Meritum Integrated Care LLP (Folkestone)

Meritum Integrated Care LLP (Folkestone) is a domiciliary care agency. The service provides personal care to adults who want to remain independent in their own home in the community.

The service also provides care and support at Summer Court. Summer Court is an extra care service. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service. People living at Summer Court had their own flats in one building.

At the time of the inspection 172 people were receiving the regulated activity personal care, 33 of these people were at Summer Court. Most of the people who use this service are older adults.

At the last inspection in December 2017 the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that the service had improved, the service is now rated Good.

There was a registered manager at the service who was also one of the providers. 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 the previous inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider and registered manager had failed to adequately assess all risks relating to people's care and support. At this inspection there continued to be areas where risks had not been adequately mitigated. However, these were addressed at the time of the inspection. Risks to people had been assessed and there was guidance in place for staff to minimise these risks. At the previous inspection we also found that provider and registered manager had failed to implement systems and processes to ensure the safe management of medicines. At this inspection we found that the service had met the standards required and the administration of medicines had improved. There were systems in place to ensure that people got their medicines as prescribed.

At the previous inspection we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider and registered manager had failed to ensure that information within people's care plans reflected their assessed needs and preferences. At this inspection we found that the service had improved. Care plans now provided staff with the information they needed about people’s assessed needs and how people liked to be supported with these needs.

At the last inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the systems in place to assess, monitor and drive improvement in the quality and safety of the service were not effective. The provider and registered manager had failed to mitigate the risks relating to the health, safety and wellbeing of people. Records were not always completed. At this inspection we found that the service had taken the necessary steps to improve. The systems to monitor and improve the safety and quality of the service were effective. Regular checks on the service were being done which had identified where action needed to be taken to improve the service and keep care plans up to date. Records were up to date and accurate.

There were enough staff to keep people safe and meet people’s needs. New staff were safely recruited with the required checks such as references were completed prior to staff starting to work at the service. Staff had the skills, knowledge and training they needed to provide safe and effective care. New staff completed an appropriate induction which included shadowing more experienced care staff. Staff received regular supervision, checks on performance and undertook an annual appraisal. Staff told us that they felt supported in their role.

People were protected from abuse. Staff knew how to identify and report abuse. The registered manager understood their obligation to report concerns and knew how to do so. Staff had access to appropriate personal protective equipment such as gloves and aprons and people were protected from the risk of infection.

Where incidents had occurred, these had been recorded, investigated and action was taken where appropriate. There was a system to identify trends in incidents however no trends were identified.

Prior to receiving a service people’s needs were assessed so that the service could make sure that it could meet these needs. Where people needed support to eat, drink and access healthcare services this was provided. People told us that they were involved in planning their own care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us that they felt that the staff were very caring. Staff treated people with kindness and supported them to maintain their dignity, privacy and independence. People knew how to complain if they wanted to do so. Complaints were dealt with appropriately and in a timely manner.

The service had a clear vision and values which were understood by the staff we spoke to. There was an open and transparent culture and staff told us that they were well supported. There were regular staff meetings and staff were provided with a handbook which contained important information such as the provider’s policies.

People, their relatives and staff were given the opportunity to feedback on their experience of the service. People, relatives and staff were positive about the service.

The service was working in partnership with other health care services to promote partnership working. The provider and registered manager understood their legal responsibilities to notify CQC about important events and display the provider's latest CQC inspection report rating.

The service had a registered manager in post. A registered manager is a person who is 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 last inspected Meritum Integrated Care LLP (Folkestone) in October 2016 when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment and person-centred care.

At our inspection in October 2016, the service was rated 'Requires Improvement'. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made, however, the provider had not met the previous breaches of regulations and one further breach was found. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our previous inspection, medicines were not always managed safely. The service did not hold a list of each medicine they administered to people if they were stored in a dosette box (pre-packaged medicines from a pharmacy) and if medicines were left out for people, the risk regarding this was not assessed. At this inspection we found there had been no change and although the provider had designed a form to record medicines this had not yet been implemented, leaving people at risk. The registered manager and senior staff were aware of best practice guidance, such as those relating to the administration of medicines in people’s homes and were in the process of ensuring they adhered to this guidance.

Each person had a care plan in place which consisted of a task list outlining what staff needed to do at each call and an assessment of the risks related to providing care and support to each person. Although risks relating to people’s care and support, such as moving and handling, mobility and any healthcare conditions had been identified, detailed guidance was not always available to staff on how to mitigate these risks. When incidents or accidents occurred staff reported these to the office, however the action taken to prevent them from happening again was not always documented.

