MK Executive Care

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.

MK Executive Care is registered to provide personal care to people living in supported living settings, to enable people to live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. At the time of this inspection MK Executive Care were not providing personal care to any people living in supported living settings.

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

People told us they felt safe with the staff providing their care. Individual risks to people’s safety were assessed and risk assessments were in place for staff to follow.

People’s dependency levels were assessed and enough staff were deployed to meet people's needs. Recruitment systems ensured only suitable staff were employed to work at the service.

People were supported safely with their medicines. Staff received training in the safe administration of medicines and their competency to safely administer medicines was assessed. Staff received training on infection control and followed the procedures to prevent the spread of infections.

People told us they received support from staff they knew and trusted. We received comments such as, "The staff were nice and kind to me," and, "It is a caring service, I’m happy with the staff who come to me; I’m pleased I have them."

People received support to eat and drink enough to maintain a balanced diet.

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.

People and / or relatives were involved in putting together their care plans. Information was available on people's likes and dislikes, hobbies and interests. This meant staff could engage with people discussing topics that were of interest to them. Records showed care plans were reviewed regularly and updated as people's needs changed.

People's communication needs were identified and described in individual communication support plans.

A complaints policy was available, and records showed complaints were responded to appropriately.

An electronic care monitoring system was embedded into practice and was used to enable the registered manager and the management team to have full oversight over all aspects of the service. The system tracked care calls and created alerts when calls took place outside of the scheduled hours. Routine audits and checks were completed to monitor the quality of the service, such as care plan and medicine record audits, and care visit monitoring.

Feedback was sought from people using the service to identify areas for further improvement. People and relatives spoke positively about the care and support they received from the service.

Notifications were submitted to the Care Quality Commission (CQC) as required by law, without delay, and contained the necessary details. The ratings from the previous inspection were displayed on the provider website and within the office.

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

Why we inspected

This was a planned comprehensive inspection based on the previous rating.

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 February 2022).

At the last comprehensive Inspection (published on 29 October 2021) the provider was in breach of regulations 9 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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.

The management quality assurance systems had been strengthened to ensure the provider had oversight of key areas of the service. People using the service told us the main area of dissatisfaction was around timekeeping. In response the provider had increased welfare calls to people using the service and spot checks on staff to monitor care practice and provide any support needed. The provider had also recently set up a service user forum for people to provide feedback direct to them.

People’s care records contained details relating to their care needs and equality characteristics including physical and mental health needs. The care plan summaries did not always contain specific details on how risks were to be managed, for example risks relating to skin integrity and moving and handling. The provider said they were working on improving the quality of information, so the care plan summaries contained clear information for staff to follow.

An electronic care monitoring system had recently been introduced, which tracked care calls and created alerts when staff had not attended calls or when calls took place outside of the scheduled time. The provider said they were working to improve the monitoring systems to ensure people received their calls punctually.

The safeguarding and complaints policies had been reviewed and systems had been strengthened to respond and record safeguarding concerns and complaints. Training in key areas, including safeguarding children and mental health had been provided to all care staff. This reduced the risk of people receiving unsafe care or care that did not meet their needs.

Enough staff were deployed to meet people’s personal care needs. Recruitment systems were in place to ensure suitable staff were employed at the service.

Notifications were submitted to the Care Quality Commission (CQC) as required by law, without delay, and contained the necessary details. The ratings from the previous inspection were displayed on the provider website and within the office.

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

Why we inspected

This was a planned focused inspection based on the previous rating.

The last rating for this service was Inadequate (published 29 October 2021) and there were multiple breaches of regulation. We issued Warning Notices under Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008.

The provider completed an action plan after the last inspection to show what they would do and by when to improve and meet the breaches in regulations. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions, Safe and Well-Led which contain those requirements.

At this inspection we found enough improvements had been made and the provider was no longer in breach of the regulations.

This service has been in Special Measures since 29 October 2021. 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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.

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

The provider failed to have adequate systems in place to assess, monitor, mitigate and review the risks to people's health, safety and welfare. The provider did not demonstrate how they consistently investigated and learned from safeguarding incidents, complaints, accident or incidents and used these experiences to improve safe care delivery. People were at risk of receiving unsafe care that did not meet their needs and placed them at heightened risk of harm or abuse.

