MHA Care at Home - Wesley Branch

MHA Care at Home – Wesley Branch is an extra care service. The service provides personal care to older people who live in their own apartments in a modern building. At the time of our inspection there were 12 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The provider's quality assurance system was not always effective and had not led to actions to improve the service or mitigate risks. Audits did not always identify shortfalls and where they did, actions were not always completed.

Medicine records were not always completed in line with the provider’s policy and did not accurately reflect medicine administered. Staff told us they had raised concerns with management about the safe management of medicines. Staff were unsure what had happened as a result of those concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice. For example, we found conflicting information regarding Lasting Power of Attorney in people’s care and support records.

People felt positive about the care they received and felt the staff were friendly and kind. They told us they felt safe and were looked after by a consistent team of people. They told us the registered manager was very approachable and responded to concerns or queries in a prompt and efficient manner.

Staff told us this was a positive place to work and they felt supported by their colleagues and the registered manager was approachable and they could speak up if they needed to. Staff had training, including safeguarding and felt they had the skills and abilities to keep people safe. There were enough staff to support the people living there.

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

Rating at last inspection

The last rating for this service was good (published 1 October 2018).

Why we inspected

We carried out this inspection due to the length of time since the last inspection.

This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for MHA Care at Home – Wesley Branch on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and effective governance at this inspection.

We have made recommendations in the safe key questions in relation to the Mental Capacity Act. Please see these sections for further details.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service is a domiciliary care agency. It provides personal care to older people living in their own flats within the Pilgrims Court complex.

Not everyone using MHA Care at Home – Wesley Branch receives regulated activity; 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.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

On the days of our inspection there were 45 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 last inspected the service in December 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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 protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at the service.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service.

We last inspected this service in May 2014. At that inspection we found the service was meeting all the legal requirements in place at the time.

MHA Care At Home Wesley Branch is a domiciliary care agency providing care to older people in their own flats within a sheltered housing complex. It does not provide nursing care. It was providing a personal care service to five people at the time of this inspection.

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 2008 and associated Regulations about how the service is run.

Staff had been trained in the protection of vulnerable people from abuse, and were knowledgeable about the signs of abuse. They knew how to report any concerns and told us the registered manager responded appropriately to such reports.

Risks to people were regularly assessed and control measures put in place to minimise any risks identified. Accidents were recorded and analysed, to prevent recurrence. Systems were in place to check the safety of the building. Plans were in place to deal with any emergencies.

There were sufficient staff hours available to ensure people’s needs were fully met, in an unhurried way. Staff recruitment processes were robust and professional, and ensured only suitable applicants were employed. The staff team were skilled and experienced and received regular training to meet people’s needs. Staff were supported in their roles by regular supervision and an annual appraisal of their work.

People were assisted to take their medicines by staff who had been appropriately trained, and had their competency checked.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom.

Appropriate assessments had been undertaken of people’s capacity to make particular decisions. Where people lacked such capacity, appropriate ‘best interest’ decisions had been taken, with the involvement of the person’s family, and these were clearly recorded. People were asked for their consent before staff members carried out any care tasks or other interventions.

People and their families were fully involved in the assessment of their care needs, including their health and nutritional needs. Support to meet those needs was given in the ways the person wished. This was recorded in their care plans, and regularly reviewed. People were encouraged and supported to be as independent as possible in their daily lives.

The staff demonstrated a genuinely caring approach to people, and treated them as individuals. Staff were knowledgeable about people’s likes, dislikes and wishes. Relationships between people and staff were based on mutual respect and affection. People’s privacy and dignity were protected by the staff team.

People were given the information they needed to understand the services available to them and to make informed choices about their daily lives. Advocacy services were available to those people who needed such support. Any concerns or complaints were responded to promptly and professionally.

People were protected from the risks of social isolation and were offered stimulating activities and companionship.

The service was well-managed and had an open, inclusive and listening culture that respected the views of people, their families and staff members. Systems were in place to monitor the quality of the service being provided and there was a commitment to continuous improvement.

We looked again at these areas on this inspection. We found significant improvement in all the areas previously identified as being of concern. People's care records had been reviewed and updated. Complaints and other forms of feedback were recorded in good detail. Information from surveys was now held in the service and acted upon. Information about the service had been updated.

People told us that they were always treated with respect and said that staff always asked their permission before carrying out any care or other tasks for them.

Appropriate systems were in place to make sure staff recognised the signs of abuse of vulnerable people and reported any suspicions promptly. We saw from documentation that this worked in practice.

People receiving personal care were protected by the robust recruitment and selection processes in place to prevent unsuitable people from being employed.

Systems were in place for gaining the views of people who used the service, and of staff, about the quality of the service offered. People told us they felt listened to and treated with respect. Staff expressed similar feelings.

Some care and other records kept in the home were not sufficiently detailed to reflect the quality of the care given, and there were some problems with the accessibility of records. There was no system for recording complaints.