Cmichaels Healthcare

CMichaels Healthcare is a domiciliary care agency registered to provide personal care to people living 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 the inspection the service supported 39 people.

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

Staff did not always have access to information to enable them to support people safely in certain circumstances. People told us that the manager was committed to good care and that staff followed guidance from families and care plans. The provider had safeguarding systems in place and staff were well-informed in how to keep people safe.

Staff were knowledgeable about infection prevention and control (IPC) and the use of personal protective equipment.

People and their relatives were given the opportunity to be involved in the assessment of needs and preferences for services provided to them. Staff received induction training. Staff supported people to prepare meals and to eat and drink. People were supported by staff to book and attend medical appointments. People received support in keeping with the principles of the Mental Capacity Act 2005 (MCA).

People had positive experiences of how they were treated and supported. People’s privacy and dignity is respected.

People and their relatives told us some staff lacked the English language skills to understand regional dialects in the United Kingdom.

The registered manager usually had oversight of the service. There a a few instances highlighted within this report of where oversight was lacking. The registered manager was open and honest with people when things went wrong.

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

Rating at last inspection:

Rating at last inspection and update:

The last rating for this service was Inadequate (published 07 March 2023).

This service has been in Special Measures since 07 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At our last inspection we recommended that the provider updates care plans with more detail and improve systems when recruiting staff. At this inspection we found significant improvement had been made, however further work is required.

The overall rating for the service has changed from Inadequate to Requires Improvement based on the findings of this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Well Led section of this full report.

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

Enforcement and Recommendations

We identified a breach in relation to assessment of risks and needs at this inspection.

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 request an action plan from 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, which will help inform when we next inspect.

Cmichaels Healthcare is a domiciliary care agency registered to provide personal care to people living 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 the inspection the service supported 72 people.

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

Risks to people’s safety and wellbeing were not always assessed, mitigated or managed. Staff did not have access to information to enable safe administration of medicines. The provider’s recruitment policy was not always followed, and recruitment practices were not safe or effective. The provider had safeguarding systems in place and staff were well-informed in how to keep people safe.

Staff were knowledgeable about infection prevention and control (IPC) and the use of personal protective equipment. However, feedback from people on staff use of PPE was mixed.

People and their relatives were not always given the opportunity to be involved in the assessment of needs and preferences for services provided to them. Staff received induction training; however, people’s needs were not always met by staff with the relevant knowledge and skills. Staff supported people to prepare meals and to eat and drink. People were supported by staff to book and attend medical appointments. People received support in keeping with the principles of the Mental Capacity Act 2005 (MCA).

People had very different experiences of how they were treated and supported. People’s privacy and dignity was not always respected, and they did not always feel able to express their views. The complaints process did not always lead to resolution or service improvements.

People and their relatives told us language barriers sometimes affected how their services were delivered.

Registered managers did not have oversight of the service. Registered managers were open and honest with people when things went wrong.

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 good (published 13 March 2020).

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the questions of Safe and Well Led. We inspected and found concerns about people’s safety and the governance of the service, so we widened the scope of the inspection to include Effective, Caring and Responsive.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

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

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 identified breaches in relation to staff recruitment, assessment of risks, administration of medicines, person centred care and oversight of the service, at this inspection.

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 request an action plan from 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, which will help inform when we next inspect.

Special Measures: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Cmichaels Healthcare is a small domiciliary care agency registered to provide personal care to people living in their own homes. The agency currently provides a service for people discharged from hospital and supported with end of life care. The service is also registered to provide a service for older people, people

living with dementia, younger adults, children 13 to 18, learning disability and mental health. At the time of the inspection the service supported seven people.

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

People were supported by staff that were caring, compassionate and treated them with dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people. Staff were very knowledgeable about people’s changing needs.

Relatives told us people were well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible. People were supported by staff who had the skills and knowledge to meet their needs.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Where people lacked capacity, 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.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

Management worked well to lead the staff team in their roles and ensure people received a good service. Audits were completed by management to check the quality and safety of the service.

Rating at last inspection: The last rating for this service was requires improvement (published 20 February 2019). We found the service was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Cmichaels Healthcare is a small domiciliary care agency registered to provide personal care to people living in their own homes. The agency currently provides a service for people discharged from hospital and supported with end of life care. The service is also registered to provide a service for older people, people living with dementia, younger adults, children 13 to 18, learning disability and mental health. At the time of the inspection the service supported three people.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

People’s experience of using this service:

The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required improvement. This meant the provider was not meeting the minimum standards required by law and you can see what action we have asked the provider to take at the end of this report.

People were protected from potential risk of harm but risk assessments were not always written to the person’s individual support needs to ensure staff provided a consistent level of care. People’s care and support needs were assessed although in parts, the assessments were generic and could be more personalised. Although the service appeared to specialise in the provision of care for people at their end of life, the provider could do more to ensure people’s end of life wishes were clearly explained within their care plans to ensure staff supported people consistently with their preferences for care at the end of their life.

Peoples’ relatives told us their family member was safe and there were sufficient numbers of staff that were safely recruited to support people. Staff had completed medication training but at the time of the inspection there was no support being given to people with their medicine requirements. Staff had access to equipment and clothing that protected people from cross infection.

Staff received the training they required to meet people’s needs. People accessed healthcare services to ensure they received ongoing healthcare support. People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way.

People were supported by kind and caring staff that knew them well. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

People were supported by staff that knew their preferences. There were two complaints made since the service started that had been investigated and resolved. People and their families knew who to contact if they had any complaints.

People and their relatives’ views were sought about the quality of the care being provided. Staff felt supported by the management team.

People, their relatives and staff were happy with the way the service was managed and the provider worked well with partner organisations to ensure people’s needs were met.

The service did not meet some of the characteristics of Good in two areas and more information is in the detailed findings below.

Rating at last inspection:

This was the service’s first inspection since their registration in November 2017.

Why we inspected:

This was a planned inspection that took place on the 16 January 2019.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

As we have rated the service as requires improvement, we will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.