Maycare

Maycare is a domiciliary care service providing personal care and support to people in their own homes. At the time of our inspection there were 42 people using 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 made some improvements to monitor people’s care call visits and completed daily monitoring, however we could not be assured people consistently received support from two care staff where this was identified. Records showed people did not always get the visits as they were commissioned by the funding authority and which they were assessed as needing. We were not assured people always received the care and support they needed in ways which met their assessed needs and preferences.

The provider had implemented a system of auditing since the last inspection. The registered manager completed a daily audit which identified, for example, if there had been missed visits or medicines concerns. Weekly meetings were held between the registered manager and office management staff. However, the provider had not identified the concerns we found during this inspection.

The provider had improved the way they recruited new staff but needed to ensure their policy met the regulation.

People were supported with their medicines when necessary and the provider had improved their monitoring of missed medicines. Appropriate action had been taken in response to errors and the number of medicines issues had reduced. Staff had received training in administering medicines and most had their competency assessed by senior staff who had undertaken advanced training for medicines administration.

The provider raised safeguarding concerns with the local authority when these were identified. However, we identified one issue which the provider had not identified as a safeguarding concern. The provider subsequently notified the local authority.

Risk assessments identified when people needed the support of two staff. However, for one person the risk assessment had not been updated to show their care needs had changed and they needed the support of two staff. The provider had a system in place to assess people’s needs before offering them a service.

We received mostly positive feedback from people, their relatives and staff about the service provided. The provider sought the views of people using the service through reviews both over the telephone and face to face. People were supported by staff who were trained and used personal protective equipment such as disposable aprons and gloves, appropriately. Some people were assessed as needing support with fluids and meals and this was detailed in care plans. Records showed people consented to their care and support.

People told us they felt staff were kind when supporting them. People and their relatives told us they could make decisions about their care and staff respected their decisions. People and their relatives told us they felt their privacy and dignity was respected by care staff. 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 had care plans in place which detailed their care and support needs and preferences. The registered manager told us they ensured people were provided with information in ways they could understand. The provider had a complaints procedure in place and people told us they could complain and were happy with the response.

The provider had systems in place to investigate where things had gone wrong and took action to reduce the risk of this happening again. Staff and management liaised with other agencies and health and social care professionals when necessary. The provider had regularly engaged with the local authority adult services.

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 (report published 25 August 2022).

At this inspection we found the provider remained in breach of regulations. Whilst the provider is no longer in breach of regulation 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, not enough improvement had been made at this inspection and the provider remains in breach of regulation 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This inspection was undertaken to follow up on action we told the provider to take at the last inspection. We conducted a comprehensive inspection to enable us to gain a view of the complete service as the previous inspection focused on the key questions Safe and Well-led.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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 Maycare on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people not always receiving the care and support they need and the governance of the service at this 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.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Maycare is a domiciliary care service providing personal care and support to people in their own homes. The service was supporting 52 people at the time of the inspection.

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

People were supported by staff who had been recruited without robust and safe recruitment procedures.

People’s care was not provided for the amount of time commissioned in order to meet their needs. Visits were consistently shorter than the scheduled call and some people and their relatives told us people felt rushed by busy staff.

Some people experienced times when care staff did not arrive, or arrived late. Some people said they were not always contacted to say staff were going to be late.

People and their relatives gave us mixed feedback about the quality of the service provided. Some people were happy with the care they received but others were not.

People were not always supported to take their medicines as prescribed.

People were not protected from the risks of COVID-19 because there was not a staff testing programme in place.

Most staff had completed training in safeguarding people and moving and handling, but not all.

The provider had not identified the concerns we found during the inspection and did not have an effective system in place to fully monitor the quality of the service.

People had risk assessments in place which considered their environment.

The provider undertook reviews of people’s care plans with them and sought their views on the care provided. Spot checks on some staff had also been completed.

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 1 October 2021).

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 the provider remained in breach of regulations.

The service remains rated requires improvement.

Why we inspected

We carried out a focused inspection of this service on 21 June 2022. We undertook this focused 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. 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 remained requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maycare 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 monitor the service and will take further action if needed.

We have identified continued breaches in relation to person-centred care, fit and proper persons employed and good governance at this inspection. We have also identified a new breach in relation to safe management of medicines.

