Medacs Healthcare - London

Medacs Healthcare Croydon is a domiciliary care agency providing personal care and support to 311 people living in their own homes at the time of the inspection.

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

At our last inspection, we found systems to manage risks and staffing were inadequate and the provider was in breach of the regulations in relation to safe care and treatment, staffing, receiving and acting on complaints and good governance. At this inspection we found the quality of the service had improved significantly. Some improvements were still required, but the provider was no longer in breach of the regulations.

People felt safe using the service. Each person had a detailed risk management plan which was personalised, although these did not always consider how some health needs were connected and might increase risk.

We have made a recommendation about the use of standardised pressure area risk assessment tools.

There were enough staff to safely cover all care visits, which usually happened on time although some improvements to punctuality were required. The provider used safe recruitment systems to help ensure people only received care from suitable staff. There were effective systems in place to protect people from risks associated with abuse and neglect, infection and the unsafe management of medicines.

Improvements to the provider’s quality assurance system meant the registered manager was already aware of and was working on several areas they needed to improve. This included communication between care staff and office staff, which people felt was not always good. Leadership was visible and the provider was open and honest when things went wrong, making sure they learned lessons and acted to prevent things going wrong again. The provider sought and acted on feedback from people, their families and staff.

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. The provider assessed the capacity of people to make decisions about their care in line with relevant legislation.

Staff knew how to provide appropriate care at the end of people’s lives and listened to what people said they wanted at this time. We have made a recommendation about exploring and recording these preferences in advance.

People had detailed assessments to allow care to be planned and delivered in line with guidance. Staff worked well with other agencies to do this and made sure people had the support they needed to stay healthy and eat well. Staff received the support and training they needed to care for people effectively.

The provider had improved their systems for responding to people’s complaints and concerns. People were satisfied with how their complaints were handled. The care and support people received was personalised and met their needs, and people were generally happy with it. People received information in suitable formats so they understood it. The provider took steps to protect people from the risk of social isolation.

The provider had made improvements to how staff were deployed, meaning people were more consistently supported by the same staff and were able to build good relationships with them. People and their relatives were involved in planning care and their views were listened to. People received the support they needed from kind, caring and respectful staff who promoted dignity and independence.

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 18 July 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

This service has been in Special Measures since 10 January 2019. 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

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The quality of care had improved since the last inspection in October 2018, after which we rated this service ‘inadequate’ in four key questions and overall. However, at this inspection we found continued breaches of the regulations in relation to safe care and treatment, staffing, receiving and acting on complaints and good governance.

People did not receive a service that was safe, because risks were not adequately assessed and managed. Risk assessments did not include information about how to protect people from risks associated with their health conditions, malnutrition, pressure ulcers or other areas where they may have been at risk. Where people had experienced harm or poor care, the provider did not review risk management plans or take other action to prevent this from happening again.

The provider took action to improve leadership and governance, including increased managerial presence, improved audits and better processes to receive and act on feedback from people and staff. However, they had failed to identify and act on the shortfalls around risk management that we found and failed to make adequate improvements in other areas such as staffing.

Although staff recorded people’s food and drink intake, the provider did not monitor this to ensure people had enough to eat and drink.

People continued to feed back that staffing was unreliable at times. Staff often arrived for visits late or not at all. Although this had improved since the last inspection, further improvement was required. The provider had improved the provision of staff training and supervision since our last inspection, but the provider's records did not show staff always received annual appraisals.

Complaints were not always dealt with in line with the service’s complaints policy, because the provider did not always record outcomes or action they had taken and it was not always clear what they did in response to complaints.

The provider had improved the assessment process since our last inspection, meaning the service had enough information about people to produce detailed person-centred care plans. The provider had also made significant improvements in the way they planned people’s care. Care plans were person-centred and detailed so staff had the information they needed to meet people’s personal care needs and provide care in line with people’s preferences. However, this did not include support people may have needed around managing their health conditions. We recommend that the provider takes appropriate steps to ensure they are aware of any support people using the service may need to access healthcare services.

