Nestora Home Care

My Homecare Huddersfield is a domiciliary care agency which provides support to people in their own homes. It provides a service to younger and older adults, people with physical disabilities, sensory impairments, learning disabilities, dementia or mental health conditions. At the time of inspection 63 people were using the service. 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

Systems were either not in place or robust enough to demonstrate medicines were effectively managed. Improvement was required to medication administration records (MARs). The provider’s medicine policy was not always adhered to by staff.

The provider had not operated robust systems and processes to assess, monitor and improve the quality and safety of the service. They had not maintained accurate and complete records. The provider did not sufficiently address all the concerns raised from the last inspection. Audit systems were not robust and governance systems failed to identify the issues we found during the inspection.

The provider had not met all of their statutory requirements. The provider had failed to notify the CQC of a change of the provider’s registered address and a change to their statement of purpose.

People were protected from the risks of abuse and harm and people said they trusted staff to keep them safe. Staff had received training in safeguarding adults and understood how to recognise signs of abuse. Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults. Staff had the necessary safety checks in place before starting work and completed a full induction.

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. We have made a recommendation about the provider considering best practise and training for completing mental capacity assessments

People told us staff were kind, courteous and sensitive. People’s comments included, “They [staff] are caring” and “They [staff] are all nice and cheer me up.”

People told us the care workers arrived on time to deliver their care, and if they were delayed people were informed of this. We received mixed feedback about the continuity of care workers. Some people told us they received regular care workers and other people felt there was no continuity.

Staff had received end of life training and the service worked closely with healthcare professionals to deliver end of life care should people wish to remain at home. We have made a recommendation about the provider reviewing their processes to give people the option to make their end of life wishes known.

Staff felt valued and supported by the management team. They were clear about the culture of the organisation and what was expected from them. Staff told us, “Management are really good. Really supportive and helpful.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 February 2019) and there was a breach of a regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

My Homecare Huddersfield is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, including people living with dementia and younger disabled adults living in the Huddersfield area. Not everyone using My Homecare Huddersfield receives a service which is a regulated activity; 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 consider any wider social care provided.

This was the first time this service was inspected since registering on 27 March 2017. During this inspection, we found one breach of regulation in relation to consent to care.

At the time of this inspection the service had a manager who had not registered to manage the service; they were also the nominated individual for the service. The previous registered manager had left the service less than a month before our inspection and we saw evidence that the provider was actively trying to recruit another manager. It is a legal requirement that the service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The provider was not compliant with the Mental Capacity Act 2005 (MCA). The manager had a good understanding of how to support people who required best interest decisions made on their behalf, however, they were not completing decision specific mental capacity assessments and best interest decisions. We recommend the provider researches and implements best practice guidance to ensure specific decisions made in people's best interest are appropriately completed and recorded.

People’s medicines were not always managed safely. We found medicines administration sheets were not always completed as required and changes to people’s medicines were not double signed and dated to prevent any errors. There were no protocols in place in relation to the correct management and administration of ‘as and when required’ medicines. We found medication audits were being completed however these were not always effective in identifying the issues found at this inspection. Staff were trained in the safe administration of medication and their competency to complete this task regularly assessed. We recommend the provider researches and implements best practice guidance to ensure people’s medicines are always managed safely.

The provider’s management of risks and care planning required improvement. We found some risks to people’s care had been assessed and details of the support required were in place, however, some other risks had a very succinct assessment and did not give enough guidance to staff. We found there was limited information in relation to the care of one person who required end of life care. Staff had a good understanding of how to support people safely and knew what to do if they had concerns about people's safety.

Most people told us they felt safe due to the support they received from staff. Staff and management had completed safeguarding adults training and knew how to keep people safe and report concerns.

Staff were recruited safely. There were always enough staff to provide people with the care and support they needed. We received mixed views from people in relation to the continuity of the staff supporting them and the manager told us this was an area they were aware needed improvement and they were working on it.

People and their relatives felt staff had appropriate skills and were competent. Staff had a good understanding of the people they supported and had access to ongoing training and supervision to support and improve their practice.

People told us the service they received from My Homecare Huddersfield was important to keep them independent and safe living at home. People and their relatives told us staff were consistently kind, caring and compassionate.

People were supported to have a balanced diet that met their individual dietary needs. They were supported to access healthcare services to maintain their health.

We received mixed views about people's involvement in reviewing their care. People told us they were treated with respect and their dignity and privacy was maintained and staff could tell us how to promote this.

People’s needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People's communication needs were assessed.

People told us they would feel comfortable to raise issues or concerns and that the management team and staff were friendly and approachable. The manager appropriately investigated and analysed complaints and incidents.

People, their relatives and staff were complimentary about the leadership and management of the service. There were several systems in place to monitor the quality of care however these had not always been effective in identifying and addressing the issues found at this inspection. We recommend the provider researches and implements best practice guidance in relation to effective quality assurance processes.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.