Archived: Ness M Care Services Peterborough

Ness M Care Services is a domiciliary care service registered to provide personal, and/or nursing, care to people living in their own homes. The service provides a range of support including to younger people, older people, people with mental health needs, people living with dementia and people with a physical disability. At the time of the inspection eight people were using the service, seven of whom received personal care.

Some people were also supported with live-in care. This is where staff stay in the person’s home for a large proportion of the day and were part of the person’s household.

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

There were enough staff, but not all staff recruitment was as safe as it should have been. Information for staff was limited in how to manage risks. This created a risk of harm.

Monitoring and oversight of the service was not effective. There were missed opportunities to improve the quality of service provided. Not all records had been completed or kept up to date. Staff did not always have accurate records they could rely on to provide good quality care. The registered manager had not always reported incidents as legally required, to the Care Quality Commission (CQC).

People and relatives told us staff knew how to safeguard and support people to keep them safe. People received their medicines as prescribed. People were supported by a consistent staff team who they felt comfortable with. Staff ensured they followed infection prevention guidance and good practise. The service and the staff team took on board learning when things went wrong.

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.

The registered manager led by example and had fostered an open and honest staff team culture. People's, relatives' and staff's views were sought, and this enabled them to have a say in how the service was provided. The provider worked well with other organisations, to provide people with joined up care.

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

Rating

The last rating for this service was good, published on 19 April 2020.

Why we inspected

We received concerns in relation to staffing and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires improvement based on the findings of this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

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.

Ness M Care Services is a domiciliary care agency providing personal care to 16 younger and older people at the time of the inspection. Staff provided a service to people living in Cambridgeshire and Norfolk.

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

People were happy with the service and the staff that provided their care.

People felt safe using the service because staff knew what they were doing, they had been trained, and cared for people in the way people wanted. Staff assessed and reduced risks as much as possible, and equipment was checked to make sure it was safe to use. There were enough staff to support people safely. The provider obtained key recruitment checks before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were

completed accurately and with enough detail. Staff supported people to have enough to eat and drink. They used protective equipment, such as disposable gloves and aprons to prevent the spread of infection. Staff followed advice from health care professionals and made sure they asked people's consent before caring for them.

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.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and made sure people's privacy was respected. Staff worked well together, they understood the registered manager's aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. A complaints procedure was in place and people knew who to contact if they were not happy.

Systems to monitor how well the service was running were carried out. Changes were made where issues had occurred, so that the risk of a similar incident occurring again was reduced. People were asked for their view of the service and action was taken to change any areas they were not happy with.

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 requires improvement (report published 6 February 2019). The provider completed actions 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 was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Everyone we spoke with was happy with the care agency and the staff that provided their care. They all told us it was the best agency they had used and that staff were reliable. One person told us, “[Staff] deal with situations and don’t leave. When they are here they are superb.” Another person said, “They’re excellent, very good. I’m very pleased with them.”

People felt safe using the agency because staff knew what they were doing, they had been trained and visited people to learn how to care for them before having to do so. One person said, “Of course, they know exactly what they’re doing, they’re very good.” There were enough staff, and the registered manager filled in for staff sometimes, who visited people regularly.

People told us they always received their medicines and that staff knew how these should be given. Staff supported people with meals and drinks and did this in a hygienic way, using protective equipment, such as gloves and aprons. They followed advice from health care professionals and made sure they asked people’s consent before caring for them.

People and their relatives thought a lot of the staff that cared for them. One person told us, “I like the care staff,” and went on to say, “What makes the difference is they’re so friendly.” Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected. Staff worked well together, they understood the agency’s aim to deliver high quality care, which helped people to continue to live in their own homes.

However, we found that there was some documentation that had not been completed, updated or looked at and despite staff knowing how to care for people, this put people at risk. Systems to monitor how well the agency was operating were not carried out well enough. This meant that where records were not detailed enough or were not available, this had not been found. Key recruitment checks were not always obtained before new staff started work. Where concerns were identified, the registered manager did not follow this up to make sure the staff member was suitable to work in this role. Medicine records were not always completed accurately or with enough detail.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was a registered manager in post at the time of this inspection.

In two areas we found that shortfalls in documentation did not meet the characteristics of Good and we have rated these areas as Requires Improvement. This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Rating at last inspection: Good (last report published 11 June 2016)

About the service: Ness M Care Services is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to younger and older people aged over 18 and over.

Why we inspected: This was a planned inspection based on our previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as scheduled in our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 24 May 2016 and was announced and carried out by one inspector.

A registered manager was in post when we inspected and had been registered since 13 September 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were kept as safe as possible because staff were knowledgeable about reporting any person being placed at the risk of harm. There was a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Arrangements were in place to ensure that people were protected with the safe management of their medicines.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was acting in accordance with the requirements of the MCA so that people had their rights protected by the law. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests. The provider was aware of the procedures to follow should any person require A DoLS application made to the Court of Protection.

Staff were trained and supported to do their job so that people received care that safely met their needs.

People were supported to access a range of health care professionals. Health risk assessments were in place to ensure that people were supported to maintain their health. People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s independence, privacy and dignity were respected. People were supported to maintain contact with their relatives.

People’s recreational and social activities that people enjoyed were identified and they were supported to take part in these. People’s care records and risk assessments were kept up-to-date and which meant that staff had the guidance in how to meet people’s individual needs. A complaints procedure was in place and this was followed by staff this meant that people could be confident that any complaints would be dealt with appropriately.

The provider had quality assurance processes and procedures in place to improve the quality and safety of people’s support and care.

Care plans and records we looked at were comprehensive and detailed and demonstrated to us that the information and guidance would allow any member of staff provide each person's care. People were supported to maintain or improve thier independence as far as reasonably practicable. We saw that regular reviews of people's care had been completed by the provider. People were supported to be seen by healthcare professionals including by their GP.

Records of staff recruitment we viewed evidenced to us that staff were only employed at the service after they had been safely and adequately assessed as being safe to do so. Disclosure and Barring Service (DBS) checks had been completed before staff commenced their employment working with vulnerable adults.

We saw that the provider sought the views of staff, healthcare professionals and family representatives on the quality of care provided. We saw that comments from people who used the service and their relatives were all positive about the care they had been provided with.