Morecare Services(UK)Ltd

Morecare Services(UK)Ltd provides personal care and support to people living in their own homes. The Care Quality Commission (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. At the time of the inspection the service was supporting 38 people, all of whom received personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People received a reliable service from staff who knew how to provide their care in a safe way. Staff understood their responsibilities in protecting people from abuse and knew how to report any concerns they had. The provider’s recruitment procedures helped ensure only suitable staff were employed.

Risk assessments had been carried out to identify and mitigate any risks involved in people’s care. Medicines were managed safely. Staff helped keep people’s homes clean and wore personal protective equipment when they carried out their visits.

People received their care from consistent staff who knew their preferences about their care and respected their choices. Staff encouraged people to be as independent as possible and provided support in way that promoted this.

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.

Right Care:

People received person-centred care that reflected their individual needs. Staff treated people with respect and maintained their dignity and privacy when providing their care.

Staff monitored people’s health effectively and highlighted any changes in people’s needs so action could be taken to address these. Staff worked well with other professionals involved in people’s care to ensure they received the support they needed.

Right Culture:

Staff were kind and caring. They had established positive relationships with the people they supported and people’s families.

Staff had access to the training they needed to carry out their roles and were well-supported by the office team. Staff had opportunities to discuss their roles and any challenges they faced at individual supervision and team meetings.

People receiving care and their relatives said the service communicated well with them. Relatives told us the office team kept them informed about their family members’ health and wellbeing.

People had opportunities to give feedback about their care and told us their views were listened to.

Quality monitoring systems enabled the office team to maintain an effective oversight of the service. These included regular audits and spot checks to observe the care people received.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 April 2021) and there were 2 breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Morecare Services (UK) Ltd is a domiciliary care agency. It provides support and personal care to people living in their own homes. The agency supported 38 people at the time of our inspection.

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

The provider had not always recruited staff safely. Two staff about whom safeguarding concerns were raised were found to have provided false documentation when they joined the agency, which had not been identified through robust checking and verification.

The provider had not always provided information in good time when safeguarding concerns were investigated. In safeguarding investigations involving members of the agency’s staff in 2020, there was a considerable delay in the provision of information, which hampered the investigations and addressing any concerns identified.

People did not always receive consistent, well-planned care. Some people were happy with the service they received. They told us staff timekeeping was good and that they saw the same care workers regularly. People who saw the same staff regularly were happy with the support they received. They told us they felt safe with the care workers who supported them and said staff understood their needs.

However, other people said staff were often late for their calls and they saw a number of different care workers. People told us late calls meant they had to wait for aspects of their care, such as meals, and could not plan their day. Some people said frequent changes of care workers affected their experience of care because staff did not know their needs well.

People’s experience of communication from the agency was also variable. Some people told us the agency was flexible if they requested changes and kept them informed about any changes to the staffing rota. Other people told us the agency did not communicate important information to them, such as changes to their regular care worker or if staff were running late.

People told us staff wore appropriate personal protective equipment (PPE) when they visited their homes and provided their care. Since our last inspection, the provider had improved the management oversight and auditing of medicines.

Staff told us they were well supported by the agency’s management team. They said support was available to them when they needed it and that they had regular one-to-one supervision online. Team meetings also took place online. Staff told us these were used to keep them up to date about people’s needs and their working practices, such as government guidance regarding COVID-19.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 1 April 2019) and a breach of regulation was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced inspection of this service on 18 January 2019. A breach of legal requirements was found in relation to of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We undertook this focused inspection to check the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Morecare Services (UK) Ltd on our website at www.cqc.org.uk

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, recruitment and governance at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The last inspection of the agency was on 12 January 2018 when we identified no concerns and rated the service Good.

This service is a domiciliary care agency. It provides support and personal care to people living in their own homes. The agency supported 61 people at the time of our inspection.

There was no registered manager in place 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. The agency’s manager was able to demonstrate that they had submitted an application for registration with CQC.

Safeguarding concerns had been raised by professionals about the agency in the latter half of 2018 and in January 2019. Some care calls had been missed and the agency had taken on a care package that it was unable to meet. There were also concerns about some aspects of care provision.

