Medinova Healthcare Ltd,

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified breaches in relation to safe care and treatment, staffing and fit and proper persons employed. The service was not always safe. Medicines were not always managed in a safe way and in line with best practice. There was not enough information about people’s medicines. Staff had not always had enough training or support to understand how to safely manage medicines and the provider’s systems for ensuring good practice were not always operated effectively. Risks to people’s safety and wellbeing had not always been assessed or planned for. This meant that staff did not have enough information and guidance to ensure they provided safe care. The provider’s systems for recruiting staff had not always been followed. They had not carried out sufficient checks to ensure staff were suitable, had the skills needed and were competent. Some staff had not completed essential training, including working with people with a learning disability, the Mental Capacity Act 2005 and practical manual handling techniques which they needed to equip them for their roles and responsibilities. There were appropriate systems for responding to complaints, accidents and incidents as well as safeguarding concerns. There had not been any such events at the service. People’s relatives knew who to speak with if they had concerns and felt these would be addressed if needed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were systems to learn from things that went wrong. However, at the time of our assessment, there had not been any accidents, incidents or safeguarding concerns. People’s relatives told us they were able to speak with the registered manager about any concerns and felt these were acted on and learnt from. One relative told us, “We understand the company’s procedure for raising complaints as this was explained to us when we took on the service.’’

Staff told us they had opportunities to discuss learning with the registered manager through meetings and supervision sessions.

There were policies and procedures for dealing with adverse events. The provider had templates to record how accidents and incidents would be recorded, investigated and responded to. There were also systems for the registered manager to track these and review any themes. However, these systems had not been tested because there had not been any accidents or incidents at the service since the agency started operating.

People using the service had not been supported by the agency with any transitions between services.

The external partner we spoke with had not been involved in supporting people transition between services.

People’s families supported them with this aspect of care. The registered manager explained this was not part of the care and support they offered. However, there were policies and procedures which were designed to guide the provider on how to respond if people needed support transitioning to another service.

People felt safe with the service. Their relatives told us they trusted staff. Relatives explained they were aware of procedures for recognising and reporting abuse and had information about these.

Staff told us they had undertaken training around safeguarding and understood this. However, we noted that some staff had not passed tests of their knowledge and learning at the end of the training. We discussed this with the registered manager in order for them to address this and make sure staff were knowledgeable and competent.

There were procedures for safeguarding people from abuse. However, the provider did not always ensure checks to mitigate risks of abuse were in place. For example, 1 person was supported to go to the shops. Their care plan stated that receipts and records of transactions should be maintained. There were no records of this, and the provider’s audits did not include checks to make sure risks of financial abuse were being mitigated. There was no indication people had been harmed, but without proper checks the provider could not give assurances people’s money was being handled safely. We discussed this with the registered manager so they could make improvements to how their systems were implemented. There had been no safeguarding concerns at the service. Staff had not had training about the Mental Capacity Act 2005.

People’s relatives told us they thought staff managed risks and kept people safe. Their comments included, ‘’[Person] has a frame to help [them] walk and the carer stands beside [them] to keep [them] safe’’, ‘’We have no concerns about safety or when the carers take [person] out to do some shopping in [their] wheelchair’’ and ‘’The carers are on time and never rush [person] so [they] feel very comfortable and safe with them.’’ While the people we spoke to expressed that they felt safe when they received care, our assessment found elements of processes related to how care was provided did not meet the expected standards.

The registered manager told us they had demonstrated how to use moving and handling equipment to staff. This included using a hoist. Staff told us they had not had formal assessed training to use this. The registered manager told us that an external professional had demonstrated to staff how to use 1 person’s wheelchair. All people being cared for at the time of our assessment used wheelchairs or other equipment to help them mobilise around their homes. There was no evidence staff had been trained or assessed to support people to move safely and in a personalised way.

Risks to people’s safety and wellbeing had not always been assessed and planned for. This meant there was not enough guidance for staff on how to keep people safe and how to manage risks. Some risks had not been assessed or recorded. For example, 1 person was on a texture modified diet, this had not been assessed, planned for or assessed. Staff supported the person with meals but there was no guidance about how to do this safely. There was no information about people’s health conditions and risks associated with this. Where risk assessments had been created these were not detailed enough or personalised. For example, risk assessments about mobility stated staff should support with ’transfers’ but did not describe how. The risk assessment for 1 person stated they were at risk of choking but the management plan relating to this did not describe how the staff should support them to eat and drink in a safe way.

CQC does not assess people’s home environments for this type of service.

We did not receive feedback from staff about this aspect of the service.

The provider had not carried out assessments of people’s home environments to make sure these were safe for people using the service and staff whilst care was being delivered. This meant that they had not adequately planned for any potential risks.

People’s relatives told us staff arrived on time and carried out tasks as needed. Their comments included, ‘’The carers always stay for the correct amount of time for each call’’, ‘’We have regular carers who we know well’’ and ‘’The carers get the job done and stay longer if needed.’’ While the people we spoke to expressed that they felt safe when they received care, our assessment found elements of processes related to how care was provided did not meet the expected standards.

The staff told us they had enough time to care for people and travel between care visits.

The systems for recruiting and selecting staff were not operated safely or effectively. The provider had failed to carry out the necessary checks on staff before they started working at the service. Therefore, they could not assure themselves staff were suitable or fit. For example, staff had not always provided consistent or reliable information, there were gaps in their employment history, and the provider had not sought or obtained suitable references. The staff completed online training courses. Some of the staff had not completed the provider’s mandatory training, and other had only completed a small number of courses. Care providers are required to make sure staff are suitably trained and competent. There was no evidence the provider had undertaken additional checks on staff competencies, skills or knowledge. Therefore, they could not assure themselves staff were suitable and sufficiently qualified to care for people in a safe way. Failure to follow safe systems for recruiting and training staff as well as testing their knowledge and skills placed people at risk of receiving inappropriate care and treatment.

People’s relatives told us staff followed good cleanliness and infection control processes. One relative explained, “When providing a shower, the carers wear their gloves and aprons.’’

Staff told us they had access to personal protective equipment (PPE), such as gloves. There were suitable procedures for managing infection prevention and control. Staff were able to view these when needed. The registered manager carried out spot checks where they observed some care visits. Part of these checks included observations about whether staff practiced good hygiene.

The relatives of 2 people told us staff helped people with their medicines. They told us they were happy with this support. Their comments included, “The carers give [person] medication on time and there have been no errors” and ‘’[Person] has [their] medication on time and the carers record this on a form.“ While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of the service did not meet the expected standards.

Staff had completed online medicines training. The registered manager said that they had observed staff giving medicines and tested their competencies but there were no records of this. After we discussed this with the registered manager, they organised a meeting and competency assessments for 3 members of staff and sent us evidence they had done this.

Medicines were not always managed in a safe manner and in line with legislative requirements and best practice. The provider had not assessed the risks relating to people’s medicines or created detailed plans about this. For 1 person who the staff supported with medicines, there was no recorded information about this aspect of their care. For the second person who staff supported the information was not consistently or accurately recorded. Administration records did not meet best practice standards. One prescribed medicine had not been recorded on administration records so the provider could not be assured this had been given. We identified a gap on the recording of other medicines for 1 day in October. These discrepancies had not been investigated or acted upon. There were not regular checks and audits of medicines management records. Some people were supported with the application of topical creams. There was no recording of this or risk assessments regarding these. Following our feedback to the registered manager, they started to make improvements and sent us the evidence of this.