Some care plans contained detailed step by step guidance regarding how to support people. However, others required more detail to adequately inform staff how people liked their care to be provided. There was generic information regarding health care conditions such as epilepsy and diabetes. However essential, personalised information such as how often people had a seizure or what action to take was not provided for staff. Staff worked independently in people’s homes, without supervision, so clear guidance was essential to ensure people received the support they needed.

Office staff completed regular checks on people’s daily notes, however they did not always cross reference them with medicines records, which meant they had not picked up on the issues regarding medicines identified at this inspection. Care plans were also reviewed regularly, but again, these reviews had not identified the lack of necessary detail to ensure staff had the appropriate guidance. Accidents and incidents were not analysed to identify any trends or patterns, meaning ways of reducing their occurrence could be missed.

People had been asked for their views on the service and these had been reviewed by the management team. The results of this feedback had not yet been published on the provider’s website. We identified this as an area for improvement.

The registered manager and senior staff worked in partnership with other professionals to ensure people received consistent care. Some people received support from the district nursing team with their health care needs and staff provided assistance with their personal care. Staff told us that communication was good and they were able to share information when needed.

At Summer Court the registered manager worked closely with the local authority commissioning team to ensure extra care housing scheme was suitable for people’s needs. The provider and senior staff were involved in a variety of local forums and worked in partnership with colleagues across the sector to develop new ways of working.

Staff had received the necessary training to carry out their roles effectively. They told us they were well supported by the management team and received regular spot checks when they were providing support to people to ensure they were doing so appropriately. Staff told us the management team were approachable and knowledgeable about providing domiciliary care.

People told us that staff were kind and caring and treated them with respect and dignity. Rotas showed that staff were allocated time to travel between people and people we spoke with said that staff were generally on time and stayed for the entire duration of their call. People said that staff at Summer Court answered their call bells promptly and they were not left waiting if they needed support in an emergency.

Some people were supported to prepare meals or to eat safely. People told us that staff supported them in a sensitive manner when doing so, and supported them at a pace which suited them. Everyone we visited had drinks of their choosing left out for them, so they could remain hydrated throughout the day. When people became unwell staff supported them to contact relevant healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had an understanding of people’s equality and diversity needs and told us they would challenge discrimination in any form. There was an open and inclusive culture and people were supported to be as independent as possible.

There was information available for people regarding how to complain and any complaints had been documented and investigated in line with the provider’s policy. Staff had been recruited safely. Staff knew how to recognise and respond to abuse and any potential safeguarding issues had been reported to the local authority. The provider had notified us of important events that had happened in the service and had displayed their rating on their website and at the service, as required by law.

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

In October 2015 72 people’s packages of care and 39 staff had transferred from another provider to this provider. Since registration the provider had worked hard to ensure this transfer went as smoothly as possible. In addition the care and support and 24 hour on call provided at Summer Court in Hythe was also transferred to this provider. This is a block of flats with additional communal facilities available for people that live there.

The service is run by an established registered manager, who also undertakes work at other services owned by the same provider. 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 received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Most risks associated with people’s care had been identified, but not all and there was not always sufficient guidance in place for staff, to help ensure people remained safe.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. However care plans varied in the level of detail and some required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

There were audits and systems in place to monitor that the service ran efficiently. These had been effective in identifying most of the shortfalls highlighted during the inspection, but not all. People told us that communication with the office was polite and courteous although some felt they did not always receive a telephone call back when told they would. People had opportunities to provide feedback about the service provided. Some people felt the service could be better organised particularly around arranging their visits.

People had their needs met by sufficient numbers of staff. All of people’s visits were allocated permanently to staff schedules and these were only changed when staff were on leave. However a number of people felt staff were “often late” for their visits and this is an area we have identified for improvement. People on the whole received a service from a team of regular staff. New staff underwent an induction programme, which included relevant training and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role and more than half of the staff team had gained qualifications in health and social care or were working towards this.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection although people had made Lasting Power of Attorney arrangements and one person had a Do Not Attempt Resuscitation (DNAR) in place. Some people chose to be supported by family members when making decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health and they told us staff were observant in spotting any concerns with their health and taking appropriate action.

People felt staff were caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs well.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.

There was an open and positive atmosphere in the office and staff were receptive to improving services people received. The provider’s aim for the service was included in literature people received and we found these principles were followed through into practice.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.