Moorcare

Moorcare is a domiciliary care service providing personal care to people in their own homes. At the time of inspection, the service was providing personal care to 55 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

Staff were trained to recognise potential risks and signs of abuse. Risks to people's safety and wellbeing were assessed and reviewed by managers. Staffing levels were safe and reviewed regularly by managers. The provider managed medicines safely. Staff used personal protective equipment (PPE) appropriately when supporting people.

Managers ensured systems were in place to monitor the running of the service. The provider had procedures in place to receive feedback on how to improve support. Managers audited support records, including accidents and incidents to assure themselves of quality. Lessons were learned when concerns were raised, and these outcomes were communicated to staff. Staff worked well in partnership with other agencies to deliver effective support.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; policies and systems supported this practice.

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 05 October 2018).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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 not changed. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Not everyone using the service received regulated activity; Care Quality Commission (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.

At the end of 2017 there was some change in personnel, with the previous registered manager and some office staff leaving. At the time of our inspection, a manager was in charge of the service. 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. Following our inspection, the chief executive told us they had appointed a permanent manager and they would be registering with the CQC in due course.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key areas of safe, effective and well-led to at least good.

At that inspection the provider had not taken appropriate steps to ensure staff supervisions had been completed in line with their policy, and Medication Administration Records (MARs) had not been fully completed. Policies and procedures were not up to date and were disorganised, documentation had not been completed for people who may lack capacity to make decisions and not all staff had completed Mental Capacity Act (MCA) training. Quality monitoring arrangements were not robust. At this inspection we found the service had made some improvements, although some further work was still required with the accuracy of information recording.

A quality assurance process was in place; however, the audit process was not fully robust and further work was needed to strengthen the consistency of information in people’s care plans and the accurate recording of support and management documentation. The manager and chief executive told us there were aware of this and in the process of strengthening the auditing process.

Medicines management systems were in place to ensure people received their medicines at the right times. However, the administration of people’s medicines was not always appropriately recorded. People told us they there were happy with how they received their medicines. When necessary staff involved GP's or the emergency services to make sure people's health care needs were met.

Staffing levels were appropriate to meet people’s care and support needs, although there were mixed views on the consistency of staffing. Recruitment processes and checks were in place and followed, to reduce the risk of employing staff who may not be suitable to work with vulnerable people.

Staff completed a range of training and had opportunity for on-going development. Training was monitored and refreshed in a timely way. Staff received supervision on a regular basis, although the chief executive told us some staff appraisals were overdue. New employees received an induction which included, training and shadowing a more experienced staff member.

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. Some people had mental capacity assessments in their care plans. Staff understanding of MCA needed to be strengthened.

People who used the service told us they felt safe with the staff and the care they were provided. Staff understood how to recognise abuse and there were appropriate systems in place to protect people from the risk of harm.

Staff had access to personal protective equipment and had completed infection control training.

People told us staff were kind and caring and they were very happy with the service they received. Staff treated people with respect and took steps to maintain their privacy, dignity and independence.

People's individual dietary needs and preferences were being planned for and met, where required.

Care plans were person centred and reviewed when required. People and staff were mostly complimentary about the manager. They said they were approachable and listened. There was a complaints procedure in place which enabled people to raise any concerns or complaints about the care or support they received.

Moorcare is a domiciliary care service that provides personal care to people in their own homes within the Leeds area. Moorcare was registered with CQC in July 2016 and this was the first inspection of the service. The service provides care for older people and people living with dementia, mental health, physical disabilities and sensory impairment. At the time of our inspection there were 82 people using this service.

The service had a manager although they had not yet applied to become the registered manager. The manager told us they are in the process of applying to the CQC for registration purposes. 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.

Governance structures were in place but these were not being followed in accordance with the provider’s procedures and policies. For example, supervisions had not been completed in line with the provider’s policy and audits for medicines did not reflect the MAR charts and the errors that we found. Policies and procedures were not up to date, disorganised and in different locations making them difficult to find. This showed the manager could not identify where improvements could be made, potential risks to a person’s safety and whether staff were monitored effectively to ensure good care was being provided.

Some people using the service did not have capacity. We found no documentation to support the assessment that people lacked capacity, and no evidence of best interest’s decisions. Staff had not all completed their MCA training.

People we spoke with told us they felt safe. The service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. Staff we spoke with had a good understanding of the safeguarding and whistleblowing process.

Appropriate and detailed risk assessments were in place to make sure people were safe, and these were regularly reviewed. Accidents and incidents were managed suitably, there were incident reports for concerns raised and clear evidence of actions taken. People told us they felt able to report any concerns to the provider.

Staffing levels were adequate and flexible to meet people’s needs. If visits were not covered by the regular staff, the manager told us they contacted other staff members to do the visits. The rota’s we looked at showed consistency where possible, people received the same carers.

Staff supported people with their health care needs and liaised with other services such as district nurses, which was clearly documented in people’s daily notes and care records. Care records clearly identified nutritional and dietary needs as some people using the service required specific plans due to their religious beliefs.

Induction programmes were in place for new staff and annual updates for training were provided to all staff. Training included, safeguarding, fire safety, privacy, dignity, equality and diversity training, moving and handling, medication and health and safety.

Staff were caring, had positive relationships with people using the service and communicated well. Staff treated people with dignity and respect and people were supported to be independent.

People received personalised care and support. They and the people that mattered to them had been involved in identifying their needs, choices and preferences and how these should be met. Staff ensured people's care plans were up to date so information was consistent for staff to follow. People were supported to do activities to avoid social isolation and promote wellbeing.

The provider had good links to several community services which people using the service accessed to avoid social isolation. This included community activities, day centres and the living project.

Questionnaires based on CQC’s key lines of enquiry, relative surveys and client forums were used to monitor the quality of service provided. People using the service and their relatives told us, overall they were very satisfied with the care; however several people felt the invoicing arrangements were poor. A complaints procedure was in place for the manager to follow in responding to any complaints and people using the service knew who to contact.

Staff were encouraged to contribute to the development of the service and regular team meetings took place.

People using the service and staff spoke positively about the manager and felt supported. Staff and people told us, the manager was approachable and had made significant changes to the service.

We identified three breaches of the Health and Social Care Act (Regulated Activities); you can see what action we told the provider to take at the end of the full version of the report.