Archived: Major Oak Homecare

Head Office aka Major Oak Homecare is a domiciliary care agency. It provides personal care to people living in their own homes in the community. The service operates in and around the city of Lincoln. At the time of our inspection, 43 people were using the service.

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

Since our last inspection, the provider had taken some steps to strengthen the monitoring of service quality and to mitigate risks to people's safety. As a result, there had been recent improvements in medicines management and the deployment of staffing resources to meet people's needs. However, significant inconsistencies remained and further action was required.

The provider had assessed risks to people's safety but, for some risks, staff required more detailed guidance to help manage them safely. The provider had strengthened infection control measures in response to the COVID-19 pandemic, although action was required to ensure used PPE was disposed of safely.

The provider had failed to submit an action plan requested after our last inspection of the service. The provider had also failed to display the inspection rating on their website.

Staff knew how to recognise and report any concerns to keep people safe from harm. Staff recruitment was safe. There was some evidence of organisational learning from incidents and events.

Most people provided positive feedback on the caring nature of staff. Despite concerns about call timings and staffing continuity, most people were also generally satisfied with the management of the service overall. Staff were happy in their work and spoke highly of the positive impact made by the new service manager.

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 6 May 2020) and there was a breach of regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected:

We received concerns about the safety of care delivery and organisational governance. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No significant issues of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions 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. The service has been rated as Requires Improvement at the last two inspections.

Enforcement:

At this inspection we have identified a continued breach of regulations due to continued shortfalls in organisational governance and the monitoring of service quality.

Please see the action we have told the provider to take at the end of this report.

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.

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

About the service

Major Oak homecare is a domiciliary home care service providing personal care to adults with personal care needs. Major Oak were providing a service to 23 people at the time of the inspection.

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

Risks to people’s safety were identified and assessed. However, care plans did not always inform staff how to lower risks to people’s safety. When incidents occurred, they were not always investigated appropriately. This meant lessons were not always learnt and there was no monitoring of potential themes to help reduce the risk of incidents happening again. Medication administration records were incomplete, and audits did not always pick up potential errors. Infection control practices were not always followed by staff. People received visits from regular care staff, but staff were not always on time. People felt safe with staff. Staff knew what to do if they suspected abuse was happening and the provider’s safeguarding policy was clear and accessible.

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 support this practice. We have made a recommendation to the provider about this.

People did not have the required assessments in place before decisions were made on their behalf. The registered manager had not ensured relatives were legally allowed to contribute to decisions about people’s care. Training was not always completed in accordance with the requirement of the provider. Some people told us staff did not always put things away and leave the area they had been working in tidy, people said staff’s knowledge and skills varied. Staff received an induction and were introduced to people before working alone. People were supported to eat and drink where needed. Staff worked with other agencies to provide consistent care. People’s needs were assessed, and care was mostly delivered in a way which met people’s needs.

People, relatives and professionals thought the registered manager and care staff were kind and caring. People were encouraged to express their views and be involved in making decisions about their care which staff respected. People were given privacy to maintain their dignity and were enabled to be as independent as possible.

The registered manager had not considered people’s communication needs when providing them with information about the service. People’s informal complaints were resolved, however information on how to make a formal complaint was not clear. People had the opportunity to discuss their end of life wishes and had a care plan in place.

The registered manager had not updated their training in line with the provider’s requirements. We have made a recommendation about this.

Audits were ineffective and not always completed. Care staff understood their own role and responsibilities. The provider had not sought feedback from people to assess the quality of the service. Staff were happy and enjoyed their work, staff felt encouraged by the registered manager to provide a caring service for people

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

Why we inspected

This service was registered with us on 5 March 2019 and this is the first inspection.

Enforcement

We found no evidence that people had been harmed; however, systems were either not in place or robust enough to demonstrate safety was effectively managed. We have identified a breach in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.