The agency had investigated these concerns when required to do so by the local authority and shared the results of its findings. However, the provider had not notified CQC of these concerns at the time they occurred, which meant the provider had not met their statutory obligations.

We found that some of the concerns had arisen because the provider’s management systems were not sufficiently robust to cope with an increase in the number of people using the agency. For example, records and call monitoring systems were in paper rather than electronic form, which meant the provider was not always aware of issues as soon as they occurred.

The provider had implemented some measures to address the issues highlighted by the safeguarding concerns, such as moving to an app-based call monitoring system, although we have made a recommendation that the provider further improve the monitoring of people’s medicines.

The feedback we received from people and their relatives indicated that staff infection control practice and their knowledge of people’s needs was good. People told us staff kept their homes clean and used gloves and aprons when necessary. Staff reported that they had attended training in infection control and always had access to supplies of personal protective equipment.

The agency carried out assessments to ensure that staff had the skills they needed to provide people’s care. Care plans were developed from these assessments, which provided guidance for staff about how to provide people’s care. However, there were no specific end-of-life care plans in place for people receiving this care. We made a recommendation about this.

People said they received their care from regular staff who knew their needs well. They told us staff had the skills they needed to provide their care in a safe way. Staff received the induction, training and support required to carry out their roles. Staff gave positive feedback about the training and support they received and said they were encouraged to obtain further relevant qualifications.

The registered provider made appropriate checks on staff before they started work to ensure they were suitable for their roles. Staff attended safeguarding training and knew how to report any concerns they had about people’s safety or wellbeing. Staff who had reported concerns gave us examples of how people’s care had improved as a result.

People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff sought people’s consent before providing their care and people told us staff respected their decisions about their care. People’s nutritional needs were assessed and any dietary needs recorded in their care plans. Staff understood people’s healthcare needs and supported them to maintain good health.

Staff were kind and caring. People told us staff treated them with respect and maintained their privacy and dignity when providing their care. Staff supported people to maintain their independence where this was important to them.

People know how to complain and told us they would feel comfortable in doing so. We saw that complaints were investigated and responded to appropriately by the agency.

People and their relatives told us they could contact the office if they needed to and get access to the information they needed. They said they had opportunities to give feedback about the care they received, including through satisfaction surveys. Staff told us that communication from the agency’s office had improved and that they had access to management support when they needed it, including out-of-hours.

We identified one breach of the of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

Morecare Services (UK) Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults and younger disabled adults. The agency provided personal care to 30 people at the time the Director submitted the Provider Information Return (PIR) on 8 December 2017. Twenty-seven care packages were funded by local authorities, two by the local Clinical Commissioning Group for continuing healthcare and one privately funded. The agency did not provide any live-in care at the time of our inspection.

There was no registered manager in place 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. The previous registered manager had left the agency in September 2017. The agency’s Director had applied for registration with the CQC but had withdrawn their application. We were advised during the inspection that one of the agency’s care co-ordinators would apply to be the registered manager of the agency.

At the last inspection on 12 November 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

Staff provided people’s care in a safe way. They understood the risks involved in people’s care and managed these safely. The rota was planned to ensure there were sufficient staff to keep people safe and meet their needs. People could rely on the agency’s staff and said their care workers had never missed a visit. They told us staff almost always arrived on time and that they were informed if staff were running late.

The providers’ recruitment procedures helped ensure the agency employed only suitable staff. Staff attended safeguarding training and understood their responsibilities in terms of keeping people safe and protecting them from abuse. The provider had developed a contingency plan which prioritised the delivery of care to people most at risk in the event of an emergency. Where people received support with their medicines, this was managed safely. People were protected against the risk of infection because staff helped keep their homes clean and hygienic.

People’s needs were assessed before they used the service to ensure the agency could provide the care they needed. People were confident that their care workers had the skills they needed to provide their care. They said staff knew how their care should be delivered and were well trained to do their jobs. Staff told us they had access to the training they needed to provide people’s care. Training records confirmed this and that staff had access to any additional training they needed to meet the specific needs of the people they cared for.

