Archived: MiHomecare - Bristol

During the inspection we spoke with the regional director responsible for the service and the provider had appointed a project manager to oversee the operation of the service in the absence of a registered manager. During the inspection, the regional director told us that as a result of current staffing issues, the service had voluntarily placed a stop on undertaking new care packages or significantly increasing existing care packages. This has been done to ensure that a safe and manageable delivery of current care packages was achieved. The regional director also sent us formal correspondence that confirmed this following the inspection.

Is the service safe?

Some aspects of the service were not safe and these had not been identified or addressed by the provider.

The planning and delivery of care was not always safe. People and their relatives told us that on occasions, care appointments at their home had been cancelled at very short notice and that staff were sometimes late.

The service had missed visits to people's homes through the absence of robust systems and poor staff practice. The missed visits had resulted in people not receiving the care they needed, for example being prompted to take their prescribed medicines.

The provider had not ensured there was always a safe level of suitably trained and skilled staff on duty to meet people's care needs. As a result, appointments had been missed, cancelled or attended late.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they intend to make in relation to the planning and delivery of care and ensuring the service has the correct number of staff to provide safe care.

Is the service caring?

Some aspects of the service did not demonstrate the provider had ensured the highest level of care possible had been delivered to people.

People who used the service and their relatives told us the staff that provided the care to them in their homes delivered good quality care. One person told us, 'They (the staff) are very good, I can't fault them.' Another person we spoke with described the care staff as 'kind and polite' and one person told us the staff were 'lovely' and spoke highly of the care they received.

Examples of where people had not received the support they needed were identified. We found that people had missed medicines due to staff not attending their homes to meet their needs. Other people had cancelled appointments as the service had failed to provide their agreed care on time and some people had called the service concerned at the amount of different staff they received care from.

Staff we spoke with told us that due to the current demands placed on them, agreed appointment times had sometimes been shortened to ensure all appointments could be made. Staff told us they currently have very little opportunity to spend time with people and speak with them, and others told us they were currently very rushed when providing care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they intend to make in relation to improving the continuity of care provided.

Is the service well led?

Some aspects of the service were not well led as action had not been taken to rectify shortfalls.

Systems available within the service to monitor the delivery of care were not being used effectively.

Where staff failings in relation to attendances at care appointments had been identified, no action had been taken to address this to assist in the monitoring of care delivery.

Where the provider had a legal requirement to notify the Care Quality Commission of a specific incident, they had failed to do this.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they intend to make in relation to monitoring staff delivery of care and notifications.

We viewed four care plans. The planning was centred on the individual and considered all aspects of their individual circumstances. The care plans were detailed and specific to the individual's needs and preferences.

Daily records accurately recorded the personal care provided in accordance with the specific instructions in the care plan. This meant that the person using the service was protected against the risk of inappropriate care and treatment arising from a lack of proper information about them.

We found that the provider had implemented appropriate systems to regularly assess and monitor the quality of the services provided.

We spoke with two people and five relatives of people who used the service. The people we spoke with who used the service provided mixed feedback regarding their experience of the service. Comments included: 'the carers are respectful and very kind' and 'they understand my husband's needs'. Some people expressed concerns regarding continuity of carers, not being sent rotas and the office not advising of late calls.

We viewed four care plans. The planning was centred on the individual and considered all aspects of their individual circumstances. The care plans were specific to the individual's needs and preferences.

Daily records did not accurately record the personal care provided in accordance with the specific instructions in the care plan. This meant that the person using the service was not protected against the risk of inappropriate care and treatment arising from a lack of proper information about them.

Recruitment procedures protected people from the risk of being supported by unsuitable care staff because references had been fully checked.

We found that the provider had inadequate systems in place to regularly assess and monitor the quality of the services provided.