MH Quality Care Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Our rating for this key question is good. Robust safeguarding procedures were in place to protect people from abuse and neglect. Staff were able to tell us the processes to be followed in the event of any safeguarding incidents, accidents, complaints and concerns.

Care plans were detailed and clear, highlighting individual risks to people. However, these risks were not documented on risk reviews and risk management forms. The information was part of the people’s care plans, which meant that staff would not have quick access to information and guidance on risks without having to search through the relevant care plan. The provider understood that this was not ideal, as staff would need quick access to this information on risks should a new situation emerge or should staff be less familiar with the person they were supporting. Staff knew people well and there were no instances where a lack of separate risk assessments placed people at risk. During the inspection, the provider completed new risk assessment documentation to use alongside information contained within the care plans for all people they supported. These were assessed as good quality and detailed.

People and their relatives told us that staff were usually punctual and did not leave earlier than the allocated time for the call. Staff received ongoing training, supervision and support to ensure they had the knowledge and skills to work safely and effectively.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us that senior staff met with them to review care plans and that they also were able to provide feedback on the service during regular visits by the registered manager. They told us that they were aware how to raise complaints, safeguarding concerns and other issues directly with the registered manager and that the registered manager always followed up on any concerns.

The registered manager and the senior staff were able to demonstrate that they understood how to keep people and staff safe and that they had the knowledge to investigate any concerns fully. Staff knew about safeguarding and whistleblowing policies and were able to identify how they could raise a concern.

We saw a register of incidents and accidents which included any near misses. The registered manager told us that they used this information to improve the service and ensure that they learnt lessons from past issues.

Staff told us that they could approach the management team with any concerns they had, and for broader advice and support on people’s safety if required. They told us that training in safeguarding was good and that the registered manager usually followed up on training within team meetings to check understanding. One staff member said, “I like to treat them [people] as I want my own parents treated.”

The provider encouraged a culture of openness in which people, their relatives, health and social care professionals involved in people’s care and staff were encouraged to raise any safety concerns. Clear systems and processes were in place to ensure any such concerns were reported, monitored, investigated and learned from to put things right, learn and improve. We saw systems in place to identify safeguarding concerns such as spot checks, gathering and analysis of people’s feedback and regular training for staff. We saw evidence of discussions around risk and planning in team meeting minutes.

People told us that the registered manager was instrumental in ensuring their individual support needs were assessed and understood prior to their care starting, and that they communicated to commissioners how these would be met by the service.

Staff told us they received a full briefing on a person’s needs when their care started, including how to support people when they may be distressed. They said they were encouraged to read people’s support plans and familiarise themselves with the person’s home environment.

We did not gather evidence from partner organisation who interact with the service as part of this assessment.

An initial support plan was developed for every person referred to the service before their care commenced. This was based on the assessment of their individual needs and more detailed support plans were then developed as their care continued, as part of a ‘Golden Thread’ approach to care.

People and their relatives told us they felt safe receiving care and support from staff. They knew how to contact the provider if, at any point, they had concerns or felt unsafe. One relative told us, “The (registered) manager gave us (their) number in case we had any concerns about staff and encouraged us to call (them) even if I had slight suspicions.”

The registered manager and staff were able to demonstrate a good level of knowledge about how to protect people from abuse. They were confident that they could identify signs of abuse, such as changes in a person’s demeanour and hygiene, and were able to explain how to escalate any concerns. The management team were able to demonstrate they had robust safeguarding processes, including verifying staff knowledge after training sessions, within one-to-one supervisions and in team meetings.

One staff member told us, “I have to safeguard my service users, as they are vulnerable, and it would really break my heart if someone abused them.” Staff understood the different types of abuse and the processes they would follow to keep people safe. One staff member said, “First call would be to (registered manager), and if they didn’t deal with it I would call the council (safeguarding team).”

The provider had robust safeguarding processes in place to ensure people were protected from abuse and neglect. This included safeguarding training for staff, and regular checks on staff’s understanding of their associated responsibilities. We saw evidence that safeguarding training was followed up in team meetings. The provider completed regular audits on any concerns, complaints or safeguarding issues raised, to ensure these had been promptly and properly responded to, to identify any patterns and trends in these, and to promote learning.

We saw in feedback gathering sessions with people, the provider discussed safeguarding and how families may ask either the provider or the local authority to investigate any concerns.

People and their relatives confirmed that, when they were about to start using the service, the registered manager had met with them to complete an initial care plan, which usually took into account the person’s needs and risks to ensure that they could provide the levels of care required. This included discussions around how risks would be managed and who was responsible for for helping people to stay safe. The local authority was involved, as well as people’s relatives, in these discussions. We also saw evidence of people and their relatives involved in reviews of support plans and risks. This meant that people could actively participate in the management of their support.

