Archived: Morningside Care Ltd

This service is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 5 people using the service.

At the inspections of the service in April 2016 and February 2017 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At each of these inspections the service was rated as requires improvement. At the inspection in January 2018 we found that some of the required improvements from the last inspections had been met, however we identified two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach that was a repeat of one found during our inspection in April 2016. This was because medicines were not managed safely, care records had not always been reviewed or updated when people’s needs changed and systems in place to assess, monitor and improve the quality and safety of the service provided were not robust. We also made two recommendations; that the service improved the way they involved and informed people about staffing arrangements and the provider discuss any staff communication problems with people who use the service.

Following the last inspection, we imposed conditions on the provider’s registration that required them to complete an improvement action plan to show how they would improve the key questions; safe, effective, responsive and well led to at least good. The rating in the Well-led domain for this service was 'Inadequate.' Services that are rated as inadequate in one domain are inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

During this inspection we looked to see if the required improvements had been made. We found the breaches of regulations had been met and the required improvement had been made.

Medicines were managed safely. Staff had received training in medicines administration and had their competency checked regularly.

Detailed assessments of people’s support needs and preferences were made. Risks to people had been assessed. Care records were person centred, detailed and reflected peoples support needs. All care records had been reviewed regularly and changes made when needed.

People were involved in decisions about their care. The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA).

Significant improvement was found with the systems in place to assess, monitor and improve the quality and safety of the service provided. Due to the inspection history of the service evidence of sustained improvement was needed.

The service is required to have a registered manager. 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. The service had a registered manager, who is also one of the owners of the company. People who used the service and staff we spoke with were positive about the registered manager and told us improvements had been made in the way the service was organised and run. Staff told us they enjoyed working for the service.

People who used the service were encouraged to give their views on the quality of the service they received and how it could be improved.

Staff we spoke with were aware of safeguarding and how to protect vulnerable people. Staff were confident the registered manager would deal with any issues they raised. There were systems in place to protect people’s security and their property.

Visits were now well planned and people usually knew in advance which staff would be visiting.

People were very positive about the staff who supported them. They described staff as; nice, gentle, friendly and pleasant. People told us communication with staff had improved.

Staff knew people well and spoke in respectful terms about the people they supported. We observed staff interacted in a polite, respectful and good-humoured way with a person who used the service.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively. Staff we spoke with liked working for the service and told us they felt supported in their work.

Suitable arrangements were in place to help ensure people’s health and nutritional needs were met.

Records of accidents, incident and complaints were kept. The service had notified CQC of any accidents, serious incidents, and safeguarding allegations as they are required to do. The provider had displayed the CQC rating and report from the last inspection on their website and in the home.

This service is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 9 people using the service.

Not everyone being supported by Morningside Care Ltd receives a regulated activity; CQC only inspects the ‘personal care’ service being received by people; which includes help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service was inspected in April 2016 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These were in relation to poor recruitment practices and the lack of quality assurance systems to monitor and review the quality of the service. The overall rating for the service at that time was requires improvement. Following the inspection we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions; is the service safe, effective and well led to at least good.

We undertook another comprehensive inspection in February 2017 when we checked if the required improvements had been made. We found that some improvements had been made and one of the requirement actions had been met. However we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including a continued breach because systems for recruitment of staff were not safe and staff did not receive all the training they needed to enable them to carry out their duties effectively. We issued a warning notice and a requirement action. We also made two recommendations relating to governance systems and business emergency planning. The service was rated requires improvement overall for the second time. Following the inspection we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions, is the service safe, effective and well-led to at least good.

During this inspection we found that some of the required improvements from the last inspection had been met, however we identified two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach that was a repeat of one found in April 2016. You can see what action we have told the provider to take at the back of the full version of the report. We are currently considering our options in relation to enforcement in response to some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded. We also made two recommendations.

Medicines were not managed safely. Records for the administration of medicines were incomplete and audits of medicines administration were not robust.

