Archived: Manchester Home Care Associates Limited

Manchester Home Care Associates is a domiciliary care service providing personal care and support to people living in their own homes. The service also works closely with healthcare commissioning teams in supporting people who have complex healthcare needs or are at the end of their life. The hours of support vary depending on the assessed needs of people. Services may be required the same day as the referral is received and may only continue for a few days.

At the time of the inspection the service was supporting 137 people within the local community. We last inspected the service on 30 September 2014 where we found the provider was meeting 3 out of 4 standards inspected at that time. The service was non compliant in requirements relating to workers or staffing.

There was a registered manager in post. 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.

People told us they received safe care, which was reliable and consistent on the whole. We were told where there were any problems with care this predominantly occurred duringt weekends. The service had sufficient staff to meet people’s needs, and people were given the time they needed to ensure their care needs were met.

We saw that people were protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. Risks to people were assessed and risk management plans were in place. We found that the staff we spoke with had a good knowledge of the principles of safeguarding.

Staff were trained and competent to administer medication. Where errors had occurred the provider could evidence that these were quickly identified and appropriate action taken. The provider was not always recording when medication was administered which was contrary to their own internal policy. We identified this as a breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 relating to the management of medicines.

The service was working to the principles of the Mental Capacity Act, 2005 which meant that care staff supported people to make their own choices about their care. Before any care and support was provided and when appropriate, the service obtained consent from the person who used the service. In other circumstances the service would discuss the support package with their relative. We were able to verify this by speaking with people who used the service, checking people’s files and speaking to staff.

The service had improved recruitment processes which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be suitable to work with vulnerable people. Staff knew their roles and responsibilities and were knowledgeable about the risks of abuse and reporting procedures.

We saw evidence of the induction process, and there was appropriate training provided for caring roles and responsibilities, along with the “shadowing” of more experienced colleagues. Staff also signed to confirm they had read policies and procedures and that they were aware of the provider's requirements in respect of data protection and confidentiality. Supervisions were undertaken with some staff but these were inconsistent with timescales and content. We saw that examples of poor practice was identified during audits but there was no evidence that this was relayed to staff so that practice could be improved.

People were supported with a range of services which enabled them to continue to live in their own homes safely. Most of the people we spoke with who used the service and their relatives told us they had been involved in the assessment and planning of the care and support provided and that the service responded to changes in people’s needs.

The care records contained information about the support people required but were written in a task-orientated way. The documentation we saw concentrated predominantly on risk however the provider had recognised this and was in the process of implementing new person-centred care plans and risk assessments. The records we saw were complete and up to date.

We found people were receiving care from care staff who were deployed in a way that met people’s needs. Some people who used the service lived alone and staff required the use of a key to access their house. We saw that keys were appropriately stored in a ‘key safe’ outside a number of houses we visited and people receiving a service were satisfied with the way this was managed.

We found from looking at people’s care records that the service liaised with health and social care professionals involved in people’s care if their health or support needs changed. We saw care plans both at the office in people’s homes contained good information and instructions with regards to specialist equipment used by individuals. The service worked alongside other professionals and agencies in order to meet people’s care requirements and professionals we contacted were complimentary of the service.

There was an up to date accident/incident policy and procedure in place. Records of accidents and incidents were recorded appropriately within people’s care files.

The service had a complaints policy in place and we could see that people using the service were aware of how to make a complaint. Formal complaints were acknowledged and addressed within specified timescales. What wasn’t clear however was whether members of staff had been notified if a complaint directly involved them or what investigatory action had been taken if this was warranted.

Staff told us they felt they were able to put their views across to senior staff and to management and we saw examples of this from minutes of meetings and supervision records. The staff we spoke with told us they enjoyed working at the service and said they felt listened to and valued.

The service undertook audits to monitor the quality of service delivery. We saw a number of audits in place including medication audits and logs of spot checks on care staff completing visits. There was no evidence of any follow-up work as a result of bad or poor practice having been identified.

We found the service had up to date policies and procedures in place, which covered all aspects of service delivery including safeguarding, medication, whistleblowing, recruitment, complaints, equality and diversity, moving and handling and infection control.

The overall rating for this service is ‘requires improvement’. You can see what action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were aware of risks associated with individual people's care needs and knew how to support people to maintain their safety and wellbeing.

There were processes in place to monitor the safety of the service and learn from events that could compromise the safety and quality of the service.

Recruitment practices required improvement to ensure that people received their care from staff of suitable character.

Is the service effective?

People we spoke with were satisfied with their service and felt that it met their needs. In general people felt the service was reliable and consistent although some people did report a lack of communication regarding last minute changes.

There were effective assessment processes in place which helped ensure staff had a good level of information about people's care needs from the point they started to use the service.

Staff felt the induction and training was of a good standard and it helped them to carry out their roles effectively.

Is the service caring?

People who used the service were in general, complimentary about the approach and attitude of care workers. People felt that their needs were met in a kind and caring manner by most staff. However, one person said that whilst the majority of staff appeared to genuinely enjoy care work there was the odd one who seemed to see it as 'just a job.'

People's care plans were based on their individual needs and wishes. People we spoke with were aware of their care plans and felt they had been involved in their development.

Is the service responsive?

The management team were described as very approachable and everyone we spoke with felt able to raise any concerns and express their views.

People were aware of the service's complaints procedure but many felt they would not need it as any issues would be dealt with straight away by the manager.

New systems had been introduced to enable the manger to monitor incidents, complaints and safeguarding concerns and respond effectively to any themes or patterns which emerged.

Is the service well led?

There was a clear management structure in place which included a registered manager.

People who used the service and staff were fully aware of the management structure and who to contact if they required support.

Audit systems had been reviewed and improved to enable the manager to monitor the safety and quality of the service in a more effective way.

One person told us: 'The staff always treat me with dignity and respect.'

'Care staff have all got hearts and care very deeply.'

'They offer person centred care and I feel listened to.'

We found that people's needs were always assessed and their care plans were updated to reflect changes in their care needs, including arrangements in respect of medication.

We found that the registered provider had developed and put in place a new system that assessed and monitored the quality and accuracy of assessments and care planning. This ensured that people who used the service had their care needs met and identified risks were identified and managed.