Archived: Midas Care

Midas Care is a domiciliary care service which runs from an office based on the outskirts of Waterbeach. The service provided personal care to people. Not everyone using Midas Care received a regulated activity; Care Quality Commission (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 our last inspection of Midas Care, between 24 and 29 January 2018 we rated the service Requires Improvement. Improvements were needed to support people safely with their prescribed medicines. Incidents where people had not been safeguarded were not acted on and investigations had not always been undertaken. The provider's policy for complaints was not followed and the providers governance systems were not effective enough in identifying and driving the necessary improvements.

We asked the provider to complete an action plan to show what they would do, and by when, to improve the key question is the service safe, is the service effective, is the service caring, is the service responsive and is the service well-led to at least good. They sent us an action plan and told us they would make these improvements by 31 March 2018.

We carried out this inspection to see if the registered provider had acted in line with their action plan. We found the service had made the necessary improvements under the questions is the service effective, caring, and responsive which are now rated as 'Good'. However, further improvement was still needed for the questions, is the service safe? and is the service well-led? The service, therefore remains rated as 'Requires Improvement'. At the time of our inspection there were 201 people using the service.

A registered manager was 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.

The registered manager was new in post at the time of our last inspection. Since that inspection, and with the support of the new director of operations, they had made some significant changes to the way the service was run. The provider’s governance system and processes had improved. However. further work was needed to ensure better monitoring of improvement plans, with robust timescales and ensure actions are embedded in practice, and reviewed. This will help to drive continual improvement and give good outcomes for people.

Further work was required to ensure risks to people’s health, safety and welfare are identified and managed safely, with sufficiently detailed care planning arrangements to guide staff on how to minimise risk and meet people’s needs effectively.

Staff were recruited safely and improvements had been made to ensure there were enough suitably trained and supported staff to meet people’s needs. Medicines were administered and managed safely. Systems were in place to support good hygiene and infection prevention standards.

People’s decisions about their care were respected. Staff effectively supported people with their food and drink with input from healthcare professionals.

Staff were kind and caring, and sensitive to their needs. They promoted people’s independence, dignity and they respected people’s privacy. People were involved in their care.

Management worked with other professionals to ensure people’s needs were met. Management responded promptly to complaints and comments and they were resolved to the person’s satisfaction. Areas for learning from incidents, accidents and complaints were actioned and completed.

Midas Care operates from an office based on the outskirts of Waterbeach. At the time of this inspection there were 270 people using the service.

This comprehensive inspection took place between the 24 and 29 January 2018 and was announced. We gave the service five days’ notice of the inspection visit. This is because the provider needed to arrange visits to people's homes so we could shadow staff’s care calls and gain consent to telephone people and their relatives.

The previous inspection was undertaken on 3 November 2016. At that inspection the service was rated as 'Good'. At our inspection between the 24 and 29 January 2018 the service had deteriorated to 'Requires Improvement'.

The registered manager had started in post under a different role in November 2017 but had only been registered as a registered manager since 9 January 2018. The previous registered manager had left in November 2017. 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.

Not all incidents of harm, or potential harm, had been referred to the local safeguarding authority. People's care and support needs were not always met by staff in a way which supported people as well they should have been. Staff were recruited in a safe way but their deployment did not always ensure that people were safe. Not all staff provided care that was as caring or dignified as it could have been.

People were not always administered their prescribed medicines safely. Advice had also not always been sought from healthcare professionals when medicine administration errors had occurred. Not all staff followed people’s care plans. Incidents were not always identified as being an opportunity for learning and to help drive improvements.

People were enabled to access healthcare services. The equipment that staff supported people with was checked to make sure that it was safe to use. A positive and good working relationship existed between the registered manager, staff and relevant stakeholders. 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. People were not always supported with their nutritional needs.

People were involved in decisions about their care and relatives or friends helped provide information, which contributed to people's independent living skills. People's care plans contained sufficient information about the person to assist staff with providing person centred care. People were provided with information about, and or enabled to access, advocacy services when required.

Complaints were not always identified and they weren’t always investigated in line with the provider's policies and procedures. Concerns were not always acted upon before they became a complaint. Arrangements and procedures were in place to help ensure that people received good end of life care.

The registered manager and provider had not always notified the CQC about events that, by law, they were required to do so. Audits were not always as effective as they should have been which meant opportunities to make improvements were missed. Where incidents occurred these had not always been investigated or acted upon.

An open and honest staff team culture had been established by the registered manager. The registered manager motivated the staff team with regular meetings, formal supervision, mentoring and using experienced staff to mentor and shadow newer staff. Audits and quality assurance systems were not effective in identifying and making the necessary improvements. Staff were supported in their role.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was for not safeguarding people, unsafe medicines’ administration, ineffective or no responses to complaints and a lack of effective governance. We also found one breach of the Care Quality Commission (Registration Regulations) 2009 for not notifying us about events that, by law, the provider must tell us about.

You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

This comprehensive inspection took place on 25 and 27 October and 2 and 3 November 2016 and was unannounced.

At the last inspection on 4 and 5 August 2015 there was a breach of a legal requirement found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to improvements required to make sure that people’s care was as respectful as it should have been. The provider sent us an action plan telling us how they would make the required improvements.

During this inspection we found that the provider had made the necessary improvement and all legal requirements were now being met.

A registered manager was in post at the time of the inspection and had been registered since 2010 under the current legislation. However, although in post they were not present during this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the agency. 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.

Staff’s knowledge about keeping people safe helped ensure that any incident of harm would be reported. People’s individual care needs were provided by a sufficient number of skilled and competent staff. An effective recruitment process was in place to ensure that staff were suitable to look after people who used the service. People’s medicines were administered safely and as prescribed.

People’s nutritional needs were met and supported by staff who possessed the necessary care skills. People, with staff’s support, could access health care services according to their needs.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. Management, office based staff and care staff were aware of, and liaised with, those agencies who were responsible for submitting applications to the appropriate authorities to lawfully deprive people of their liberty. Staff had an awareness of the application of the MCA code of practice.

Staff were provided with the necessary training and skills they needed to do their job and undertake their role effectively.

People’s privacy and dignity was provided by staff in a respectful way. People, their relatives or representatives were provided with various means to be involved in the review of people’s care plans.

People were provided with various opportunities to help reduce the risk of social isolation. Assistance was provided by staff so that people could be as independent as possible such as help with hobbies, shopping and maintaining an active lifestyle based upon people’s preferences and needs.

A system was in place to listen to, record and respond to people’s concerns and complaints.

The registered manager was supported by a team of management staff and care staff. Appropriately trained staff had regular mentoring, training and they had the management support they needed.

Various methods and opportunities were provided so that people, their relatives and staff were able to make suggestions to improve and maintain the quality of the service that was provided. An effective quality monitoring and assurance process was in place and actions were taken whenever improvements were identified.