Maidstone Home Care Limited

Maidstone Home Care Limited is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of inspection, the service was supporting 20 people. 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

People were not always protected from harm. The provider had not always understood their responsibilities to report concerns through safeguarding processes. Appropriate professionals (Kent County Council who consider safeguarding concerns) were not made aware of a concern and this resulted in a potential delay to actions to support a person. The registered manager and staff had not ensured they had safeguarding training which would have supported them to understand their responsibility to share concerns appropriately in a timely manner.

Care plans did not always contain detailed information about people’s health conditions and this increased the potential risk of harm. Where risks had been identified, these had not always been considered within care or risk planning processes. We did not find evidence that people had experienced harm. Incidents had not always been managed in accordance with safeguarding practice and CQC had not always been notified of concerns. Following the inspection, the provider notified CQC retrospectively of concerns.

People and relatives spoke highly of the support managers and staff provided. One person said, “They are excellent, marvellous, they can’t do enough for you”. A relative told us how the registered manager had contacted them to discuss providing additional support to manage a health concern. They said, “[The registered manager] rang to say [person] was confused due to an infection and suggested they do an extra call at lunch time to make sure [person] takes their antibiotics until [they] get better”.

Staff were consistently positive about the registered manager and how they received support through working alongside managers, telephone calls and messages. Staff did not always receive sufficient training and supervision was generally informal. Following our inspection, the provider told us they had implemented a new training programme to ensure staff received sufficient training.

Systems and processes did not effectively identify or manage concerns found with care planning, safeguarding or staff training and this is an area in need of improvement. The service did not always have robust arrangements for managing confidential information to ensure it was secure and shared appropriately in line with data security standards. Following the inspection, the provider responded promptly to review their systems to ensure they were able to demonstrate improvements were being made. People, relatives and staff spoke positively about the registered manager.

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 08 March 2019)

Why we inspected

The inspection was prompted in part due to concerns received in relation to safeguarding people from abuse. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well led sections of this full report.

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 full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Maidstone Home Care Limited 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding and governance of the service at this inspection.

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.

People’s experience of using this service:

We found the service met the characteristics of a Good service in all areas.

People's experience of using this service:

People received safe care and support. Staff knew what actions to take to ensure people were protected from abuse.

The registered manager was mindful to be sure there were enough staff before considering supporting new people.

People told us staff were skilled in carrying out their role. Staff said they were supported by the registered manager and senior staff.

People received support to manage their health needs. Relatives told us they appreciated the support and guidance given to them by care staff.

Staff worked well together and with each other to ensure people received joined up care and support.

People received support from staff who had a caring nature.

People were treated with kindness, and their privacy and dignity was respected.

People received personalised care which was responsive to their needs and choices.

The service had a registered manager who was dedicated in providing high-quality care which promoted an open and fair culture.

Audits were in place to assess the performance of the service and to action any concerns as they arose.

Rating at last inspection: Good (report published 21 March 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found the service continued to meet the characteristics of Good.

Follow up: We will continue to monitor the service through the information we receive. We will carry out another scheduled inspection to make sure the service continues to maintain Good.

Maidstone Home Care Limited is a small domiciliary care agency which provides personal care and support for people living in their own homes. Maidstone Home Care Limited specialises in end of life care at home and in delivering care services to clients with Dementia, Alzheimer's and Parkinson's disease. At the time of the inspection, the service was providing personal care to nine people who were private clients.

Rating at last inspection

At the last Care Quality Commission (CQC) inspection on 19 July 2016, the service was rated overall Good and Requires Improvement in the ‘Well Led’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 July, 2016. We found a beach of legal requirements. After the comprehensive inspection, the provider failed to tell us what they would do to meet legal requirements in relation to the breaches of Regulation 17 of the Health and Social Care Act Regulated Activities Regulations 2014 Good governance.

We undertook this focused inspection to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Maidstone Home Care Limited on our website at www.cqc.org.uk.

Why the service is rated Good.

At this inspection, we found that the provider carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. The management team included the registered manager and the operations manager who were partners in the business. They both carried out hands-on personal care alongside frontline staff for people in their homes. This enabled people to get to know the provider.

The agency now had processes in place to monitor the delivery of the service. As well as talking to the provider at spot checks, people could phone the office at any time. People’s views were also obtained through annual surveys. These could be completed anonymously if people wished. The provider analysed these and checked how well people felt the agency was meeting their needs as part of their quality assurance system.

Both the registered manager and the operations manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. Staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements in their service provision.

Further information is in the detailed findings below.

Maidstone Home Care Limited is a small domiciliary care agency which provides personal care and support for people living in their own homes. Maidstone Home Care Limited specialises in end of life care at home and specialise in delivering care services to clients with Dementia, Alzheimer’s and Parkinson’s disease. At the time of the inspection, the service was providing personal care to five people who were private clients.

There was a registered manager at the service. The registered manager was also the provider. 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 and associated Regulations about how the service is run.

The provider had no quality assurance systems in place to monitor and improve the quality of the service provided. We did not see any audits being undertaken. However, the provider was in touch with both staff and people who used the service daily. Following our inspection, the operations manager sent us quality audit templates to be implemented.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. However, all staff had not received training in the Mental Capacity Act 2005. Staff were not able to tell us anything about the Act or its principles, and how it affected their practice. Staff did not have an awareness of Deprivation of Liberty Safeguards. We have made a recommendation about this.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe with staff providing the service; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

The agency provided sufficient numbers of staff to meet people’s needs and provide a flexible service. The provider operated safe recruitment procedures.

Staff had received regular individual one to one supervision meetings and appraisals as specified in the provider’s policy.

People were supported with meal planning, preparation and eating and drinking.

People said that they knew they could contact the provider at any time, and they felt confident about raising any concerns or other issues.

People spoke positively about the way the agency was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

During this inspection, we found a breach of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.