Assessments were used to develop care records which provided information and guidance to staff on the support people needed. Potential risks to people’s health and well-being had been identified and management plans had been put in place to help minimise potential harm or injury to people. However care records had not always been reviewed or updated when people’s needs changed.

Systems in place to seek people’s feedback about the service or assess, monitor and improve the quality and safety of the service provided were not robust.

People did not always know which staff were going to be arriving to provide their support. We have recommended the service reviews the way they involve and inform people about staffing arrangements.

Some people told us they had difficulty communicating with some of the staff and that this was affecting the quality of the experience of the service provided. We recommend the provider discuss any communication problems with people who use the service.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively. Staff we spoke with liked working for the service and told us they felt supported in their work.

Staff we spoke with were aware of safeguarding and how to protect vulnerable people. Staff were confident the registered manager would deal with any issues they raised. There were systems in place to protect people’s security and their property.

Accidents and incidents were appropriately recorded. Risk assessments were in place for the general environment.

People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support. Where people were unable to consent to their care and treatment the principles of the MCA had been followed

Suitable arrangements were in place to help ensure people’s health and nutritional needs were met.

People told us they were supported by staff who were caring and kind. They told us staff were respectful.

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. People who used the service and staff we spoke with were positive about the registered manager. Staff told us the enjoyed working for the service.

The service had notified CQC of any accidents, serious incidents, and safeguarding allegations as they are required to do. The provider had displayed the CQC rating and report from the last inspection on their website and in the home.

The rating in the Well-led domain for this service is 'Inadequate.' Services that are rated as inadequate in one domain will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures and the service will be placed in special measures.

Morningside Care Ltd is a domiciliary care agency which at the time of our inspection was providing personal care to 19 people who lived in their own homes.

The service was last inspected in April 2016 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014; this resulted in us making two requirement actions. Following the inspection in April 2016 the provider wrote to us to tell us what action they intended to take to ensure they met all the relevant regulations. During this inspection we checked if the required improvements had been made. We found that some improvements had been made and one of the requirement actions had been met. However we found a continued breach of regulation 19.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because systems for recruitment of staff were not safe and staff did not receive all the training they needed to enable them to carry out their duties effectively.

You can see what action we have told the provider to take at the back of the full version of the report.

Systems for recruitment of staff were not always safe. We found that the application forms in three of the staff personnel files we looked at did not detail a full employment history, and did not include a written explanation for any employment gaps. Two staff personnel files did not contain any references. We also found that for five staff the provider had not undertaken the required additional checks when applicants had worked previously with vulnerable adults or children in order to find out why the person’s employment in those positions had ended. This meant the required checks on staff’s suitability to work with vulnerable people were not made. The safety of people who used the service was placed at risk as the recruitment system was not robust enough to protect them from being cared for by unsuitable staff.

Staff received an induction when they started to work for the service and told us they felt supported. However we found that staff had not had all the training necessary to enable them to carry out their duties effectively.

The service had 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.

We found that some improvements had been made in how the quality of the service was monitored. Systems were in place to monitor the quality of the service but they were not all robust enough. We have recommended the service reviews its monitoring and auditing systems to ensure they are sufficiently robust.

People told us they felt safe using Morningside Care Ltd. Staff aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

Care records contained assessments that had been completed before people started to use the service.The assessment process ensured staff could meet people’s needs. The assessments were used to develop care plans and risk assessments. People told us they had been consulted about their care records and felt involved in how their care was provided.

Care records contained detailed care plans and risk assessments that guided staff on the support people needed to meet their health and social care needs. Care records were reviewed regularly to ensure they reflected people’s needs. There were also detailed risk assessments about risks around people’s homes.

Continuity plans that highlighted risks and events that may disrupt the service did not detail action staff should take. We recommend the service reviews its emergency plans to ensure clear guidance is available for staff.