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.

Follow up

We will meet with the provider and request an action plan from them to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Maycare is a domiciliary care service personal and support to people in their own homes. The service was supporting 61 people at the time of the inspection. 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 did not have an effective system in place to ensure staff were safe to work with people who received care.

People’s care was not provided for the amount of time commissioned in order to meet their needs. Records consistently showed visits were shorter than the scheduled call and people confirmed visits were shorter than planned.

People told us staff were rushed, they had several visits booked in at the same time and did not arrive at a consistent time. This impacted on their well-being, for example, by staff being very early or very late to provide their support. People were not always contacted to say their carer was going to be late.

Some people needed support with their meals. When staff arrived late, this meant they were waiting for a meal.

Staff told us they had up to four calls scheduled for the same time and that they needed to ‘jiggle’ people around to fit them in. There was no travel time built in between care calls. This meant calls were not scheduled according to people’s needs or preferences and people waited to use the toilet and receive support with personal care.

We heard two conversations in the office, where staff and management had not respected people’s wishes, regarding the staff who visited them, or the timing of a visit.

The provider had not identified the concerns we found during the inspection.

The provider did not have an effective system in place to monitor when staff arrived at a person’s home, or when they left. The system did identify the length of the visit, which was usually shorter than commissioned. The provider had not understood this concern nor did they understand the impact upon people when calls were late or shorter than they should have been. The provider was not always promoting a person-centred and empowering service and people did not always receive good outcomes.

People’s needs were assessed before support was offered. Where people needed the support of two staff, staff arrived at the same time. Records showed people usually received visits from the same staff team which meant staff knew people well.

The provider had a safeguarding policy and procedure in place. Senior staff were aware how to refer concerns to the local authority safeguarding teams and gave an example of when they had done so.

People were supported by staff who had received on-line training in medication awareness.

We were assured that the provider was using personal protective equipment (PPE) effectively and safely and staff had twice weekly tests for COVID-19.

Staff based in the office were clear as to what their individual role was and what areas of work they were responsible for.

The provider contacted people up to twice a year to undertake a formal review of their care. If people’s needs changed, or if they expressed concerns, reviews could be held more frequently than twice a year.

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 26 September 2019). 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 been made and the provider was still in breach of regulations.

The service remains rated requires improvement.

Why we inspected

We carried out a focussed inspection of this service on 23 and 24 June 2021. We undertook this focused 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.

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 remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maycare 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 safe recruitment, care which meets people’s commissioned needs and preferences and governance.

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.

Follow up

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.

Maycare provides a domiciliary care service to enable people living in Basingstoke and the surrounding area to maintain their independence at home. There were 72 people using the service at the time of the inspection, who had a wide range of physical and health care needs. Not everyone who used the service received personal care. The CQC only inspects services where people receive personal care which is help with tasks related to personal hygiene and eating. Where services offer personal care, we also consider any wider social care provided.

Why we inspected

We received concerns in relation to the management of staff recruitment, unsafe care and poor management of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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.

People's experience of using this service

People were not always safe. There were systems in place to report safeguarding concerns to the appropriate authorities. However, we found evidence that concerns were not always reported. Staff were aware of their responsibilities to report concerns.

The service was led by a registered manager who had systems in place to monitor the service. However, these systems were not always effective and failed to fully identify our concerns. Records were not always well managed and readily available. We saw the registered manager had identified this issue and work had begun to resolve this concern.

Accidents and incidents were not always fully recorded and investigated. The registered manager could not provide us with current accident and incident reporting documents.

People received their medicines as prescribed. However, staff did not always use body maps for the application of creams.

Risks to people's safety and well-being were managed through a risk management process. There were

sufficient staff deployed to meet people's needs. Staff had undergone background checks before working at the service.

Systems were in place to ensure people were protected from the risk of infection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-Led sections of this report. 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 Maycare on our website at www.cqc.org.uk.

The inspection was conducted between 18 December 2017 and 5 January 2018 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

The service had an experienced registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was supported by a an experienced home care manager, a business excellence manager, a coordinator and six senior staff.