People received a more consistent service than previously, with care workers changing less frequently so people had opportunities to build relationships with the staff supporting them. People generally found staff polite and respectful, with reports that this had improved since the last inspection. There were robust recruitment processes to protect people from risks associated with being cared for by unsuitable staff.

Although the provider obtained information about people’s diverse characteristics, they did not always consider how this would impact on the delivery of their care.

The provider had improved standards around medicines management, although staff were not recording the application of topical medicines appropriately.

Staff followed procedures to protect people from the risk of infection.

People who had capacity to consent had signed their care documentation to indicate consent to their care. However, it was not always evident that the provider had followed the appropriate processes the law says they must follow when planning and delivering care to people who do not have capacity to consent.

The service promoted people’s privacy, dignity and independence.

More information is in the full report.

Rating at last inspection: At the last inspection, the service was rated Inadequate (published 10 January 2019).

Why we inspected: This inspection was brought forward from the planned date in response to information of concern. This included safeguarding reports and information we received from people who used the service and their relatives.

Enforcement: 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.

Follow up: This service is rated ‘Inadequate’ in one key question and therefore remains in ‘special measures.’ The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and

work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will

seek to take further action, for example cancel their registration.

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.

This inspection found a continued breach of the legal requirements in relation to staff training as well as further breaches in relation to the safety of care, staff deployment, person centred care, complaints, governance and statutory notifications.

This service 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, younger disabled adults, and children.

Not everyone using Medacs Healthcare - Croydon receives 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 take into account any wider social care provided. At the time of our visit 648 people were receiving personal care from Medacs Healthcare – Croydon.

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.

The care people received was not safe. Records relating to risks people faced were inconsistent and inaccurate. People’s medicines records were not kept up to date and we identified instances where medicines records showed a potential overdose. The majority of people’s care calls were not delivered at the time they were expected and people gave us examples of where this had impacted significantly upon them and the safety of the care that they received.

Improvements to staff training had not been implemented and we found gaps to staff training records. One to one supervision meetings and spot checks were not taking place as planned. People’s consent was not sought in line with legislation and there was a lack of information about people’s nutritional needs. Assessments of people’s care were not always carried out and lacked information. Where people received ‘reablement’ support, the provider did not identify and plan for them to achieve their goals. Records showed a lack of communication with health and social care professionals.

The service was not always caring. People did not always receive support from a consistent staff team. Records contained no evidence of people having been involved in their care planning and there was a lack of information about how to promote people's independence. The service did not consider the impact people’s religious beliefs, cultural background, sexual and gender identity had on their care preferences. We have made a recommendation about this.

Care was not planned in a personalised way. Care plans lacked information about how to provide support to people in a way that responded appropriately to their needs. Care plans did not identify what was important to people. The provider’s systems for monitoring care delivery and reviews was not robust enough to identify and respond to changes in needs. People’s wishes regarding end of life care were missing from records, despite them having conditions that would require this information to be in place. People and relatives told us their complaints were not responded to and we saw that numerous concerns about staff punctuality and care delivery had not been picked up through monitoring.

There was a lack of governance at the service. The provider’s systems had not adequately identified and addressed the numerous concerns identified at this inspection and improvements following our last inspection had not been implemented. Record keeping was not up to date and there was no robust system for management to check care records. The systems to involve people, relatives and staff in the running of the service were not working. The provider had failed to notify CQC of important events that they had a statutory duty to do so.

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.

Medacs Healthcare – Croydon provides home care across a number of London Boroughs. This includes long term domiciliary care packages as well as short term reablement packages and support to people receiving end of life care in their own homes.

At our last inspection in December 2015 and January 2016 we rated the service ‘good’ overall and for each key question. At this inspection on 6 & 7 March 2018 we found the service’s rating had deteriorated to ‘requires improvement’.

Since our last inspection a new registered manager had been appointed in January 2018. 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.

