Michael Batt Foundation Domiciliary Care Services

About the service

Michael Batt Foundation Domiciliary Care Services (hereafter The Michael Batt Foundation) is a Domiciliary Care Agency that provides support to people with a learning disability, autistic people or who have multiple health needs associated with their mental health. The service was providing personal care to 12 people at the time of the inspection.

People’s experience of using this service and what we found

Right Support:

The Model of Care provided by The Michael Batt Foundation was not safe. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans and risk assessments relating to the health, safety and welfare of people were not kept under regular review. Some peoples risk assessments were outdated and did not reflect their current risk to themselves and/ or others.

People were placed at the risk of not receiving safe care as there was not an effective structured system to ensure staff had been deployed effectively. Medicines were not always managed safely and in line with the National Institute for Health and Care Excellence (NICE) guidance Managing medicines for adults receiving social care in the community.

Right Care:

The Model of Care provided by The Michael Batt Foundation was not person-centred and did not promote people’s dignity and human rights. The language sometimes used by staff to describe people within their care notes, was outdated and disrespectful. Staff were able to describe the actions they could take if they had safeguarding concerns for the people they supported. However, records showed appropriate action had not always been taken.

There was an absence of a person-centred care planning review process, and we could not be assured that peoples care plans were up to date and contained sufficient information to guide staff in providing good quality personalised care. People were not supported to live their lives according to their preferred routines. There was a lack of sufficient evidence to show that all reasonable steps had been taken to re-engage people in meaningful activities and social interactions following the COVID19 Pandemic.

Right Culture:

Restrictive practices, poor application and understanding of the Mental Capacity (MCA), a lack of openness and transparency and inadequate governance and oversight had helped to create a 'closed culture' at The Michael Batt Foundation. A 'closed culture' is a poor culture that can lead to harm, including human rights breaches such as abuse. In these services, people are more likely to be at risk of deliberate or unintentional harm.

It was evident from a review of the data and information held by the provider and our findings throughout our inspection that staff did not receive regular, effective supervision and support. The registered manager was aware of their regulatory responsibilities such as submitting statutory notifications but failed to carry this out.

The findings of our inspection identified a culture that was not based on learning. This meant that when things had gone wrong, the potential for re-occurrence was inevitable because there was no action taken to review, investigate and reflect on incidents.

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 9 May 2018)

Why we inspected

The inspection was prompted in part by information shared with CQC about a series of incidents which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk, MCA, and unlawful restraint. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. However, further concerns and risks were identified so a decision was made to carry out a comprehensive inspection to include the key questions caring and responsive.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, consent, dignity and respect, person centred care, notifications of other incidents and governance.

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

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger adults who may have a physical or learning disability or a mental health need.

CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection, four people were being supported with personal care. The service supports these people on a 24 hour basis.

The service had a 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains Good.

We visited and spoke to three people in their own homes and observed the interaction between them and the staff supporting them. People were not able to fully verbalise their views, so staff used other methods of communication, for example visual choices and sign language.

People remained safe using the service. People were protected by safe recruitment procedures to help ensure staff, were suitable to work with vulnerable people. Staff confirmed there were sufficient numbers of staff to meet people’s care needs, and support them with additional support including activities.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received medicines training and understood the importance of safe administration and management of medicines. Where staff supported people to manage their finances, amounts of money spent on the person’s behalf were carefully recorded and balances maintained and checked to help ensure people’s finances were managed safely.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to help support and enable people to retain as much independence as possible.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training and the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the equality and diversity needs of people.

People's human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People's nutritional needs were met because staff followed people's support plans to make sure people were eating and drinking enough, and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

People were enabled and supported to lead fulfilling, independent and active lives. People were supported to reach their goals and ambitions. 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.

Risks associated with people's care and individual living environment were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. People's independence was encouraged and staff helped people feel valued by engaging in everyday tasks where they were able, for example helping prepare meals.

People continued to receive a service that was caring. Staff showed kindness and compassion for people through their conversations and interactions. If people found it difficult to communicate or express themselves, staff showed patience and understanding.

People received information in a format suitable for their individual needs. Throughout the inspection we saw evidence of how the provider and staff understood and promoted people's rights as equals regardless of their disabilities, backgrounds or beliefs.

The service remained responsive to people's individual needs and provided personalised care and support. People had complex communication needs and these were individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received were fully investigated and responded to.

Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.

The service continued to be well led. People used a service where the registered manager’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager was very approachable and made themselves available.

The provider had systems in place to monitor, assess and improve the service. There was an open culture, and people and staff said they found access to the office and management team welcoming and easy. Staff, were positive and happy in their jobs. There was a clear organisational structure in place.

Further information is in the detailed findings below.

People were encouraged to maintain their independence and set themselves goals. Staff told us how people were enabled to meet their own personal hygiene needs and to retain their mobility. Staff made positive comments to reinforce and encourage people's independence and achieve their goals.

The service provides personal care and support to people who live in their own homes. We saw that support plans were personalised to reflect the needs of the person they were about. Information was comprehensive and showed evidence of review and update. Risk assessments had been developed around individual areas of risk, these showed evidence of updating and review.

Assessment and monitoring of the service was in place through meetings held with people who used the service. Their views were sought and suggestions welcomed for any areas of improvement.

The manager demonstrated a good awareness of the needs of people that use the service and looked at guidance in order to improve care when needed. This meant the service sought professional advice for the best interests of the people who use the service.

On the second day of our inspection we met three people in their own home. This gave us the opportunity to speak with people using the service as well as observe the care being provided.

Information and care records within the agency office and people's homes were well organised and safely stored. When possible people using the service had been involved in the planning and delivery of their care and any changes were well communicated to the person concerned.

We saw that staff treated people respectfully and knew how to support people to make choices and to have control over their lifestyle.

Staff were aware of issues relating to abuse and had clear procedures to follow to ensure that people were kept safe. One staff member said 'There are plenty of opportunities to raise any concerns, training is good and someone is always available to talk to if needed'

Systems were in place to regularly monitor and review the quality of the service provided. Examples were given of changes made to the service as a result of accidents and incidents that had occurred.