Archived: MSC Home Care Limited

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

MSC Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and people who may have a disability or conditions such as dementia. There were 80 people using the service at the time of our inspection.

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.

There was 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.

We found there was lack of oversight and coordination of the service and attempts to put systems in place had not been effective. Issues were not always being identified which placed people at continued risk of harm.

People did not have risks associated with their care or health conditions assessed, planned for or mitigated which left them at risk of harm. Staff did not have guidance to assist them to keep people safe at all times. We could not be assured that people were always receiving their medicines as prescribed.

Staff were not always recruited safely and staff were not always effectively deployed to ensure that everyone received their planned care. People were not always protected and lessons were not always learned as timely action was not always taken.

Staff did not always have the knowledge and skills to care for people effectively and staff had mixed feedback about the support they received. People’s rights were not protected as their capacity had not been assessed when necessary and representatives were consenting to care when their legal right to had not been verified. There was no guidance and staff did not know what to do in relation to some peoples’ health conditions. Referral were made to other health professional but timely action was not always taken to ensure this guidance was incorporated into people’s care and care plans.

Risks associated with people eating were not always considered when necessary, however some people told us they were offered a choice of food and drinks and the food was well-presented.

People did not always have a consistent team of staff which they felt impacted upon the quality of support they received. We were also told of poor conduct by some staff member which caused people and relatives upset. People were not always informed if their staff were going to be late.

There were minimal care plans in place by the service and people and relatives found the lack of guidance for staff to be a problem and meant care was not always personalised. If people raised concerns they did not always feel listened to and action was not always taken or responded to.

People, relatives and staff did not find the service to be well run and found communication to be sometimes difficult. People did not always feel they could speak to someone from the service if they needed to.

People and relatives found their individual staff kind and caring.

People were protected from the risk of cross infection as staff had personal protective equipment.

The service was not supporting anyone who required palliative care.

This announced inspection was carried out by one inspector and an expert by experience. The expert by experience had knowledge of care services including domiciliary services.

There was a registered manager in the service. 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.

We rated this service as Requires Improvement in September 2016. Following the last inspection we asked the provider to complete an action plan to show what they would do to improve the key questions ‘Is this service effective, responsive and well led?’ to at least good. This was because we found quality monitoring systems were not always effective. The provider had not identified concerns with people not receiving the correct length of support time and recording of medicines. People generally received the support visit on time but some people did not have their support for the agreed length of time. The views of people were sought but this was not used to drive improvements within the service. We also found where people lacked capacity, the provider had not gained assurances that other people were making decisions in their best interests and whether people had the required legal authority to do so.

On this inspection we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions. People were asked for their feedback on the quality of the service and their contribution supported the development of the service. The results of the survey were now reviewed and people were informed of where the service needed to make improvements and how they planned to do this. Systems were in place to identify whether people received the supported they wanted at the right time.

Improvements are needed within the key question ‘Is this service responsive?’ as people felt they did not always receive a response to the concerns they raised. Formal complaints were responded to but people did not always receive a call or information to let them know about their general concerns. People did not always know who would be providing their support as information was not provided to them; people had to ask for this information from other staff.

Risks to people’s health and wellbeing were assessed and plans were in place to monitor people and to assist them in a safe manner. The staff understood how to protect people from harm and were confident that any concerns would be reported and investigated by the registered manager. Some people received assistance to take medicines and records were kept to ensure that this was done safely. There were safe recruitment procedures in place to ensure new staff were suitable to work with people.

People felt the staff had the right skills to provide the care they wanted. People’s health needs were monitored and the staff worked with health care professionals and helped people to attend appointments where necessary. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed need.

People developed good relationships with staff and the registered manager. Care was planned and reviewed with people and the provider ensured that people’s choices were followed. People’s privacy and dignity were respected and upheld by the staff who supported them.

People had care records that included information about how they wanted to be supported and this was reviewed to reflect any changing needs. Quality assurance systems were in place to identify where improvements could be made and the provider worked with other organisations to share ideas and to develop the service. The manager promoted an open culture which put people at the heart of the service.

The service provides care and domiciliary support for older people who live in their own home in and around Stoke on Trent. At the time of the inspection 108 people were receiving a service.

There was a registered manager in the service. 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.

There were processes to monitor the quality of the service provided although these systems were not effective. The provider had not identified concerns with people not receiving the correct length of support time and recording of medicines. People generally received the support visit on time but some people did not receive their support for the agreed length of time. Travelling time was not included in the staff roster which impacted on the support people received. The views of people were sought but this was not used to drive improvements within the service.

Where people had capacity to make decisions about their own care their consent was sought before staff provided any care and support. Where people lacked capacity, the provider had not gained assurances that other people were making decisions in their best interests and whether people had the required legal authority to do so.

People were protected from the risks of abuse because staff knew how to recognise this and knew how to report their concerns. Safeguarding incidents were reported to the local authority to ensure these could be investigated.

People received care and support from staff who were well trained and knew how people liked things done. Staff received supervision and had opportunities to develop their skills to meet people’s changing needs.

People were treated with care and kindness and they were supported to be as independent as possible. Positive and caring relationships had been developed between staff and people who used the service. People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. People were supported to express their views and be involved in planning their care.

People knew how to make a complaint if they needed to. People and staff were confident they could raise any concerns or issues with staff in the office and the registered manager, knowing they would be listened to and acted on.

We found a breach 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.

We spoke with people that used the service and staff as well as other agencies who had an interest including the local authority and health professionals. Comments about the service were positive.

People's care needs were assessed and planned and there was evidence of people's involvement in decisions and consent to the care they received. People's care was regularly reviewed to ensure that information was up to date.

We saw that recruitment procedures were robust and appropriate employment checks were carried out before staff were allocated to work independently with people.

We saw that staff received support and training to enable them to undertake their role and provide the support people who used the service required.

The service was well managed but monitoring and auditing procedures, although in place did not always show how the service had improved or developed.

People who used the service felt able to raise concerns and their views about the way they were cared for were taken into account by the provider.