Archived: Mears Homecare Limited - Mary Seacole House

A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 time of this inspection the service did not have a registered manager in post. The provider had arranged for the registered manager of another service to temporarily manage the service. The provider had also seconded an experienced extra care scheme manager to deputise for the acting manager when required and provide supervision and support for the staff team.

We found issues of concern in relation to the management of people’s prescribed medicines. The provider did not demonstrate that its own monitoring and auditing of the storage, administration and disposal of medicines was conducted in a thorough manner to protect people from the risks associated with unsafe medicine practices.

People informed us they felt safe living at the service. Staff understood how to safeguard people from abuse and report any concerns about people’s safety and welfare.

Risk assessments had been recently revised and updated to ensure that risks to people’ safety and wellbeing were identified and measures had been implemented to mitigate these risks.

People stated that there were enough staff deployed to meet their needs. Staff recruitment was properly conducted to make sure that staff were suitable to work with people who use the service.

The frequency of one to one formal supervision meetings to support staff with their duties had been disrupted, although the supervision programme had been commenced again by the interim management team. Staff had undertaken an assessment to ascertain their training and development needs and the provider’s forthcoming training programme had been arranged to take account of the staff team’s identified training requirements.

People told us they received the support they needed to meet their nutritional and health care needs; however, we received comments from relatives in relation to occasions when people had not been supported to attend health care appointments.

Staff confirmed they had received training and guidance about the importance of seeking people’s consent and promoting people’s entitlement to make decisions. The management team were aware of the actions to take if a person did not appear to have capacity to make decisions about their health and social care needs, for example the interim manager liaised with health care professionals at the local memory clinic if staff observed changes in people's cognitive abilities that could impact on their ability to make decisions.

Improvements had been achieved in regards to how people’s care and support plans reflected their individual needs, wishes and circumstances. People had been consulted by the provider at their annual review meeting and new documentation recorded relevant information about people’s social history, interests and family/friends support networks.

Although people were supported to participate in social activities which included chair based exercises and art sessions, there was no active approach by the provider to develop people’s access to a wider range of meaningful and fulfilling activities.

People were provided with information about how to make a complaint. Records indicated that the provider had not received any complaints since the previous inspection.

The provider’s record keeping system to demonstrate how people were supported by staff with their shopping and other expenditures was not accurately maintained. We found discrepancies and noted that filing was at times disorganised.

People’s views about the quality of their care and support had been sought and the provider had received some positive comments.

Our findings during this inspection demonstrated that the provider needed more rigorous monitoring systems to identify and address areas for improvement.

We have identified two beaches of regulation. These are in relation to the safe management of people’s medicines and the accurate record keeping for people’s finances. One recommendation has been made in regards to the need to provide people with a Service User Guide that addresses their circumstances as opposed to a general document not designed for people living in extra care schemes.

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

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

Most people told us they felt safe using the service. Staff had received safeguarding training and understood how to report any concerns about people’s safety and wellbeing. There were systems for recording how people were supported with their groceries and other personal shopping; however it was not clear how the provider monitored people’s ongoing satisfaction with how staff met their shopping needs.

Risks to people’s health and wellbeing had been identified and written plans had been implemented in order to reduce risks. This included liaison with physiotherapy services and referrals to the local falls clinic.

People reported there were sufficient staff to meet their needs. The recruitment process did not demonstrate that all references were verified for their authenticity. However, the recruitment had taken place when the service was managed by a different provider and Mears Homecare Limited was aware of its responsibilities in relation to appointing staff.

Systems were in place to monitor that people were appropriately supported with their prescribed medicines and staff had received training. The provider demonstrated that learning took place following medicine errors.

Staff received training and development to meet the needs of people who used the service. The provider was organising further training for staff in regards to how to support people living with dementia. Annual appraisals were conducted and staff received formal one to one supervision.

During this inspection we received predominantly positive comments about the kind and caring approach of staff. Concerns were raised earlier this year by some people who use the service, who felt that staff spoke with them in a patronising manner which did not demonstrate that people were respected. The provider was addressing the culture of the service, however the staff training programme did not evidence specific training about how to promote people’s dignity and rights.

Staff understood about the importance of seeking people’s consent and whether people had capacity to make day to day decisions but did not appear clear about the principles of the Mental Capacity Act 2005 (MCA), which could impact on their ability to ensure that people’s rights were upheld.

People received support to meet their health care needs, although we received mixed responses about whether staff consistently supported people to attend external health care appointments. We received feedback that staff needed training to understand people’s health care needs, including how to best interact with and support people living with memory loss and dementia. The provider was participating in an integrated health project, which enabled regular direct contact with health and social care professionals involved in the health care of people with complex needs.

People told us they liked the meals served at the provider’s cafeteria and were satisfied with the support they received with meals preparation. Care files showed that people were referred to health care professionals including GPs, speech and language therapists and dietitians if there were concerns about their nutritional needs.

People’s care and support plans showed that people’s needs were assessed and kept under review. The care and support plans did not demonstrate that people received personalised care that reflected their individual needs, wishes and circumstances.

Activities and entertainments were organised in order to provide people with social opportunities and stimulation. These activities included specific sessions to promote people’s health and wellbeing, for example weekly chair based exercises and fortnightly yoga classes. It was noted that although events took place at the service such as barbeques, bring and buy sales and an annual party to commemorate the life of Mary Seacole, there were limited opportunities for people to go on outings to places of interest.

People were provided with information about how to make a complaint and the complaints logs showed that complaints were properly investigated. The complaints guidance did not include any details of local independent advocacy organisations that people could contact if they needed support to make a complaint.

Generally we received complimentary remarks about the approach of the registered manager and about the leadership they provided. In particular, relatives praised how the registered manager and the team leader were visible when they visited and kept them up to date about the welfare of their family member.

There were systems in place to seek people’s views about the quality of the service and a range of audits were carried out to check that care and support was being delivered in line with the provider’s policies and procedures. Findings at this inspection showed that although the provider was steadily addressing issues at the service, further actions and progress was needed in areas including staff training and supervision, personalised care planning and scrutiny of financial transactions on behalf of people who use the service.

We have made two recommendations. These are in relation to the spot checking of whether people are satisfied with staff support for shopping and dignity and respect training for staff.