Mayden Support

Mayden Support is a domiciliary care service that provides support and personal care to adults in their own homes. Not everyone who used the service received personal care. At the time of our inspection 20 people received support with their 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

During the inspection, we found that the provider had recruited a senior member of staff without following a safe recruitment process. This led to an unsafe appointment and placed people at potential risk. At the time of our inspection, this person no longer worked for the service. Care staff recruited by the manager had however been recruited safely.

Medication management was not safe. There were no adequate systems in place to check that people’s medicines were administered as prescribed. Medication administration records were not accurate, and information relating to people’s medication needs was not up to date or accurate.

People’s needs and risks had not been adequately assessed and care plans had not been updated appropriately, when people’s needs and visit preferences had changed.

People’s visits times did not always correspond with the visit times they had agreed with the service. Visits were sometimes much later or earlier than agreed. Records relating to the length of time staff spent providing support to people, were also not accurate. This lack of accurate record-keeping made it impossible to tell if people’s visits were occurring as planned in order to mitigate and manage risks.

The provider had a policy in place with regards to COVID-19. Staff testing for the virus at the time did not adhere to government guidelines in place at the time of the inspection.

There were limited systems in place to monitor and audit the quality and safety of the service. This meant they did not identify the concerns we found during the inspection. The manager and provider failed to have sufficient oversight of the service to monitor and mitigate risks to people’s health, safety and welfare. The provider had also not always acted with respect for the duty of candour at all times.

People and their relatives said staff were kind, caring and supportive. They said that it was easy to get in touch with ‘the office’ to speak to someone if they needed to and that they were happy with the support they received from staff.

Rating at last inspection and update

The last rating for this service was good (published 01 October 2021). At the last inspection the domains of safe and well-led were rated good. At this inspection, the domain of safe had deteriorated to inadequate and the domain of well-led to requires improvement. A breach of regulation 12 (Safe care and treatment), regulation 19 (Fit and proper persons) and regulation 17 (Good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

Why we inspected

We received concerns from the Local Authority in respect of the recruitment of a senior member of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayden Support on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.

Mayden Support is a domiciliary care agency and supported living service; providing personal care to adults and children in their own homes and supported living settings. Mayden support provides care to people who are living with dementia, younger and older people, people living with a physical disability, sensory impairment, learning disabilities and autistic spectrum disorders. At the time of the inspection nobody was receiving support in supported living settings, but 22 people were receiving domiciliary care.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. ‘Personal Care’ 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

Risk management procedures and areas of support were thoroughly assessed. The provider ensured that they were safely and effectively able to provide the support people needed. We did identify that some guidance and risk measures needed to be more detailed in people's care records. This was raised with the provider and was immediately addressed.

Staffing levels were monitored however, we did receive mixed feedback about the punctuality of staff and call duration times. The interim manager openly discussed that staffing levels had decreased during the summer months, but an on-going recruitment drive was in place. We have made a recommendation regarding staffing levels.

Infection prevention and control (IPC) and covid-19 procedures were in place. Staff received IPC training, were provided with the relevant personal protective equipment (PPE) and were engaged in weekly COVID-19 testing regimes.

Safe medication administration procedures were in place. Staff were required to complete medication training and regularly had their competency levels checked. An electronic medication administration recording system enabled the provider to maintain effective oversight in relation to medicine management.

Staff were familiar with accident, incident and safeguarding reporting procedures. The provider ensured that all such incidents were investigated and follow up actions / lessons learnt were acknowledged.

Pre-employment recruitment checks were conducted; people received care and support by staff who had been safely recruited. Staff expressed that they felt thoroughly supported by the management team; they received regular supervision and supported with learning and development opportunities.

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; the policies and systems in the service supported this practice.

We received positive feedback about the quality and safety of care being provided. People told us, “Staff are brilliant” and “It’s amazing treatment.”

Relatives informed us that staff provided kind, dignified and compassionate care and the care provided was tailored to their loved ones needs.

Effective quality assurance measures and systems were in place. Such governance processes helped to monitor, review and improve the provision of care people received.

We received positive feedback about the culture and ethos that had been established at Mayden Support. One external professional told us, “They’ve done fantastically well since I’ve been working with them.” One staff member said, “I love it (working here).”

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports The Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Although the service was not providing support in this area of care, the staff received training and support to enhance their skills and understanding in relation to maximising choice, promoting person-centred care and creating the right culture.

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

Rating at last inspection

This service was registered with CQC on 1 July 2019; this was the first inspection.

Why we inspected

This was a planned inspection following their registration with CQC.

Follow up

We will continue to monitor information we receive about the service until we return to our inspection programme. If we receive any concerning information we may inspect sooner.