MiHomecare - Raynes Park

MiHomecare Raynes Park is a domiciliary care agency providing personal care to 170 people at the time of inspection. The service provides support to older people.

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

Governance processes needed improvement to ensure they promptly rectified issues in relation to medicines administration recording, staff training and audits. Care records would have benefitted from additional personalisation.

Risk management plans were sufficient in responding to identified need. Staff arrived on time for calls; or communicated with the office or people where there were delays. Incidents and accidents were effectively investigated.

Staff received regular supervision and competency checks to ensure they were skilled in carrying out their role. People were supported to access other healthcare professionals and with their eating or drinking needs.

People and their relatives found staff to be caring. People’s support needs were respected and they were treated with privacy and dignity, Where able to do so, people were supported to be independent.

Care records reflected people’s needs. Where people wished to express their end of life wishes these were recorded. Complaints were appropriately responded to.

People, relatives and staff were positive about the management of the service and support they received. Staff felt supported to undertake their roles and raise any feedback.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 February 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

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 a breach in relation to good governance. We have made recommendations in relation to medicines management and training.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

We gave the service two working days’ notice of the inspection to ensure a senior member of staff would be available to meet with us. This inspection took place on 10 January 2019.

At our last focused inspection of the service in January 2018 we found breaches in the regulations relating to safe care and treatment and good governance. This was because staff lateness and missed visits meant people were at risk of neglect. In addition, people’s medicines were not always managed safely by staff. The provider lacked governance systems to identify and improve in relation to the concerns we found. At this inspection we found the new management team had improved the service in all areas and people received a good standard of care.

There was no registered manager in post at the time 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. In October 2018 a new manager began overseeing the service with close support from a registered manager from another branch, the quality assurance team and director of care. Processes were in place to register a manager with us.

People were cared for by the right number of staff needed to keep them safe. The provider monitored visits closely to ensure people received care at the right time and there were no missed visits. Staff stayed for the allocated time. Staff were recruited through processes which checked they were suitable.

Risks relating to people’s care, including moving and handling, infection control and health conditions were well managed as staff understood the risks and had clear guidance to follow in reducing them. The provider improved their oversight of medicines management ensuring staff were suitably trained and supported and medicines records were frequently audited. Staff understood their responsibilities to safeguard people from abuse and staff were encouraged to whistle blow regarding any poor practice.

Care plans were reliable in guiding staff as they contained accurate information and were regularly reviewed. People were involved in developing and reviewing their care plans. People received their choice of food and drink and any support they required relating to their day to day health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff received a suitable programme of induction and training to help them understand their roles and responsibilities. A supervision schedule was in place to improve the frequency staff received supervision.

People found staff to be kind and caring and staff understood people’s needs. People were supported to maintain their independence. People felt the provider listened to them and acted on any concerns or complaints they raised. The provider communicated openly with people and staff and had systems to gather feedback and make improvements.

Leadership at the service was visible with a clear hierarchy. The managers and staff understood their roles and responsibilities. The provider had good oversight of the service.

We gave the service eight working days’ notice of the inspection visit because we needed to be sure the provider was available over the festive season.

This inspection took place on 2, 19 and 22 January 2018.

At our last comprehensive inspection of the service in February 2017 we found it was meeting the fundamental standards and we rated the service Good overall. At this inspection we found the service had deteriorated and the rating was Requires Improvement overall.

There was no registered manager in post at the time 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. There had been instability in management since our last inspection and the most recent manager resigned shortly after we announced our inspection. A new manager had permanently transferred to the role from another branch within the organisation a few days before our inspection. The manager in post had promptly made an application to register with us before we inspected the service. We found they understood their role and they told us they were committed to improving the service in light of our findings.

We arranged this focused inspection because of the high number of safeguarding alerts we received relating to missed visits. Since our previous inspection there had been over ten allegations of neglect due to missed calls or people not receiving their care at the agreed time. We found people still experienced problems with missed calls and also lateness. In addition the provider did not always inform people in advance who would be caring for them which made people feel unsafe. When people felt uncomfortable with a staff member the provider did not always respond to their request to no longer send that member of staff. The provider had not taken sufficient action to assess, monitor and improve in relation to these concerns.

People’s medicines were not always managed safely by the provider. Three people told us staff lateness and missed visits meant they did not always receive the right support to take their medicines, some of which were time critical. The provider had not audited people’s medicines in recent months and this had not been identified until the day of our inspection. The provider was unable to show us recent medicines records for people and instead showed us medicines records for one person for July and August 2017 which had several omissions the provider had not identified and was unable to explain. The provider told us they would improve medicines management immediately in response to our findings.

