Archived: MRL Healthcare Limited

Updated 27 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 inspection took place on 23 and 24 September 2015 in line with our current methodology for inspecting domiciliary care agencies. This inspection was announced to ensure that the registered manager or other responsible person would be available to assist with the inspection visit.

The inspection team comprised of one adult social care inspector 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 service. The expert by expert who joined us had experience of domiciliary care services. Following our inspection visit to location’s office, an expert by experience conducted telephone calls to six people using the service and three relatives. These people had been contacted previously by the management of the agency to ask if the expert by experience could contact them and ask them some questions about the service they received from MRL Healthcare Limited. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection took place, we considered all the information we held about the service, such as notifications about safeguarding matters. We had not, on this occasion, requested the service to complete a provider information return (PIR); this is a document that asks the provider to give us some key information about the service, what the service does well and any improvements they plan to make.

During the inspection we looked at the care records for eight people who were using the service. We looked at five staff personnel records, staff training records and policies and procedures. We also looked at a range of records relating to how the quality of service was monitored. These records included medicine administration record checks and care records checks.

We talked with six people using the service and three relatives via pre-arranged telephone calls. We also spoke with the registered provider, two care supervisors, the office manager, three care co-ordinators and four members of the care staff team. The registered manager of the service was on holiday at the time of this visit.

Updated 27 November 2015

This inspection took place on 23 and 24 September 2015. This was an announced inspection. Individual telephone calls were made to six people who used the service and three relatives by an Expert by Experience on 28 and 29 September 2015. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

This was the service’s first inspection since MRL Healthcare Limited had registered with the Care Quality Commission at this location.

MRL Healthcare Limited is a domiciliary care service, which provides support with personal care, domestic tasks and shopping to people living in their own homes. At the time of this inspection the service was providing support to people living in Manchester, Stockport and Tameside.

The service had 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 and associated regulations about how the service is run. The registered manager of the service was on annual leave at the time of this inspection.

We identified five breaches 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 this report.

We were supported throughout the inspection by the registered provider and a care supervisor, who was managing the service in the absence of the registered manager.

People were not properly safeguarded from harm when being supported with the prompting or administering of their medicines. Staff with this responsibility were not always following the safe policy and procedure guidelines. The provider did not have safe systems in place to make sure medicines were prompted or administered as prescribed. Medication administration records and care plans had not always been completed correctly.

This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The proper and safe management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

People using the service told us they felt safe and comfortable when staff were delivering their support and staff were able to demonstrate a clear understanding of what safeguarding people involved and their roles and responsibilities in doing this.

Not all staff had received up to date training in the Mental Capacity Act (2005) and they were unclear about their duties under this legislation.

Many of the staff working for MRL Healthcare Limited had transferred across from other domiciliary care agencies within the last two years. Although some training had taken place, we saw from the staff training files we looked at that this was limited, with some staff having no specific training with MRL Healthcare since their employment with the agency had begun. Some staff had yet to complete moving and handling training, safeguarding training and infection control training.

This was a breach of regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) 2014. Staffing. You can see what action we told the provider to take at the back of the full version of the report.

Those staff we spoke with understood their role and responsibilities in making sure they respected people’s individuality and personal choices and the need to ask for a person’s consent prior to carrying out any care related tasks. People we spoke with said that they thought staff were capable and understanding and did their job well.

People told us they were happy with the support they received from the service and the staff that delivered that service. Individual care files contained information about people’s needs, likes, dislikes and preferences.

Of those care plans we examined, we could see that care reviews had taken place and saw that the person using the service and / or their relative had signed to indicate their involvement in that process.

Files were inconsistent in their contents, which made it difficult to find all documentation. For instance, although some risk assessments had been completed, these were not directly linked to a specific care plan.

Lack of such important information being available in care plans was a breach of regulation 9 (1) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Person- centred care. You can see what action we told the provider to take at the back of the full version of the report.

The company had a complaints policy, and people were given a copy of the policy when they began to receive care and support from the service. We saw evidence that complaints had been dealt with efficiently and in a timely manner by the registered manager. The staff we spoke with told us they would report any concerns or complaints they received to the office. They also told us they would listen to and act on what a person told them, especially if the person felt unable to raise the concern themselves.

We asked the registered provider and care supervisor about the quality assurance processes or systems in place that were used for monitoring the quality of service provided. We were told that the registered manager carried out some audits, but these had not been done on a consistent basis and were not available for us to review. From the information shared and lack of the consistent monitoring of service provision, we found no meaningful audit processes were in place for the service and this had resulted in some of the shortfalls and breaches of regulations we had found during the inspection process.

This was a breach of Regulation 17 (1) (2) (e) (f) 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.

We found the statement of purpose did not contain up to date information.

This was a breach of regulation 12 (1) (2) (3) of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.