At our last inspection in December 2016 we found people were not protected from the risks associated with unsuitable staff being employed by Maycare. The provider’s failure to operate safe recruitment procedures, and ensure that all staff were of good character prior to being employed, was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan detailing the improvements they were going to make to ensure they were meeting the requirements of this regulation.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. Staff had undergone relevant pre-employment checks which had assured staff suitability for the role, before they were allowed to support people in their own homes.

During our last inspection we found the provider had failed to ensure there were sufficient staff deployed to meet people's needs at all times was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan detailing the improvements they were going to make to ensure they were meeting the requirements of this regulation.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. The registered manager completed a daily staffing needs analysis which ensured there were sufficient numbers of suitable staff, with the right mix of skills to provide safe care which met people’s assessed needs.

During out last inspection in December 2016 we found that some people experienced inconsistent care from staff who did not know them or their needs. The provider had failed to ensure that the care and support people experienced was appropriate and met people’s needs at all times. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. People consistently experienced care from staff who knew them well and how to deliver the support they required.

At our last inspection there was a quality assurance process in place, but this was not always effective in monitoring and improving the quality and safety of the service. At this inspection the provider’s quality assurance process now ensured people received visits for the full time allocated and people were protected from the risk of receiving care from staff whose suitability had not been fully assessed.

Since our last inspection the provider had implemented an electronic system which enabled the office team to assure people’s and staff safety. The new system enabled the management team to check that staff had arrived and left each call and raised an alert if there was an excessive delay.

During our last inspection we found that the provider did not have procedures in place for dealing with emergencies, which could reasonably be expected to arise from time to time. Staff had not received practical advice or guidance about how to remain safe or to keep people safe.

At this inspection we found the provider’s business excellence manager had reviewed their lone worker policy and had developed procedures to deal with adverse weather conditions and disruptions to the service’ communication systems. Staff had now received practical guidance about how to remain safe and to keep people safe.

Staff understood their role and responsibility to safeguard people from abuse. People were kept safe by staff who could recognise signs of abuse and knew what to do to protect people from avoidable harm.

People’s needs and risk assessments contained all the information staff required to meet their needs safely and to mitigate any identified risks. Staff understood people’s risk assessments and provided support in accordance with risk management plans to keep people safe.

People’s prescribed medicines were administered safely, in accordance with the provider’s policy and people’s individual support plans. Staff had their competency to administer medicines assessed annually to ensure they had maintained their skills and knowledge.

Staff had been trained in relation to infection control and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene, whilst supporting people in their homes.

The registered manager had ensured that staff had the skills, knowledge and experience to deliver effective care and support to meet people’s needs. Supervision and appraisal were used to develop and motivate staff, review their practice and focus on their professional development.

The service protected people from the risk of poor nutrition, dehydration and other medical conditions that affected their health. The service had clear systems and processes for referring people to external services, which were applied consistently. Staff made prompt referrals to health professionals when required and acted swiftly on their recommendations.

Staff upheld people’s rights to make sure they had maximum choice and control over their lives, and supported them in the least restrictive way possible.

People were consistently treated with dignity, respect and kindness by staff who made them feel that they mattered. The registered manager ensured staff had the time, information and support they needed to provide care and support in a compassionate and person-centred way.

People were confident that if they complained they would be taken seriously, and their complaint or concern would be explored thoroughly. The registered manager used the learning from complaints and concerns as an opportunity to drive improvement in the quality of the service.

At the time of inspection the service was not supporting anyone with end of life care. However, we letters from bereaved families described the care provided to their loved one to be outstanding, compassionate and understanding, whilst referring to the staff as loving and caring.

The registered manager provided clear and direct leadership and had created an open and inclusive culture within the service.

The provider had adopted a clear set of values based upon caring passionately about people, supporting and enabling them to live life to the full and delivering person centred care which met their needs.

The inspection was conducted between 1 and 13 December 2016 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was a registered manager in place. 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.

At our last inspection we made two recommendations. These related to way staff monitored people’s nutritional needs and the training staff received in supporting people who are living with dementia. At this inspection, we found the service had acted on these recommendations.

However, we identified fresh concerns that compromised people’s safety. Pre-employment checks, to make sure staff were suitable for their role, were not always completed before new staff started working at Maycare. There were not always enough staff to meet people’s needs at the time they required support, particularly at weekends, and staff did not always stay with the person for the allocated length of time.

