication within the service.

People spoke positively about the care they received, and the staff providing their care. People were safely supported with their medicines and systems were in place to ensure good infection prevention and control practice was in place.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 September 2022). At our last inspection we found breaches of the regulations and we issued the provider with a warning notice. At this inspection we found improvements were still needed in some areas, but progress had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to regulation’s 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement based on the findings of this inspection.

Whilst there were some improvements, we have found evidence that the provider still needs to make further improvements. Please see the Safe, Effective and Well-Led sections of this full report

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Link Medical Staffing Solutions on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have made a recommendation that the provider research current guidance and best practice in supporting people who have a learning disability and autistic people.

Follow up

We will meet with the provider and request an action plan 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.

Link Medical Care Staffing Solutions Ltd Haverhill Branch is a domiciliary care service providing support to people in their own homes. 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 our visit there were 17 people in receipt of the regulated activity of personal care.

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

The provider did not have fully effective systems to monitor and assess the quality and safety of the service people received. Record keeping in areas such as care planning and risk assessing was not robust and did not support the consistent delivery of safe and effective care. A focus on meeting the requirements of the last inspection has resulted in other areas of the service and systems not being as closely monitored as needed.

At our previous inspection we found concerns with the oversight of the service and the management of infection control risk and the safe recruitment of staff. At that inspection this was a breach of the Regulations and we issued the provider with a warning notice. At this inspection whilst the provider had met the warning notice and there were some improvements, further work was still needed to make quality assurance systems more effective, and the provider remained in breach.

Quality assurance checks were not always effective and robust enough to provide effective oversight of the service as they had failed to identify the issues we found at this inspection. The provider acknowledged that improvements were needed in their governance systems and told us that they would take action to address this including the recruitment of a skilled and experienced manager.

Risks associated with people's care were not consistently assessed and well managed and some care plans were not completed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Improvements were needed to make sure best interests’ decisions were made where people lacked the capacity to make their own decisions. We have made a recommendation that the provider ensure people's care and support needs are fully assessed, planned and completed in line with recognised Mental Capacity Act best practice and current legislation

Despite these concerns, people and their relatives were happy with the service and complimentary about the care they received. One person’s relative said, “I would highly recommend [Link Medical Staffing Solutions] to anyone. They are absolutely accommodating, they actually listened and wanted to help.”

People and their relatives told us they felt safe with the care provided and that they were supported by a regular team of care workers who attended their calls on time and stayed for the full duration of their visit.

People told us they received the support they required with their medicines however, the systems in place to oversee this were not always effective. We have made a recommendation that the provider reviews their approach to the auditing of medication administration records so that any gaps in records are explored and there is evidence of appropriate action being taken in response to prevent a reoccurrence.

There was improved oversight of care calls through an electronic system the provider had introduced.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 9 September 2021) and there were breaches of regulation. Following the last inspection, we issued the provider with a warning notice relating to the breach of Regulation 17 Good Governance. We told the provider they needed to be compliant with the Regulations by 5 November 2021.

We have found improvements but also evidence that the provider needs to further their oversight and auditing. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This inspection was carried out in order for us to follow up on a warning notice we issued the provider with.

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 in relation to safe care and treatment and good governance. 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

We will meet with the provider and request an action plan 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.

Link Medical Care Staffing Solutions Ltd Haverhill Branch is a domiciliary care service providing support to people in their own homes. 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 our visit there were 11 people in receipt of the regulated activity of personal care.

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

At our previous inspection we found some systems for checking the quality and safety of the service were not in place putting people at risk of harm. At that inspection this was a breach of the Regulations. At this inspection improvements were still needed to make quality assurance systems more effective, and the provider remained in breach.

The provider did not have an effective system to monitor and assess the quality and safety of the service people received. We found failings in the service's infection prevention systems which increased the risk of the transmission of COVID-19, and placed people at increased risk.

People were supported by a staff team who were not always safely recruited, whilst there were improvements overall to the providers recruitment processes, this needed to be applied consistently.

