Archived: My Care Direct Also known as My Care Direct

My Care Direct provides a service to people in their own homes. It has a contract with Trafford Council to provide care for people after they have had re-enablement and/or following a stay in hospital. In most cases the service provides care for a short period of weeks or a few months at most. At the date of this inspection there were 15 people using the service in this way. My Care Direct was supporting a further six people with shopping and cleaning and other related services.

There is a registered manager who has been in post since January 2015. 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.

People told us that they felt safe receiving the service. They told us they could rely on their care workers to arrive on time, or to contact them if they were running late. There were a few examples of late or missed calls, but we received explanations of why these had happened and the actions taken to prevent a recurrence.

Staff received rotas in advance and any changes were notified to them. One member of staff told us that 15 minute calls were not always long enough, for example if they had to make and serve a meal. No person receiving the service told us that the calls were too short. Care workers logged in and out using their own mobile phones, but the system did not currently alert the office if a care worker had not arrived.

All staff were trained in safeguarding and in moving and handling in order to keep people safe. We saw that people’s safety and the safety of staff were both high priorities.

Records were kept of medicines for those people where My Care Direct assisted people. The registered manager told us the accuracy of these records was important. Staff had recently received training on medicines administration.

Correct processes were followed to explore the background of new members of staff and ensure they were suitable to work with vulnerable people.

We saw there was a high rate of completion of training in all mandatory topics. New staff had all received induction training in those areas. Staff told us they found the training worthwhile. New staff were also doing the Care Certificate, a new set of standards for care workers. Not all staff had been trained in understanding the Mental Capacity Act 2005.

People using the service gave positive feedback about the standard of training, except in one case where a relative told us the care worker had not been trained to use a particular type of catheter bag.

The fact that some staff had not been trained in the Mental Capacity Act 2005, and the example of a member of staff not having received sufficient training in catheter care, were a breach of the Regulation relating to the appropriate training of staff.

Staff received regular supervision. Spot checks were conducted on new staff. The registered manager was introducing annual appraisals, although most of the staff had worked less than one year.

The registered manager showed a good knowledge of the Mental Capacity Act 2005 but had not conducted any mental capacity assessments. This meant there was a risk that some people’s needs might not be assessed. This was a breach of the Regulation relating to the need for obtaining in consent in line with the Mental Capacity Act 2005.

Where care workers prepared food people were satisfied. Care workers recorded food intake when it was important to do so. People told us that their care workers were kind and pleasant. They said that the care workers listened to them and often asked them what needed doing. Usually the same care workers visited the same people, enabling relationships to be built up even in the comparatively short time the service would be delivered.

One person gave an example of how the care workers could be flexible and rearrange the time of their visit to make it more convenient.

We looked at five care records and saw that the care plans provided sufficient information to enable the care workers to deliver care safely. The plans were based on the information supplied by Trafford Council. Because people were with the service for short periods, there was not a great deal of personal history in the plans.

People were not always aware that they had a care plan, and there was scope to involve people more in the creation of their own plans. Care plans were reviewed by the registered manager who visited each person to discuss how the care delivery was going.

A record of complaints was kept and we saw that complaints were dealt with thoroughly and lessons learned from them. We considered that one complaint ought to have been recorded as a formal complaint. Some of the complaints policies on file were inaccurate. These failings were a breach of the Regulation relating to handling complaints.

People receiving the service and staff had a high opinion of the registered manager. A deputy manager had recently been appointed but was not spending much time with My Care Direct. This meant that the registered manager had to fulfil all the office functions. There was no cover immediately available if the registered manager needed to visit or assess someone.

Staff meetings were held which enabled the staff to contribute their ideas. Minutes of meetings were sent to staff who could not attend.

Surveys were sent out but did not reach everyone who had used the service. We have recommended that the provider investigates better ways of obtaining feedback from people who use the service. Policies were available in the office. We saw that medicine administration record sheets were checked each month. The registered manager told us she conducted audits of care files and staff files, but did not keep a record of those audits.

The registered manager was aware of her duty to notify CQC about significant events.

One of the issues facing My Care Direct was the high turnover of staff, but this was not entirely within the control of the registered manager and provider.

We considered that the governance systems were insufficiently robust and this was a breach of the Regulation relating to good governance.

In relation to the breaches of Regulations you can see what action we told the provider to take at the end of the full version of the report.