The provider took action to improve systems to safeguard people following safeguarding incidents, including cooperating with the safeguarding investigations by the local authority, carrying out their own internal investigations and reporting back to the safeguarding team. However, the provider had not always thoroughly investigated why missed visits occurred as part of improving the service.

The provider identified, assessed and managed risks relating to people’s care. The provider held a monthly quality forum where all safeguarding investigations, complaints, compliments and accidents and incidents were discussed in depth as part of reducing the risk of recurrence.

The provider carried out recruitment checks on staff to ensure they were suitable to support people. We received mixed feedback from people and relatives regarding whether there were enough staff deployed to care for people.

The provider’s governance systems had failed to improve people’s experience of lateness, missed visits and inconsistency of care workers. Although the provider carried out quality monitoring audits, satisfaction surveys and spot checks of carers these had not identified and improved the issues we found. The provider’s systems had failed to recognise people’s experience of poor communication from office staff. In addition the provider had failed to recognise the issues relating to medicines management, including that audits of medicines had not been carried out as expected.

The provider worked openly in partnership with key organisations. For example, the provider met with the local authority regularly to review service delivery including any accidents and incidents and worked with the safeguarding team in relation to any allegations of abuse.

The provider submitted statutory notifications to CQC as required by law, such as in relation to allegations of abuse.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. MiHomecare – Thornton Heath provides personal care for over 340 people in the London boroughs of Lambeth and Croydon. It provides a service to older adults, and younger adults with disabilities.

At the last inspection of the agency in February 2015 the service met all the regulations we inspected.

At this inspection, there was no registered manager in post. 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. A new experienced manager was in charge and present during the inspection. A registered manager’s application had been completed and sent to the Care Quality Commission (CQC).

The agency had policies and procedures in place to help protect people from abuse, and staff had a clear understanding of what to do if safeguarding concerns were identified. Contacts and a whistle blowing hotline were available for all staff to enable them share information confidentially and make the working environment transparent. Staff retention was good and helped promote continuity of service. Staff had been recruited, using a robust recruitment process, to check they were suitable and safe to visit or work in people’s homes.

People were safe when using the service because staff had been trained and knew how to protect people in their care. Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them, and protect people from harm. Appropriate support plans and guidance were provided for staff to follow and make sure that people were kept as safe as possible.

Procedures were in place for supporting staff to respond appropriately to emergencies. Care staff had guidance to follow and were aware of the on call service available so that they had access to information and management guidance at all times when they were working.

People told us they felt safe with the care provided. One person told us, "Most carers that come here are punctual; staff are very caring and fit the service around our needs." Medicines were managed safely and people received the support they required from staff. Independence was promoted for as long as possible with clarity about support such as prompting people to take their medicines as prescribed. Where people had help with their medicines they told us this had worked well.

Staff understood and protected people’s human and civil rights. People were asked for their consent prior to care being undertaken. They were encouraged to make as many choices and decisions for themselves as they could. People and their relatives told us they were supported by kind and caring staff. One person told us they were happy with the care and support provided by the members of staff who visited, they said, “The carers are great, they go way above and beyond the call of duty, truly great."

Staff were suitably trained, well supported and helped develop the knowledge and skills required to ensure people’s health and well-being needs were met. If staff competency and performance were an issue, performance improvement plans were put in place to ensure that staff were competent to carry out their duties. Where it was identified that staff needed training in a particular area, this was provided.

The provider had systems in place for seeking feedback from people using the service which included spot checks, customer reviews and quality monitoring visits. The quality of care provided was continually reviewed by management. Developments or improvements in the service were on-going and made, as appropriate.

We spoke with thirty five people who use the service and/or their family members; we also met with two of the people in their own homes. We talked with 21 care workers, four care coordinators and two field supervisors. We met with the branch manager, locality manager who was the acting manager, and regional director. We spoke with commissioners and monitoring officers from all four local authorities. The named registered manager had left the service and an acting manager was in post at the time of our inspection.

We considered all the evidence gathered under the outcomes inspected. We used the information to answer the five questions we always ask: - Is the service safe, effective, caring, responsive and well led?

This is a summary of what we found-

Is the service safe?