People received their care from a consistent team of staff, which they said was important to them. People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training in this area and how the principles of the Act applied in their work. People were asked to record their agreement to their care plan and confirm their consent to the care being provided.

People’s nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Where people needed assistance with eating and drinking there was a care plan in place to outline the support they required. Staff understood people’s healthcare needs and supported them to maintain good health.

People reported that the staff who supported them were kind and caring. They said they had positive relationships with staff and enjoyed their company. Relatives said staff treated their family members with respect and maintained their privacy and dignity when providing personal care. Staff understood the importance of enabling people to manage their own care and encouraged people to maintain their independence wherever possible.

People received a service that was responsive to their needs. People’s care plans reflected their individual needs and preferences about their care. Staff told us they were always given enough information about people’s needs before they began to provide their care. They said they reported any changes in people’s needs to the agency’s care co-ordinators, who reviewed the care package to ensure the time allocated at each visit was sufficient. People told us their care workers had enough time at each visit to provide the care they needed. They said that if their needs changed, their care plan was amended and their visit time extended.

People knew how to complain if they were dissatisfied. The agency’s complaints procedure was provided to people when they started to use the service. Four complaints had been made about the agency in the last 12 months. These complaints had been investigated and responded to appropriately. No complaints about the agency had been made to the CQC.

People and their relatives told us the agency was generally well managed. Some people said they had never had any concerns regarding the reliability of the service they received and were satisfied with the agency’s communication with them. Other people told us the service they received had not been reliable service when they began to use the agency but that the service had improved when they registered their concerns.

Local authorities who commissioned care with the agency also reported that the service had not always been reliable in the past but that standards of reliability had improved significantly. Social care professionals from the local authority told us the management team had responded positively when concerns about timeliness and reliability had been raised and that, as a result, the service people received had improved.

Staff told us they received good support from the agency’s management team. They said they were always able to contact a member of the management team if they needed advice or support, including out-of-hours. Staff told us that care workers worked well as a team to ensure that all the agency’s care commitments were met. The agency’s care co-ordinators monitored the quality of the care people received through regular spot checks on staff. A care co-ordinator visited people’s homes to check that staff arrived on time, provided people’s care safely and in line with the their care plan, promoted their independence and treated them with dignity and respect.

Records relating to people’s care were accurate, up to date and stored appropriately. Staff maintained a daily care notes for each person, which recorded the care they received and, where relevant, any medicines they were given. Care and medicines administration records were checked by care co-ordinators each month to ensure that records were accurate. The management team were aware of the requirement to inform CQC about notifiable incidents and the process for doing so.

During our visit to the MoreCare's office we looked at records which included care files of people who use the service, personal files of employees and information the provider used to assess and monitor the quality of the service. We visited the homes of two people and spoke with a relative. During the home visits we were able to observe how staff interacted with people. We saw staff treat people in a sensitive, respectful and professional manner.

People told us that they were happy with the support they received and that the staff were very good. One person told us that they felt 'very safe' and that the staff were 'very kind and friendly'. A relative told us that staff visit three times a day and that the staff were very good, and treated the person with dignity and respect. The relative also told us that when it was the person's birthday that staff had sung 'happy birthday' which they all enjoyed.

We saw that care plans were person centred and people's care needs were reviewed. We found that MoreCare had processes in place to regularly monitor the quality of the service.

We spoke with one person and one relative of a person who used the service and asked them what it had been like to have received services from MoreCare. Both people were positive about the service they or their relative had received.

People we spoke with told us that they were treated with dignity and respect. We were told that people were fully involved in decisions about their care and were able to make choices about their care and support.

People were aware of their care plan and confirmed that they knew where it was and that staff would always write in it when they visited. We were told that staff were kind and that people felt safe with the staff.

We reviewed staff records and spoke with staff. There were four staff, which included the manager and deputy manager and they were in the process of recruiting more staff.

People expressed satisfaction with the quality of the care being provided. People told us that they were asked to comment on the quality of the service and one person told us that MoreCare 'Offer a very good service.'