There were not sufficient numbers of staff to meet people’s needs. We heard occasions of missed visits or only one staff member attending when two staff were required to keep people safe. Scheduling difficulties meant people often experienced late calls and at times people felt staff were rushed to get to other appointments which impacted on the quality of care provided.

Staff told us they had good access to training opportunities, however, the training matrix showed staff were not up to date with their annual refresher training. Staff received regular supervision and annual appraisals.

People told us they were supported with their medicines, however, accurate medicines administration records were not always maintained. The service quality assessors and in-house trainer were working with staff to help improve the quality of medicines records.

Staff were knowledgeable about the risks to people’s safety and how these were to be mitigated, and staff followed safeguarding adults’ and children’s procedures. Staff followed best practice in regards to infection control.

Staff provided people with any support required with nutritional, hydration or health needs. Staff adhered to the principles of the Mental Capacity Act 2005.

People were complimentary about the support they received from their regular care workers and the caring relationships they had built with them. Staff assessed people’s needs and detailed records were maintained about how people wished to be cared for. Staff were respectful of people’s privacy and dignity, and supported them to maintain, and regain where possible, their independence. People were empowered to make choices about their care and staff were aware of any sensory impairments people had which impacted on their ability to communicate their choices.

A complaints process was in place. We heard that previously people felt their complaints were not listened to and responded to in a timely manner, however, we also heard that this had much improved recently.

The management team had recently been restructured to provide stronger management and leadership across all areas of the service. The management team had regular meetings with the local authorities they had contracts with to ensure consistent and coordinated care.

The provider’s quality monitoring processes had identified areas requiring improvement and new systems had been introduced to address some of these concerns, including in relation to scheduling and out of hours arrangements. It was too soon to assess the impact of these new systems and we will look at this at our next inspection, but staff had been gathering regular feedback from people to ensure the changes were making a positive change.

The registered manager adhered to the requirements of their registration including submission of statutory notifications and displaying their inspection rating.

The provider was in breach of legal requirements relating to staffing. You can see what action we have asked the provider to take at the back of this report.

Medacs Healthcare - Croydon is a domiciliary care agency that provides care and treatment to approximately 400 people of all ages and with varying needs in their homes across a number of London Boroughs.

The service has a registered manager. 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 felt safe and secure with staff from this service. Staff had attended safeguarding training. They recognised different types of abuse that may take place and understood how to report it. Risk assessments reflected people’s needs and supported their goals and supported staff to provide safe and appropriate care and support. There were sufficient numbers of suitable staff to meet people’s needs. People told us staff generally arrived on time and remained for the allocated period. If there were any delays the service informed people. Staff went through an appropriate recruitment process before being employed. People’s medicines were administered safely.

Staff received regular training and management support. Training included an induction process for new members of staff and refresher training for existing staff. Training, management supervisions and appraisals took place in the areas where staff worked including e-learning. Some training that required the practical use of equipment was delivered in the service’s training room. Staff were supported on occasions to obtain further, relevant qualifications. Staff had completed Mental Capacity Act training and the service was working within the principles of the Act. People consented to their care and support.

People told us staff were kind and treated them and their relatives with dignity and respect. Care and support was delivered by staff in a patient, friendly and sensitive manner. The service supported people to express their views and to be involved in planning their care and support. Staff respected people’s dignity and privacy and encouraged people to be as independent as they wanted to be.

The service was responsive to people’s needs. People’s needs were assessed before the service started providing care and support. Care plans were person centred and identified needs, goals and preferences. The service encouraged feedback from people and their representatives about their experiences of the service through monthly monitoring telephone calls, quarterly visits and annual surveys. The service had an appropriate system for dealing with complaints.

Staff told us they felt valued and appreciated. There were systems to obtain feedback from staff which included regular staff meetings and surveys. Any adverse incidents or incidents of note, including safeguarding and other statutory notifications were reviewed by the provider’s clinical lead to identify and implement any learning or improvements. There were systems and processes to monitor and assess the quality of service provided and identify any risks to the health, safety and welfare of people using the service and staff. Records were accurate, up to date, accessible and were fit for purpose.