Archived: Mosaic Care Group Limited

Updated 18 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, younger disabled adults and children.

This comprehensive inspection took place across 4 dates 25, 26, 27 October 2017. We continued the inspection on the 10 November 2017. This was because the registered manager was not available on the first two days of our inspection and we needed to speak with them. The first day on the inspection was unannounced.

The inspection team comprised of two adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care home. The expert-by-experience had background knowledge of domiciliary health and social care services.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the time of inspection there were 50 people who used the service, 17 of these were children. We spoke with a range of people about Mosaic Care Group Limited. They included five people who used the service, four relatives, the manager, the provider, three staff members and two professionals.

Before the inspection visit we contacted the commissioning department at Lancashire County Council. In addition we contacted Healthwatch Lancashire. Healthwatch Lancashire is an independent consumer champion for health and social care. This helped us to gain a balanced overview of what people experienced accessing the home.

We closely examined the care records of seven people who used the service. This process is called pathway tracking and enables us to judge how well the home understands and plans to meet people's care needs and manage any risks to people's health and wellbeing.

We reviewed a variety of records, including policies and procedures, safety and quality audits, five staff personnel and training files, records of accidents, complaints records, various service certificates and medicine administration records.

Updated 18 January 2018

Mosaic Care Group Limited is a privately owned domiciliary care agency, operating from offices in Ashton, Preston. The agency provides personal care services to support children, older people and adults with disabilities living in the community. At the time of our inspection there were 50 people receiving a service from Mosaic Care Group Limited.

At the last inspection, the service was rated Requires Improvement. At this inspection we found the service remained Requires Improvement. This is the first time the service has been rated Requires Improvement under the Care Quality Commissions ‘Next Phase’ methodology.

The service had a manager in place however they had not yet applied to become a registered manager. 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.

We found inconsistencies in individualised risk assessments and the plans in place to mitigate these. The documentation did not always contain information to adequately mitigate the risks to individuals.

We looked at how the service was staffed. We reviewed staff rotas and focused on how staff provided care within a geographical area. We looked at how many visits a staff member had completed per day. We did this to make sure there were enough staff on duty at all times to support people in their care. We found one example where a family member was being asked to provide care alongside staff on a double up call. This practice was unsafe as the service could not be sure the family member had the required skills and knowledge. The practice was not risk assessed and there was no plan in place to support the practice. This put the person who used the service, staff and the family member at risk.

The risk management issues around unsafe practice and risk planning identified amounted to a breach of Regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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; the policies and systems in the service did not support this practice

This failure to follow the code of practice amounted to a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Need for consent). You can see what action we told the provider to take at the back of the full version of the report.

We saw evidence quarterly quality monitoring was being undertaken, however the audits were not always effective. We found little information surrounding the details of issues found and how these had been rectified and lessons learned. We also noted the audit system had not identified the breaches of regulation and areas of improvement we had noted during this inspection.

These shortfalls in quality assurance amounted to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance). You can see what action we told the provider to take at the back of the full version of the report.

People raised concerns about late visits. Two people we spoke with told us the office informed them about late visits. One we spoke with told us they had missed visits. We spoke with the manager about this and they informed us sometimes late visits can happen due to unforeseen circumstances. We have made a recommendation around this.

We looked at the procedures the provider had for the administration of medicines and creams. We found one person’s medicine support plan did not list their prescribed creams. We looked at policies and procedures related to medicines management. We found the medicines policy had not been reviewed to include the most up to date NICE guidance for medicine in a community setting. We have made a recommendation around this.

During the inspection we looked at the care plans for seven people. We found current needs were not always identified. We found care plans did not always have enough detail considering the complex needs of the individual cared for. We have made a recommendation around this.

Staff told us there are always changes in the office and they don’t always know who they are speaking to when they contact. At the time of the inspection not all staff were aware that there was a new manager in post. Staff told us they would like to be more informed about what was happening within the service, such as staff changes. We have made a recommendation around this.

The ratings were not displayed on the website for the service. We spoke with the provider who explained the website had been recently changed and not all of the information had been updated. The ratings were added to the website prior to the end of the inspection visit.

We looked at how people were supported to have sufficient amounts to eat and drink. The few people who said they had food prepared had breakfast or snack lunch prepared. All said they chose what to eat and the food and drinks were hot, nicely prepared and how they liked them. Care plans we looked at guided staff on how people liked their meals prepared.

We asked people about staff who visited their homes and if they had time and treated people with compassion dignity and respect. All the responses were positive. Staff understood how to respect people's privacy, dignity and rights and received training in this area. Staff described how they would ensure people had their privacy protected when undertaking personal care tasks.

People were supported by staff with activities to minimise the risk of becoming socially isolated. An example was seen in one person's care file where the person was being supported to go shopping.

The management team were receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.