Archived: Monarch Care Services Coventry

Updated 23 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of our inspection, 33 people were provided with personal care and support.

Before the inspection visit we reviewed information we held about the service to inform and plan our inspection. This included information that we had received about the service as well as statutory notifications the provider had sent to us. A statutory notification contains important information about certain events that they must notify us of. We contacted the local commissioners who funded the care and support people received. They had concerns that people were not receiving their care calls at the expected time.

The inspection was informed by feedback from questionnaires completed by a number of people using the service. We had also received information of concern from three people who shared their experience of the service with us.

We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

The inspection site visit took place on Thursday 25 January 2018 and was announced. The provider was given 48 hours’ notice of our visit. This was because we wanted to be sure staff would be available to meet with us as part of the inspection visit. The service was inspected by one inspector.

When we visited the office location we spoke with one member staff, the registered manager and the care manager. We also looked at the records of the three people who used the service, and records related to quality and safety. We spoke to two more staff by phone on 30 January 2018.

We spoke by phone with two people, and five relatives of people who used the service on Wednesday 31 January 2018.

Following our inspection we sent the provider a letter expressing our concern about their service and asked them to report to us actions they were taking to improve the service. They responded to our letter of concern, but we did not feel the response was sufficient to reduce immediate risks.

Therefore on 23 February 2018 we visited the service again after being informed there were not enough staff to provide care for people the week-end of 24 and 25 February 2018. By the end of the day we received confirmation that agency staff had been contacted and all care calls were covered, the majority by staff from different care staff agencies.

Updated 23 March 2018

This inspection took place on 25 January 2017 and 31 January 2017 and was announced. We also visited the service on 23 February 2018 in response to staffing concerns.

This was the first inspection of the service trading as Monarch Care Services UK Ltd. The service took over the provision of care calls which had previously been provided by another care agency which closed.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service is registered to provide care to older people, people living with dementia, people with autism and learning disabilities, and younger adults. At the time of our inspection visit, the agency provided support to 33 people.

The registered manager worked part time in the Coventry office and part time in another of the provider's locations. 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.

Since taking over the provision of the previous care provider, Monarch Care Services Coventry accepted a local authority contract to provide care to people in a designated area of Coventry. This meant the service grew quickly to provide care to a much larger group of people than they originally anticipated. The registered manager informed us they had struggled to meet the needs of the larger volume of people their contract required them to support.

The management team acknowledged they had been 'fire-fighting' to keep pace with the number of people who required care and support. They had not had the time to undertake some of the management functions such as assuring themselves of the quality of service provided by carrying out the appropriate checks on service delivery. This meant there was a breach of Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations; Good governance.

There were not enough staff to meet people's needs. The provider had not been able to recruit enough staff to meet the higher demand of people who used the service. Because the existing staff team were stretched, this led to people often not receiving their care calls at the expected time, and care undertaken by staff they were not familiar with. Whilst pre-employment checks had been started, we found prospective staff had gone into people's homes with other staff before initial clearances had been confirmed. This might have put people at risk as the provider did not know whether the prospective staff member had a criminal record. This meant there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations; Staffing.

Medicines were not managed safely, and health and social risk assessments of people did not always support staff to know what actions they should take to reduce the risks from occurring. This meant there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations; Safe care and treatment.

Care records did not always provide enough detail to help staff know about the person they supported and how to meet their needs. At times, staff visited people without having any prior knowledge of their needs. Reviews were not always undertaken in a timely way. This meant the provider was in breach of Regulation 9, Person-centred care.

Staff knew how to reduce the risks of infection from spreading by using hand gels, gloves and aprons.

Staff had received training which the provider considered essential to meet people's health and safety requirements. Some had undertaken Care Certificate training. Most people and relatives thought staff had the skills and experience to meet their or their relatives care needs.

Staff supported some people with eating and drinking. Concerns were raised that some staff did not offer people choices when making their drinks or meals.

People and relatives told us staff asked permission before they carried out any care tasks. Staff understood the importance of gaining people's consent.

Staff mostly supported people with kindness and consideration and treated people with dignity and respect. However we were told of occasions where this had not been the case.

The provider had recognised the service required more support and had started to make changes in the management structure to provider this.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

.