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

Rating at last inspection and update

This service was rated Requires Improvement at the last inspection published on 15 January 2020

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

We undertook this focused inspection in response to a concern and to follow up on the previous breach of Regulation 12 [Safe Care and Treatment] to check the provider had followed their action plan and to confirm if they now met legal requirements. A decision was made for us to inspect and examine those risks.

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12, safe care and treatment and Regulation 17 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 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 return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Link Medical Staffing Solutions Ltd Haverhill Branch is a domiciliary care service providing support to people in their own homes.

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 our visit there were 23 people in receipt of the regulated activity of personal care.

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

Improvements continued to be needed to the safe management of medicines. Medicines administration records were not always clear or fully completed.

People felt safe with the service they received. There were systems in place to protect people from the risk of infections.

Recruitment practices had been improved and were safer. The provider undertook the necessary pre-employment checks prior to new staff working at the service to ensure they were suitable for the job role of providing care to people.

There was increased oversight however, governance systems required further strengthening as systems in place did not identify areas where safety was being compromised.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 18 September 2019) and there were two breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulation(s). This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 1 and 13 August 2019. Breaches of legal requirements were found in safe care and treatment and good governance and we issued the provider with a warning notice for their non-compliance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Link Medical Staffing Solutions on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person failed to ensure risks relating to the safe management of medicines were assessed and managed. Please see the action we have told the provider to take at the end of this report.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 our visit there were 23 people in receipt of the regulated activity of personal care.

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

Safe recruitment practices were still not being followed. Recruitment records showed several staff were working without the necessary pre-employment checks which placed people at risk of harm.

Medicines were not always managed in a safe or proper way. Medicines administration records were not always clear or fully completed.

People were not supported to have maximum choice and control of their lives in line with the principles of the Mental Capacity Act. Assessments had not been completed to ensure people were supported in the least restrictive way possible. The policies and systems in place at the time of the inspection did not support this practice.

The provider had commenced checks of staff competency and was ensuring that regular ‘spot checks’ of staff practice were now being made.

People told us they were treated with kindness by the carers and were involved in making decisions about their care.

People were treated with respect and their privacy and dignity was protected. People were supported and encouraged to remain independent.

People were supported to meet their health care needs, when necessary.

Some improvements had been made since our last inspection. People had more detailed care plans and the recording of care delivered by staff was more detailed.

Governance systems required strengthening as systems in place did not identify areas where quality and safety were being compromised.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 3 September 2018) and there were multiple breaches of regulation. 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 and the provider was still in breach of regulation 11, the need for consent, regulation 12, safe care and treatment, regulation 17 good governance and regulation 19, fit and proper persons employed. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in post at the time of our inspection. The registered manager was also the owner of the provider company. We have referred to this person as the ‘provider’ throughout this report. A registered manager is a person who has registered with the Care Quality Commission (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.

This was the service's first inspection. The provider first registered with CQC in September 2017. This inspection was brought forward due to a number of concerns we received about the service. At this inspection, the service was rated requires improvement overall. We found they were in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to implement a quality monitoring system to ensure the agency

functioned safely and effectively. This meant they were not aware of issues such as inconsistencies with recruitment practice. The lack of effective audits also meant the provider had not identified a wide range of records relating to people's needs were missing from the service. The provider's governance arrangements had failed to identify when things had gone wrong and take action to put this right.

Recruitment measures were not robust in contributing to protecting people from unsuitable staff being employed. The provider had failed to monitor the quality and safety of the service, including spot checks of staff practice, supervisions and audits of care records.

Staff did not have sufficient formal opportunities to discuss their performance or their training and development needs.

Care plans were not all reflective of people’s current support needs; the information within them was not always detailed.

People knew how to raise complaints and concerns however complaints were not compiled to show how the service had analysed and responded to information gathered or used this information to make improvements to the service.

People who used the service and their relatives spoke highly about staff and told us they were caring. They said staff were respectful at all times and they were encouraged to remain independent.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.