There were no plans in place to deal with foreseeable emergencies, such as extreme weather. The system used to check staff had arrived at each call was not robust and did not protect staff who worked alone. However, the provider had tested the use of technology to assist with this and was researching the use of other solutions to monitor staff attendance at calls.

People told us their regular care staff were skilled at supporting them and meeting their needs. However, they said fill-in staff, who covered when their regular care workers were absent, were not always able to provide them with effective care and support.

There was a training programme in place. However, the induction procedures did not follow the standards of the Care Certificate (a learning programme designed to enable staff new to the role to provide safe and compassionate care to people). Also, there was no clear process in place to check that new staff were able to support people safely and effectively, for example when administering their medicines.

Staff felt supported in their role by their managers, although arrangements for one-to-one meetings to discuss their progress and raise concerns with managers were ad hoc and not organised.

The provider did not have a duty of candour policy to help ensure staff acted in an open and honest way when people were harmed. Not all of their policies and procedures were up to date or reflective of the type of service they provided.

The quality assurance procedures had brought about some improvements, but were not always effective in identifying and addressing improvements to the quality and safety of the service. Spot checks to assess the performance of staff were not conducted regularly. However, staff were happy and motivated in their work and described managers as “supportive” and “approachable”.

Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. The care manager conducted effective investigations into allegation s of abuse. Risks relating to the environment or the health and support needs of people were assessed and managed effectively.

Staff were caring and compassionate. They took care to be discreet and unobtrusive when working in people’s homes. They protected people’s privacy, involved them in decisions about their care and developed positive relationships. Staff also followed legislation to protect people’s rights, by seeking consent from people before providing care and support.

Most people‘s meals were prepared or provided by family members. However, staff encouraged people to maintain a healthy, balanced diet based on their individual needs and preferences.

Care plans provided appropriate information to enable staff to provide care in a consistent way. Staff responded promptly when people’s needs changed and referred them to healthcare professionals when needed. People were encouraged to remain as independent as possible.

There was a complaints procedure in place and most complaints had been investigated and responded to appropriately. The provider sought feedback from people and their families and had developed an action plan to address concerns raised.

We identified several breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

On the day of our inspection 81 people were being supported in their own homes by 36 staff. We spoke with 13 people who use the service and the relatives of four others. We also spoke with the registered manager, the home care manager, five senior care workers and seven care workers.

We considered our inspection findings to answer questions we always ask;

Is the service safe? Is the service effective? Is the service caring? Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that the service was not always safe because the provider had not ensured the health and welfare of people due to the number of missed calls. We have told the provider to make improvements to ensure the care and welfare of people who use the service.

On 17 May 2014 ten people had a missed visit when a care worker was absent on sick leave and the provider had not reallocated their calls. The following day five different people who required support from two care workers received a visit from only one care worker. Again a care worker had gone sick and their visits had not been reallocated. The registered manager confirmed that the local authority had been appropriately notified about these missed visits.

People had not been protected from the risks of unsafe care because not all people's needs had been appropriately assessed and reviewed. The service had not ensured people were safe because they had not provided care and support in accordance with people's care plans. People who had been assessed as requiring two care workers to support them with moving and positioning safely frequently had just one care worker to support them.

The service had not ensured that people were safe and their health and welfare needs had been met by staff who had been appropriately qualified and physically and mentally able to do their job. We have told the provider to take action to improve the service' recruitment and selection processes.

The provider had failed to obtain full employment histories from all new staff and satisfactory explanations of any gaps. We saw that one care worker had been recently employed by another service providing social care. There was no evidence of their conduct whilst employed in this role or verification of the reason why their employment in that position had ended. We found that some care workers had been offered employment based purely on the provision of personal references from family members. We found that the provider had completed appropriate Criminal Records Bureau (CRB) or Disclosure and Barring Service (DBS) checks to confirm that staff were of good character. However, some care workers told us that they had been employed by the service before the results had been received. We found no evidence that urgent interim checks had been completed whilst awaiting results of the DBS check. This meant that the provider had not undertaken appropriate checks before staff began work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home care manager told us they had not needed to apply for any DoLS authorities but they were aware of the process to follow. Staff told us that they had received training about the Mental Capacity Act 2005.

Is the service effective?

