Archived: MCJA St. Helens Office

Our last inspection of MCJA took place in April 2016. During this inspection we found the service was in breach of regulations relating to the governance of service. The service was rated as Requires Improvement. Following our inspection in April 2016, the provider sent us an action plan detailing what steps they were going to take to ensure the breach was met. We checked this during this inspection and found that the service had made the required changes.

MCJA is a domiciliary care agency based in St. Helens. It offers care and support to around 220 people in their own homes including personal care. The agency has offices based in St. Helens and is registered as a supplier of services to St. Helens Local Authority. They employ around 65 support staff.

During our last inspection in April 2016 we found the service in breach of regulations relating to governance. This was because regular audits (checks) were not routinely performed on medication which meant people were at risk of not having their medication managed appropriately. We checked this during this inspection and saw that the registered manager and deputy manager had formulated a new checking and auditing system which helped ensure people’s medication was appropriately accounted for and stock was balanced. In addition, all forms of quality assurance were subject to the same auditing process. When omissions were found action plans were formulated, shared and discussed with coordinators and the members of staff responsible. The service was no longer in breach of these regulations.

Everyone we spoke with shared positive experiences of MCJA and were complimentary about the staff. People said they felt safe and trusted the service.

People’s medication was stored in their own home in line with their wishes and choices. A medication assessment was completed with each person and they were required to sign the consent agreement to enable staff to support them with medication needs. People were only supported by staff who were trained by the service and had passed competency assessments.

Staff were recruited safely. We saw that staff were only offered positions in the company once all satisfactory checks had been completed and references had been obtained.

Risk assessments were completed and reviewed every six months or when there was a change in people’s needs. Risk assessments were completed for various aspects of people’s clinical and emotional needs.

Staff were aware of their role with regards to safeguarding and raising an alert if they needed to. We saw staff were trained in this subject, and it was often a topic for discussion during team meetings. We discussed a recent safeguarding incident and saw the provider had taken appropriate action.

People received care and support by staff who were trained and had the correct skills to be able to support them. Staff completed a training programme which was aligned to national guidance, as well as completing the service’s mandatory training topics.

The service was working in accordance with the Mental Capacity Act and DoLS (Deprivation of Liberty) and associated principles. We saw that where people could consent to decisions regarding their care and support this had been well documented, and where people lacked capacity the appropriate best interest processes had been followed.

People were supported with meal provision. There was information within the staff training around providing meals and snacks including simple meal ideas and how to ensure people were eating healthy and nutritious meals.

The service liaised with other medical professionals such as GP’s or district nurses to ensure any changes or requirements to people’s care was documented.

We received positive comments about the staff and caring nature of the service in general. Staff told us they enjoyed supporting people.

Staff were able to describe how they preserved people’s dignity and respect when providing personal care.

Information contained in people’s care plans was person centred and reviewed regularly to ensure it was up to date and relevant. Information about people’s likes, dislikes and life history was recorded and reviewed. Staff we spoke with demonstrated that they knew the people they supported well and enjoyed the relationships they had built with people.

Complaints were well managed and documented in accordance with the provider’s complaints policy. The complaints policy contained contact details for the local authorities and commissioning groups. There had been no complaints since our last inspection.

Quality assurance systems were effective and measured service provision. Regular audits were taking place for different aspects of service delivery. Action plans were drawn up when areas of improvement were identified. Staff meetings took place.

MCJA is a domiciliary care agency based in St. Helens. It offers care and support to 240 people in their own homes including personal care. The agency has offices based in St. Helens and is registered as a supplier of services to St. Helens local authority. They employ 65 support staff.

This was the first comprehensive inspection of this service. .

The service had a registered manager who had been in post since July 2014. 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.

At this inspection we found a 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 the report.

People’s needs were assessed and risk assessments were in place. People’s histories, wishes and preferences were not consistently reflected within their care plans. This meant that staff may not provide support in line with a person’s wishes. Care plans were regularly reviewed however new up to date information was not transferred into the care plans. Documentation was not always updated following notified changes. This meant people may not be receiving the most up to date care and support they required. Daily records which were maintained for each person which showed they had received the care and support.

The registered provider did not have in place any formal systems for assessing and monitoring the quality of the service. This meant that there was a risk that they would not identify where quality and safety were compromised and to be able to respond appropriately to concerns.

Staff received training and support to carry out their job and they were provided with further opportunities to develop within their roles. Staff had access to policies and procedures in relation to safe practice However, the registered provider failed to ensure that staff were observed carrying out support tasks such as medication administration and therefore could not be assured of their competence.

People had no concerns about their safety and the way they were treated by staff. There were systems in place to protect people from abuse which included training for staff and policies and procedures for staff to follow. Staff spoken with demonstrated a good understanding of what action needed to be taken in the event of a person being at risk from harm. Recruitment practices helped ensure that only people suitable to work with vulnerable people were employed by the service.

People felt that they could be better informed about which staff they could expect or if they were running late. However, people told us that the staff were caring. People told us that they had a core team of staff which was good because they got to know each other well. They told us that staff met their needs and had the right skills to provide their support. The registered provider employed a sufficient number of staff to meet the needs of the people they supported.

Staff were confident about dealing with emergency situations and they had details of people and services they could contact if they needed advice, guidance or support at any time of the day or night.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that policies and guidance were available to staff in relation to the MCA. Staff had received training and had a basic understanding of the principles of the act. Care planning documents included consideration of the MCA which meant that people’s rights were protected.

People had access to information about how to complain and they were confident about voicing any concerns they had. Complaints were taken seriously and dealt with in a timely way. People’s views about the service had been sought at review and through questionnaires.