2M Health & Home Care Services Ltd

2M Health & Home Care Ltd is a domiciliary care agency. The service provides personal care to people living in their own homes. At the time of our inspection there were 30 people 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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

Positive behavioural support plans were now in place; however, the records did not provide staff with guidance on how to respond to expressions of distress. 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 found the records used to assess people's ability to make decisions was not always detailed enough. We have made a recommendation about this in the effective part of this report.

Right Care

Care plans continued to lack information about the support people needed and their preferences. Medicines related documents were completed correctly, however medicines care plans required improvement. Risk assessments were not always in place for people who required equipment to mobilise. People on high-risk medicines did not always have associated risk assessments in place. The provider had safeguarding systems in place and staff were well informed in how to keep people safe.

Right Culture

Systems and processes to assess the quality and safety of the support provided required embedding and sustaining and had not always identified shortfalls. The provider sought feedback from people and those important to them, however where issues were raised, there was no evidence action was taken. Staff had received an induction and training to support them in their role.

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 inadequate (published 1 September 2023). Breaches in regulations relating to person-centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing, and fit and proper persons employed were identified. The provider completed an action plan after the inspection to show what they would do and by when, to improve and meet the breaches in regulation related to person-centred care, consent, safeguarding service users from abuse and improper treatment, staffing, and fit and proper persons employed. Warning Notices were served for the breaches relating to safe care and treatment, and governance. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 1 September 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served had been met and they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, and Well-led which contain those requirements.

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 inadequate to requires improvement. 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 2M Health & Home Care Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

2M Health & Home Care Ltd is a domiciliary care agency. The service provides personal care to people living in their own homes. At the time of our inspection there were 32 people using the service.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture. This meant we could not be assured of the choices and involvement of people who used the service in their care and support. Initially the provider told us they did not support any people who lacked capacity, had a learning disability or autism or expressed emotional distress. However, we identified that there were people being supported by the provider who had multiple needs including those with a learning disability.

Right support: People were not always supported to have maximum choice and control of their lives as their care plans and risk assessments did not provide a full overview of their needs. Staff did not always support them in the least restrictive way possible and in their best interests. We found an absence of information and guidance for staff members to follow when supporting autistic people or people with a learning disability who may express distress or frustration. Care documents and risk assessments did not provide staff with information on how to respond to such expressions of distress, how to de-escalate or how to provide positive re-enforcement.

Right care: People’s care and support plans did not reflect their individual needs or promote their wellbeing and enjoyment of life. People who were known to display emotional distress or frustration did not have proactive positive behaviour support plans in place. This meant staff were not equipped with the detail on specific actions to take to ensure practices were least restrictive to the person and reflective of a person's best interests.

Right culture: People did not receive personalised care that reflected their needs and preferences. Care plans failed to provide staff with clear guidance on meeting people's diverse needs. People's communication needs were not always identified within care records and the provider was unable to evidence how specific communication needs were met.

Governance systems did not ensure people were kept safe and received a high quality of care and support in line with their personal needs.

The provider was unable to demonstrate all staff had received training in relation to the Mental Capacity Act 2005 (MCA).

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection:

The last rating for this service was good published 16 August 2019.

Why we inspected

We were prompted to carry out this inspection due to concerns we received about catheter care, incident reporting and escalation, medicines and pressure care. A decision was made for us to inspect and examine those risks.

Enforcement

We have found breaches in relation to consent, safe care and treatment and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means we will start processes that will prevent the provider from continuing to operate the service.

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

Follow up

The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

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