People we spoke with, and their relatives, told us they felt safe with the care workers especially with their regular staff, but there were concerns that if the regular care worker was absent they may get a late call, or there was a risk of the call not being covered if they did not call the office.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. However, acts of omission in the form of missed calls were placing people at

risk of harm. There had been a number of missed calls experienced by people and the service had not learned and implemented effective systems to prevent these from reoccurring.

Is the service effective?

The majority of people told us that they were satisfied with the individual care workers provided who were regular staff and who went way beyond the call of duty. However, they were unhappy with replacement staff as they often did not arrive at the correct time or stay the correct length of time. Three people told us, "It may not be the relief worker's fault as some of them had incorrect times on the work sheet.'

Regular care workers were found to be skilled and dedicated and demonstrated a good understanding of how to support people in their own homes and promote their independence. However, arrangements in place were not satisfactory for ensuring the service was well coordinated and planned. A constant change in the office based coordinating staff and another change in management had impacted on the consistency and continuity of care people experienced.

Is the service caring?

People we spoke with told us care staff were 'kind and conscientious' and their needs were being met. One person told us, "They are such lovely kind people; they always do the things I cannot manage and remember the things I usually forget.'

A person commented, "The care workers do the little extras like a daughter would do, and always makes time to have little chats which my relative loves.'

Is the service responsive?

Some people felt that the service had listened to them and responded to their needs and told of the difference it made 'Having a regular care worker come at the right time.' However, a large number of people told us that they did not feel listened to by office based staff, and that the service was not tailored to meet their needs fully despite frequent communication with care coordinators.

The service did not have a suitable system to respond to specific needs where there were communication needs and areas of vulnerability. Arrangements were not appropriate for monitoring the needs of people with dementia or those who were cognitively impaired. Staff at the agency office did not demonstrate they understood the needs of people with specific communication issues.

Care needs and risk assessments were routinely reviewed, however the information was not always used effectively to make the necessary changes such as preferred times for home visits or for other changes to the care plan.

People who use the service and their representatives were asked for their views about their care but they found these were not always considered and acted upon. People we spoke with confirmed they had been visited by field supervisors and some had visits from the manager as a result of their complaints. They shared the problems they experienced with the agency team and were promised an improved service with frequent monitoring of the service. One person told us this had not been followed up and the service delivery had not improved.

Is the service well-led?

The service had experienced a number of changes with other services merging with this branch, and this was not well managed.

There was no registered manager in the service and temporary management arrangements had proved not to be satisfactory. The service lacked clear leadership. People using the service spoke of not getting the response required from office. A number of people told of broken promises, a common trend in responses received was of people phoning the office and being told they would receive a call back and of not receiving a call.

Care workers told of enjoying their roles in caring for people but told of not feeling valued by the service and not getting the support they needed. Care workers told of not knowing the new management team as they had not all officially met since changes took place in July 2014.

The provider had a system in place to regularly assess and monitor the quality of the services provided. However this was not always effective and the service did not take on board the shortfalls in the service and address these within acceptable timeframes.

For the past eight months there was a high volume of complaints, these had not been dealt with satisfactorily. The failure of the service to deal with these caused much anxiety to people as the service had not responded appropriately. Some complainants did not receive an acknowledgement or a response within acceptable timescales. The branch had recently taken control of these issues with a complaint's coordinator in post who was addressing all the concerns raised.

We found evidence during this review that indicated the agency had taken appropriate action to improve the way it coordinated its carers. The provider told us in the action plan they supplied us that they had introduced a new Information Technology system to help office staff coordinate support worker visits. Since our previous inspection we have not received any information of concern with regards support workers punctuality or missing home visits altogether. Most of the written feedback we received from people who used the service and their relatives who participated in our July 2013 survey were complimentary about the overall standard of care and support the agency provided. For example, the majority of stakeholders told us they felt support workers usually arrived on time and stayed for the agreed length of time. People also told us that support workers always treated them with respect and that they always felt safe when their support worker visited.

Most people who used the service and their relatives told us staff that 'regularly' provided their care were usually kind and compassionate. One person told us 'the carer's are lovely. They will do anything for my mother'. Another person said 'the service is better now. The carer's we have now are fantastic and my weekday carer is very obliging'.

However, although most stakeholders told us they were satisfied with the overall standard of care they received; we found that failures to ensure care workers were properly coordinated meant peoples needs were not always fully met because staff sometimes missed home visits, turned up late or were not always able to stay the agreed length of time.

In this report the name of a registered manager appears who was no longer employed in that post and was therefore not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.