The service had an infection control policy; this gave staff guidance on preventing, detecting and controlling the spread of infection and staff received training in infection prevention and control.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People told us they had been consulted about their care records and felt involved in how their care was provided. They said that staff always consulted them before providing support. Staff were able to tell us how they supported people to make their own decision. The registered manager was aware of the process to follow should a person lack the capacity to consent to their care.

People told us that the service was reliable and that visits were never missed. People were complimentary about the quality of the care and support they received and the way the service was managed.

All the people we spoke with said the service was very caring. Everyone was positive about how they were supported and the kind and caring attitude of staff. People said of the staff, “They are very, very nice” and “They are star players.”

We found that the registered manager and all the staff we spoke with were able to tell us about the people who used the service. They knew their likes and dislikes and things that were important to them. They all spoke respectfully and with warmth about people who used the service. Staff placed great importance on promoting and maintaining people’s independence.

During our inspection we found the registered manager to be friendly caring, kind and committed to providing a person centred service. Staff were very positive about the registered manager and working for the service.

Policies and procedures we reviewed included protecting people’s confidential information and showed the service placed importance on ensuring people’s rights, privacy and dignity were respected.

The service had notified CQC of incidents and events they are required to. Notifications enable us to see if appropriate action has been taken by the service to ensure people have been kept safe.

There was a complaints procedure for people to voice their concerns. People told us they had no complaints but were confident that they would be listened to and action would be taken to resolve any concerns they had.

The CQC rating and report from the last inspection was displayed in the office and on the providers website.

Morningside Care Ltd. is a Domiciliary Care Service that provides personal care to people in their own homes. At the time of our inspection there were 15 people using the service.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We saw that policies and procedures on staff recruitment were in place. Checks were made with the disclosure and barring service (DBS) for criminal convictions of applicants. However in three staff files we found full employment histories had not been recorded. This meant people were at risk of being cared for by unsuitable staff.

The service did not have a robust system for monitoring and reviewing the quality of the service. Where checks and audits were carried out there was no record of the outcome of the audit or any action recommended or taken if errors were found. Staff were receiving regular supervisions and team meetings were being held, however were no records of supervisions and team meetings. These processes needed to be more robust to identify and drive forward required improvements in the service.

Staff had an induction and received basic training through the care certificate. Following our inspection we saw that staff had received additional training in medicines management. The service had planned more training for staff in medicines, emergency first aid and manual handling.

The service has a registered manager who was present on the day of our inspection. 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.

People told us they felt safe with Morningside Care Ltd. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

We saw that medicines management policies were in place and people received their medicines as prescribed.

Risk assessments and support plans were detailed and contained sufficient information to guide staff on how support should be provided. Staff completed a record of each visit they made. We saw that each person’s nutritional needs were recorded in support plans. Risks associated with poor nutrition were assessed and there was guidance for staff to follow.

People’s rights and choices were respected. People’s records had not always been signed to indicate they gave their consent, but people and their relatives told us they had been involved in planning and agreeing how support was provided. Although staff had not received training in the MCA, staff we spoke with had an understanding of the principles of this legislation. They were able to tell us how they ensured people had consented to the care they provided and what they would do if someone did not have the capacity to consent. The provider was working within the principles of the Mental Capacity Act 2005 (MCA)

People told us the service was reliable, well organised and that visits were never missed. We found there were sufficient staff to meet people’s needs and a good system in place for alerting managers if a visit was late.

People told us they liked the staff and the service they received. One person told us “They are kind and they don’t rush me.” A relative told us “They care for my [relative] very nicely, they are all good, I keep my eye on them.” We found that the registered manager and staff we spoke with new people who used the service very well. We saw that staff were caring and respectful when talking about people and when supporting them.

People spoke positively about the registered manager. They told us “She has become a good friend” and “She likes her work, she is honest”. We found the registered manager to be approachable and committed to providing a quality service.

Staff told us they felt supported and enjoyed working for the service and spoke fondly of the registered manager and felt supported in their work. We found there were policies and procedures in place to guide staff in their work and an out of office hours “on call” system they could use to seek advice.