Archived: JKs Majestical Care Limited

JKs Majestical Care Limited is a domiciliary care agency providing personal care to one person in their own home at the time of the inspection.

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

The person using the service told us they were happy with the service provided.

People could not be assured that staff were safe to work with them as the appropriate pre-recruitment checks were not carried out.

People were not always supported by staff who had been trained about safeguarding and abuse. Some staff did not have training in infection control. People were at risk of not having their needs met by staff who were not suitably trained in their role.

Staff did not have adequate knowledge of one person’s medical healthcare needs, although they were supported with their medicines appropriately.

The provider did not have effective systems and processes in place to ensure good governance of the provision of care for people. Shortfalls we had identified at our last inspection had not been addressed and we identified a lack of improvement.

Staff worked with other professionals to ensure they could support people’s care needs.

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

The last rating for this service was requires improvement (published 4 May 2019) and there were three breaches of regulations. We placed conditions on the provider’s registration which required the provider to send us monthly audits to support them to improve the standards of quality and safety. At this inspection, not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected

The inspection was prompted due to concerns about the safe recruitment of staff and the absence of the registered manager, who is also the provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We have identified continued breaches in relation to the safe recruitment of staff and the lack of an effective management structure. We identified a new breach regarding the safeguarding knowledge of staff to keep people safe and the lack of an effective management structure at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will write to the provider to ask them what action they are proposing to take to improve the standards of quality and safety and address the regulatory breaches we found. We will continue to monitor progress through the audits the provider is required to submit to us each month.

We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to older people living in their own houses and flats in the community. The service currently provides a service to two people.

There was a registered manager in place. 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 service has been the subject of an ongoing large-scale safeguarding enquiry conducted by the local authority. The Care Quality Commission and the local authority have both received concerns about the care and safety of people using the service.

Recruitment procedures were not robust and did not always ensure that staff were safe to work with people who receive care. There was no evidence that staff had received training in safeguarding people and there had been one incident the service should have referred to the local authority safeguarding team, but this had not been done. Staff supported people to take their medicines but there were gaps in the records which meant it could not be evidenced that people had taken their medicines as prescribed. The registered manager completed risk assessments which covered the environmental risks for where people lived, as well as moving and handling and the use of equipment, however, one risk assessment did not identify a health risk to the person or give information on how to manage the associated risks for them safely.

There was not a suitable staff training programme in place to ensure staff’s training was up to date, consistent and designed to meet people’s needs. There was not an effective system of support for staff, such as an induction to their role, regular supervision or an annual appraisal.

There was not a clear vision or credible strategy to deliver high-quality care and support. The governance framework did not ensure that staff’s responsibilities were clear. The governance of the service had not resulted in improvements being made for people.

The registered manager ensured there were sufficient numbers of staff to support people’s needs. There were systems in place to protect people from the risk of infection. Where incidents had occurred, lessons were learnt by the registered manager and staff. The registered manager visited people at hospital or at home to assess their needs before they agreed to provide people with a service. Staff supported people with preparation of both their meals and shopping, where necessary. People were supported to access healthcare professionals when necessary. The registered manager and staff had worked together with healthcare professionals which meant people received treatment and support which met their needs.

People felt they were supported by caring staff. People were supported by staff who ensured people made their own choices. Staff were mindful of people’s privacy and dignity. People received personalised care that was responsive to their needs. The service had supported people with end of life care. The provider had a complaints procedure in place and people had a copy in their care plan. The registered manager sought feedback from people using the service, which was positive.

JKs Majestical provided personal care to older adults living in their own homes. At the time of our inspection ten people were receiving personal care from the agency.

Medicines were managed safely and people received their medicines when they needed them although records did not show why there were some gaps in the medicine administration records.

Staff were completing training although this had not all been completed by new staff. Staff were receiving formal and informal supervision. Essential pre-employment checks were undertaken.

There were sufficient staff to provide people with the care they required. People said staff were caring. Staff spoke to people in a kind and patient manner. We observed staff supporting people with respect whilst assisting them to maintain their independence as much as possible.

People and their relatives said they were very happy with the service and care they received. They told us care was provided to them with respect for their dignity by a consistent care staff team. Care staff, and the registered provider always asked for consent from people before providing care.

Staff were aware how to spot the signs of abuse and report it appropriately. People said they felt safe with care staff and were complimentary about the staff caring for them.

People’s care plans were person-centred and their preferences were respected. Care plans were reviewed regularly and people felt involved in the way their care was planned and delivered.

Staff said they worked well as a team and that the registered provider was supportive and provided guidance when they needed it. Formal quality monitoring systems were in place.

We considered all the evidence we had gathered under the outcomes we inspected. We also spoke with one staff member and the registered manager who was also the provider. We used the information to answer the questions we always ask to determine if the service;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is it safe?

People's needs had been assessed and care plans were clear and informative. Staff were aware of people's needs and how to meet them. Risks relevant to individual people had been identified and care plans contained guidance on how these should be managed. Records kept of people's care were clear and understandable.

Systems were in place to manage the risk of infections. However, the manager had not yet completed an infection control audit or annual infection control statement. Staff were booked to attend infection control training.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection prevention and control.

Is it effective?

Records of care people had received stated people had been cared for in line with their care plans. Records also showed that where two staff were required these had been provided. This meant people were receiving effective care as detailed in their care plans.

Is it caring?

