Mk Hospital@Home

Updated 5 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors, a regulatory coordinator who spoke to some staff and an Expert by Experience who made telephone calls to people using the service and some relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure the registered manager was available to speak with us. Inspection activity started on 25 October 2023 and ended on 3 November. We visited the location’s office on 25 and 30 October 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and 6 relatives about their experience of the care provided. We also spoke with 5 members of care staff, a company director and the registered manager who is also the nominated individual and company director. The nominated individual is responsible for supervising the management of the service on behalf of the provider We reviewed a range of records. This included 6 people’s care records and medication records. We looked at all the staff files that were available in relation to recruitment, training, and supervision. A variety of records relating to the management of the service, including policies and procedures were also viewed.

Updated 5 January 2024

About the service

Mk Hospital@Home is a domiciliary care service providing personal care to older and younger adults who may have dementia, a physical disability, sensory impairment, or a mental health condition living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection 37 people were receiving personal care.

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

The systems and processes used for the recruitment of staff were not safe. The required checks of suitability to work with vulnerable people had not always been completed sufficiently to ensure fit and proper persons were employed. Risks associated with people’s needs were not always identified or accurately assessed. Records about managing risks were not always completed or shared with staff.

Accident and incidents had not always been documented appropriately; therefore, we could not see what or if actions had been taken to protect people. Medicines Administration Records (MARS) were not completed correctly so we could not be certain medicines had been given safely or correctly. Medicine audits and checks had not been effective in identifying these concerns. We were assured about IPC practices. People and their relatives told us they felt the service they received was safe.

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.

People and their families told us they had been involved in care planning and reviews of their care. Referrals were made to other healthcare services where necessary. People were supported with their dietary and nutritional needs as they preferred. Training records demonstrated relevant training was provided. People and their relatives told us they thought the care they received was very good and spoke very positively about the staff who supported them.

Care and support plans generally provided guidance for staff on how to meet people's needs and minimise some risks. People told us their care plans had been reviewed. However, records we viewed showed some changes in needs were not always recognised or recorded in a timely way. Actions had been taken promptly to respond to any complaints.

People, their relatives and staff were consulted in the running of the service. A recent survey about the quality of the service had been completed but was not sufficiently analysed to show how the service could improve. Some regular audits had been undertaken. However, these were not effective or robust enough in highlighting the concerns we found with recruitment, records for managing risks and medicines.

The leadership in the service commenced working immediately on the shortfalls identified during the inspection and people's experiences appear not to have been impacted by those shortfalls identified.

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 20 February 2023)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks. This inspection examined those risks.

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

The provider took immediate action during the inspection to address some of the shortfalls we found.

Enforcement

We have identified breaches in relation to assessing and recording risks, the management of medicines, recruitment processes and the oversight of the safety and quality of the service.

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.