Archived: MiHomecare - Boston

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful and attentive. They considered staff to be kind and to be genuinely committed to helping them.

Is the service responsive?

We found that the service was responsive. This was because people's individual needs for care had been assessed and met. Staff knew about each person's care needs, choices and preferred routines. People said that their care needs were met in a flexible way. They found that staff were happy to adjust the assistance they provided according to their changing needs and wishes.

Is the service safe?

We found that the service was safe. This was because staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse. This included having policies and procedures to guide staff in the correct application of the Mental Capacity Act 2005. This helped to ensure that when necessary people were supported to make decisions that were in their best interests. However, most staff had not received the updated training the provider said they needed in relation to keeping people safe from abuse and promoting their best interests.

We have said that the provider may find it useful to note that this shortfall increased the risk that not all staff would have the competencies they needed to safeguard people from abuse and to promote their best interests.

There were reliable arrangements for helping people to manage their medication so that they used it safely. However, we found that most staff had not received the updated training the provider said they needed in relation to managing medication.

We have said that the provider may find it useful to note that this shortfall increased the risk that not all staff would have the competencies they needed to safely support people to use medication.

Is the service effective?

We found that the service was effective. This was because there were adequate arrangements to ensure that visits were usually completed on time.

However, the provider had not recruited to all of the care worker posts it needed. This had resulted in problems completing all visits on time when a member of staff was absent from work. Five of the 21 people we spoke with and four of the six staff thought that the provider should do more to address this problem. They said that if more staff were available it would be easier to cover absences so that all visits could be completed on time.

We have said that the provider may find it useful to note that the number of care workers it employed had not enabled it to always complete visits at the times people expected and wanted.

Is the service well led?

We found that the service was well led. Although the manager was not registered with us, she had submitted an application for this to happen. The law says that the provider is required to have a registered manager. This is because we need to establish that there is someone in charge who has the knowledge and skills necessary to ensure that the service is caring and meets people's support needs.

The provider had consulted with people who used the service so that their views could be taken into account when making improvements.

The provider had completed a number of important quality checks. These had helped it to ensure that people safely and reliably received the care they needed at home. However, we noted that although quality checks had identified shortfalls in training effective action had not been taken to address the problem.

The provider may find it useful to note that not always having robust arrangements to address problems reduced its ability to monitor and develop the service that people received.

We observed staff speaking to people on the telephone and noted they spoke politely and patiently to people.

When we looked at the daily records we found they reflected the care people required. The people we spoke with told us their care notes were kept up to date.

We asked people about the times of their visits and one person told us, 'Carers do not always stay as long as they should." Another person said, "Carers should be given more time for a visit instead of always having to hurry."

Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities in order to provide safe care to people. We saw staff had received training and support to provide them with the skills necessary to meet the needs of their roles.

One person told us, 'I am given choice about dressing and bathing and carers will do most things I ask'.

During our visit we looked at care plans and found they lacked detail as to how care should be provided. Risks were identified but plans were not in place to support the management of the risks.

We looked at medicine records and found they were not completed according to the provider's policy for the administration of medicines. It was not clear from the records if people had received their medicines or not.