We spoke with one staff member who was able to talk about the individual needs of the people they looked after. They said they had time to meet people's needs. They described how they had stayed longer than planned with a person who had been unwell whilst waiting for an ambulance and the person's relatives to arrive. This showed they were considerate of the person's needs.

Is it responsive?

The manager had addressed the majority of the concerns raised at the previous inspection in April 2014. Where some action had not yet been completed they were aware of what needed to be done. The manager had sought external guidance and assistance to ensure they met the regulations. This showed they had responded to the concerns raised and taken action to rectify these appropriately.

Is it well-led?

Staff told us the manager was available to talk to at any time. One staff member told us, '[They] are really approachable. You can discuss anything with them'. The agency now had a care supervisor and some management tasks had been delegated to them. This meant the manager had more time to complete other management tasks.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led

This is a summary of what we found-

Is the service safe?

The prevention and control of infection was not safe because we found a lack of evidence of effective staff training, of assessment of risks, of auditing of staff practices and comprehensive policies and procedures to ensure staff were fully informed of infections. This meant there was a risk that people were not fully protected from cross infections.

Risk assessments in people's care packages were incomplete and did not always identify the risks to each person or include specific guidance for staff to ensure the risks were minimised and care carried out in the safest way for each person.

Medicines management was not monitored to ensure that staff were following correct procedures and not all staff administering medicines had been trained. Recording of medicines did not include creams used and this meant they may not be safely used.

Recruitment practices were not safe and thorough. The provider had not put an effective system in place to make sure processes and checks were followed and completed before staff provided care to people.

We have asked the provide to make improvements and meet the requirement of the law in relation to , infection control, medicines management , recruitment and risk assessments .

Is the service effective?

People told us they had been asked about the care they wanted before it was provided and assessments had been completed. People told us they felt able to ask for help with additional things and these were responded to when assistance needed. For example they offered to complete extra tasks such as contacting the District Nurse, GP or pharmacist and they followed this up.

People were all satisfied with the care provided. They said they could rely on the service being provided when they expected it. Each said they always had two carers for each visit and they received the care they expected and that was agreed. However, incomplete risk assessments for individuals meant staff action may not be effective.

Records of training staff had received were incomplete and did not provide the details of the knowledge and skills they had acquired. There was insufficient information to demonstrate an effective system of staff supervision was in place to evidence that staff care practices were monitored.

We have asked the service to make improvements and meet the requirement of the law in relation to staff training and supervision.

Is the service caring?

People told us staff listened to them and attended to their needs. They told us staff were caring and 'nothing is too much trouble'. Another person told us 'they are very good'. They told us staff would 'stay if they were waiting for a doctor to call 'and 'I don't want anybody else." Another person told us 'they have never let me down yet '. People said their dignity was promoted and they felt respected.

Is the service responsive?

The service did not have a formal system to demonstrate that it sought people's views and made changes as a consequence of it.

People told us they had not had any complaints about the service and would feel able to talk to the manager about them if necessary.

Records were in place of complaints made about the service and action taken. However, we found that a recent concern raised by a third party and action taken had not been recorded to demonstrate that any changes from the complaint had been considered or acted upon.

We have asked the service to make improvements in their responses to complaints.

Is the service well-led

There was no developed system in place for monitoring the quality of the service or ensuring that all risks were identified, assessed and monitored. The manager was not clear about what was required to quality assure the service. We found there was no auditing system in place and the manager did not identify, monitor and manage risks to people who use or, work in the service.

This meant that systems for medicines management, infection prevention and control, staff recruitment, training and supervision were not well developed or managed or well documented.

We have asked the provider to make improvements and meet the requirement of the law in relation to quality assurance and record keeping.

People using the service told us their care and support were delivered in a caring way. One person said, 'They are very good, always very helpful, always with a smile.' Another told us, 'They even made me a cake on my birthday.'

Care and support were delivered with people's consent and agreement. People using the service and family members confirmed care plans and risk assessments were compiled with their participation. The provider listened to people and was responsive if they changed their mind about care. One person said, 'Whatever you ask, they do.'

We found the provider had care plans which were based on assessments of people's needs. The plans were designed to ensure effective care was delivered. Risk assessments were in place to protect people from the risk of care or support which did not ensure their safety and welfare.

The provider took steps to obtain people's consent and agreement to their care and support. They were aware of the required processes if people did not have capacity to make decisions.

The service did not have any employees at the time of our inspection, with care being delivered by the registered manager and other managers of the agency. Procedures were in place to support staff in future to deliver care to the required standard.

Care workers took practical steps to protect people from the risk of cross infection. However we found the service was not following published guidance designed to ensure people continued to be protected against the risks of healthcare associated infections. There was no on-going training in infection control. Training records and other records relating to the management and recruitment of staff were either not kept or not managed in a systematic way.

We found that people were involved in making decisions about their care and support. Care and support were delivered according to plans which were base on individual needs assessments. The service had taken steps to ensure that people were protected from the risk of abuse. It had effective recruitment and induction procedures, and made sure that employees were suitable people to provide care in people's homes. It was monitoring the quality of the service it provided and responding to incidents to improve people's care.

We found that care plans did not ensure the privacy and dignity of people using the service and that they were not protected against the risk of unsafe or inappropriate care. Risk assessments were incomplete and did not have associated action plans. Procedures to protect people from abuse or neglect were inadequate and staff had not undertaken recent training in safeguarding. The provider was not regularly assessing the quality of the service provided and was not regularly seeking the views of people or relatives who could act on their behalf. The provider was not maintaining accurate and appropriate records in relation to the management of the regulated activity.