A lack of robust governance and quality assurance systems meant the provider did not have effective management oversight of key areas of the service. They could not assure themselves of the quality and safety of care provision to people receiving care and support. Improvements were required to the timeliness of responses for requests for information from external agencies such as safeguarding teams and commissioners.

Training in key areas, including safeguarding children, mental health and meeting people's oral health was not provided to all care staff. This meant all care staff were not fully trained for their roles, placing people at heightened risk of receiving unsafe care or care that did not meet their needs.

People did not always receive their personal care calls punctually or which lasted for the full duration. People did not always have access to staff on time to provide support with personal care, administering medicines as prescribed and support with eating and drinking.

People’s care records did not always contain specific details relating to their holistic care needs and equality characteristics including their physical and mental health needs. The care planning processes did not always ensure people received person-centred care.

The provider was not fully meeting the requirements of the Accessible Information Standard for people with sensory impairments.

We received mixed comments from people using the service and relatives on how staff preserved their privacy and dignity when providing personal care.

Further improvement was needed to ensure statutory CQC notifications were submitted to the Care Quality Commission (CQC) as required by law, without delay, and contain sufficient detail.

People were not always supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We have made a recommendation about the Mental Capacity Act.

Staff knew how to recognise the signs of abuse. People were involved in decisions about their care and positive feedback was received about their preferences being supported. The management team undertook visits to people's homes and spot checks of staff practice to monitor practice and provide any support needed. Recent questionnaires received from people and their representatives indicated many people were satisfied with the care they received.

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 3 February 2021) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made. We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection. It was also prompted in part due to increased concerns received by CQC from other stakeholders. These included, concerns of people using the service experiencing missed care calls. The providers lack of managerial oversight and slow response to requests for further information in connection with safeguarding and complaint investigations. Based on these concerns a decision was made for us to inspect and examine those risks.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for MK Executive Care on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 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.

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

MK Executive Care is a domiciliary care service, which provides personal care to children and older adults. At the time of the inspection 68 people were receiving care from the service.

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

The provider had not consistently maintained oversight of the safety and quality of the service. The systems to monitor and handle safeguarding concerns and complaints were not effective, to ensure all people using the service were prevented from receiving unsafe care and treatment and avoidable harm or risk of harm.

Staff recruitment records contained the necessary pre-employment checks. There was enough staff to meet people’s needs. Staff received induction training and refresher training to update their knowledge and skills. Where the provider held the responsibility, people’s medicines were appropriately managed.

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 had access to and were using personal protective equipment (PPE) to prevent the spread of infection.

Why we inspected

We received concerns in relation to poor management of safeguarding incidents and complaints. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

The last rating for this service was good (report published 19 July 2019).

We reviewed the information we held about the service. No areas 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 has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for MK Executive Care on our website at www.cqc.org.uk

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safety and management of the service at this inspection.

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

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

MK Executive Care is a domiciliary care agency providing personal care to people (including children) living 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 inspection 34 people were receiving personal care.

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

Since the last inspection the provider had started providing care for children. Feedback received from the local safeguarding authority raised concerns about the registered managers understanding of the procedures for reporting children’s safeguarding concerns to the Local Area Designated Officer (LADO). The registered manager explained they would be attending further training to ensure they were fully up to date with the reporting procedures.

There was limited information available on the actions taken by the registered manager in response to safeguarding concerns. The registered manager said going forward they would ensure full detailed records would be retained of the actions they had taken.

Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing support matched the level of assessed needs.

Staff were trained to support people effectively. Systems were in place to ensure staff received supervision and support to be confident in their roles.

People were supported to eat and drink. Staff ensured people’s healthcare needs were met, and any deterioration in health was brought to the attention of health professionals as required. Staff followed the advice of health care professionals in providing people’s care and support.

Staff treated people with kindness, dignity and respect. They knew about the needs and preferences of the people they supported.

People and their representatives were involved in planning their care as much as was possible. Their support plans reflected their needs, and preferences.

A complaints system was in place. The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

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.

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

The last rating for this service was Good (report published 30 November 2016). Since this rating was awarded the provider has altered its legal entity. This service was registered with us under the new legal entity on 15 April 2019 and this is the first inspection.

We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.