We found that the service had not been effective. The provider had not ensured that staff had been supported to deliver care to people safely and to an appropriate standard. We have told the provider to take action to improve the support provided for workers.

The service had not completed supervisions, appraisals or spot checks where supervisors observed care practice, in accordance with the provider's policy. One care worker told us, 'The training is not very good. I like to learn by doing something and actually being shown how to do it by someone who knows what they are doing.' This meant that staff professional development had not been effectively managed because they had not received appropriate training and supervision.

Is the service caring?

Overall we found that the provider was not always caring. Most people praised the 'kind and caring' service from their care workers but thought the 'office' lacked compassion. People told us that some office staff were patient whilst others were either rude or disinterested. One person told us, 'Sometimes I don't know whether it is just totally disorganised or the office just don't care.'

One person we visited was extremely ill and at high risk from infection. This person had therefore requested continuity of care to be provided by a group of dedicated care workers. We reviewed their daily notes and found that 19 different staff had visited the person between 8 and 15 June 2014. They told us 'I'm so upset but don't know what to do because they take me to my hospital appointments.' This meant that the provider had not ensured that people experienced safe and appropriate care that met their needs.

We saw that people had been supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. Whilst talking about their care workers one person said, 'They are very caring and keep my spirits up. I just wish the office cared as much.' The care staff we spoke with enjoyed working with people they supported. One care worker told us, 'Even on holiday I am always thinking about the people I care for and I look forward to seeing them when I get back.'

Is the service responsive?

We found that the service was not always responsive. The relative of a person told us that their family member became anxious and confused if they did not know the care workers attending or the time of their arrival. They told us that recently seven different staff had visited their relative in one week, despite their requests for continuity. They had also requested the night time visit to occur no earlier than 21.30. The two nights following this request staff had arrived much earlier. This meant that the provider had not responded effectively to ensure that people's changing needs had been met.

A person living with dementia had required support with personal care. We spoke with their relative who told us that they had serious concerns about their family member's personal hygiene and continuity of care. They said, 'We have repeatedly requested Maycare to update the care plan for over three months and as for continuity of care, they never send the same carers. Surely they know people get confused and need reassurance from faces they know.' This meant that the provider had not responded to ensure that reasonable adjustments had been made to reflect people's needs, values and diversity.

Is the service well-led?

The service had always been well led. We found that the service had not protected people against the risks of inappropriate or unsafe care because the service had not effectively operated quality assurance systems. We have told the provider to make improvements to regularly assess and monitor the quality of the service and to identify, assess and manage risks relating to the health, welfare and safety of people.

We found that safeguarding and medication training had not been updated within the previous year and the service had failed to complete supervisions, spot checks and appraisals in accordance with the provider's policy and procedures. This meant that the provider could not be assured that staff had been appropriately trained, supervised and appraised.

Positive comments were made about the quality of care received by people using the service. One relative told us, 'The staff are fantastic. They're always making him laugh but are so kind and careful". Some people said the quality of their care was good but were critical of the support from the office. One person said, 'The carers are absolutely brilliant. They are so good with my wife and always go the extra mile. I just wish the office staff were as good'.

People who used the service were protected from the risk of harm because the provider had taken reasonable steps to identify and prevent abuse from happening. We saw that people were cared for by qualified staff, who had received effective training and supervision.

The range of self auditing ensured the manager effectively assessed and monitored the welfare and safety of people using the service. Complaints were effectively recorded, investigated and resolved.

Most of the people we spoke with praised the quality of care provided by experienced care staff they knew. One person spoke highly of one of the care staff who pointed out a skin inflammation to the district nurse, ensuring proper treatment was given.

However, strong concerns were raised by people using the service regarding the regularity of missed calls and with the level of competence and training of new care staff. One relative said, 'It's chaos, absolute chaos. I get more stress worrying if they are coming. Some carers are good. Some just don't know what they are doing.'

Staff had a good knowledge regarding the medicines being taken by the people they supported and knew what medicines were required, the times they needed to be taken and how to support people taking them safely.

There were effective recruitment and selection processes and appropriate checks were undertaken before staff began work. The provider did not ensure that staff were properly supervised or appraised.

People using the service had not had their complaints listened to or acted on effectively. People said they did not feel supported to make complaints. One person said, 'All they do is say we'll look into it, then nothing happens.'