Staff had the information they needed to keep people safe and to manage risk. They told us how any reviews or changes were discussed within team meetings and one-to-one discussions and that they had access to information on risks and support planning documentation in the electronic support planning application. Staff told us that they felt confident in the registered manager listening to any concerns. One staff member said, “I am able to make suggestions within team meetings so feel my voice is listened to create a better service.”

The registered manager was able to demonstrate how they would ask about changes in risk during staff spot checks and one-to-one discussions with staff so that they could ensure that they were kept aware of any issues that may arise. Staff were able to explain how they would escalate risks to their line manager, and they were confident that these would be acted upon. Training records and discussions with staff indicated that staff had good quality training in risk management and that they knew how to raise concerns.

The registered manager was able to demonstrate the processes they used to ensure that risks were well managed, and that people were an active part of the mitigation process. They explained that people and their relatives would have meetings with them during review periods, and that they would check if information was still relevant and effective.

However, comprehensive risk assessments were not completed with people as part of their pre-assessment before their care started, with clear arrangements in place to review these. The registered manager explained, “We place all risk documentation within support plans so staff do not have to go to different documents to understand the risks and needs of people.” When we explained that sometimes new staff may not read the full support plan, to identify risks as well as updates, due to the size and complexity of such integrated support/risk plans, the registered manager agreed that this could pose potential problems when risks changed as staff may not necessarily read to the end of the document. They created separate risk plans during the inspection for all supported people and made staff aware of these documents individually.

All care records were electronic and so the registered manager had information from care calls immediately. They could then act upon concerns quickly and support staff effectively. Staff worked with healthcare professionals such as district nurses and podiatrists and these appointment were recorded to ensure that people were safe.

People did not provide any feedback the assessment or management of risks in their home environment, therefore we have scored this evidence category as a 3.

Staff did not provide any feedback the assessment or management of risks related to people's homes, therefore we have scored this evidence category as a 3.

The provider’s systems, processes and policies were designed to promote safe environments within people's own homes.

We were told by people and their relatives that they received good quality consistent care from the provider and their staff. They said that they had regular staff who they knew and that staff would rarely change without notice or discussion. The provider told us that they recruited staff with “the service user in mind”. They explained that they recruited when people professed a need for language skills or gender of staff member. This helped them individualised care.

The registered manager told us that they were confident in the abilities of their staff to provide good quality safe care. They explained that training was at the heart of the recruitment process and that induction was the most important part of this process. Staff told us that they received a good quality induction which included shadowing experienced staff as well as online and in person training. The shadowing was individualised to people’s levels of competence and could last up to a week. Staff could ask for more training, and we saw evidence that diabetes training was provided upon request.

One staff member said, “(Name of registered manager) would always make sure that we understand special skills such as how to move someone or use equipment. (They) always come and watch how we work, and it doesn’t feel like they are just checking up on us, but genuinely want to make sure we know how to maximise our skills.” One-to-one supervisions were detailed and took into account staff’s needs and staff told us that the management team were always considerate to their needs such as caring responsibilities at home.

The provider had robust recruitment processes. These ensured that staff were recruited according to the skills required for the role and that relevant pre-employment checks were completed. This included identification checks, right to work checks and Disclosure and Barring Service (DBS) checks on prospective staff before they were allowed to start work with people.

Staff were provided with a robust induction which ensured that they were ready to provide care. Staff were mentored by more experienced colleagues and supported by the leadership team. Training was discussed as part of induction and mandatory training was complimented by face to face explanations about people’s care needs for those who required this.

The provider checked the effectiveness of staff training through, for example, staff supervision and spot-checks.

The provider used electronic call monitoring to ensure people received a consistent and reliable service. Supervisors monitored if staff were running late and ensured people were informed and received an apology.

People did not provide any feedback regarding staff infection prevention and control practices, therefore we have scored this evidence category as a 3.

Staff told us they were provided with appropriate personal protective equipment (PPE). Staff knew how to safely use and dispose of the PPE made available to them.

The provider’s systems, processes and policies were designed to promote good infection control practices.

People and their families told us they usually dispensed their own medications. However, they stated that staff knew which medications to give when there was a requirement for them to do so.

Staff demonstrated a good level of knowledge around the management of people’s medicines, including the need to remain alert to signs and symptoms of changes in people’s health such as hypoglycaemia or hyperglycaemia in people with diabetes.

Medicines policies were robust, and staff confirmed they were trained in medication management. There was an audit in place for medications that was completed regularly with people and their families to ensure these were managed safely and in line with the provider’s expectations.