Medacs Healthcare PLC

Medacs Healthcare PLC is a domiciliary care agency providing personal care. At the time of our inspection there were 93 people using the service. Everyone who used the service, at the time of our inspection, 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

Risks to people’s health and safety were assessed but related documentation had not always been completed. Some care records needed to be updated and better organised to make sure staff were using up to date information about people’s needs. The registered manager had identified this issue and was addressing it. Staff were recruited safely and the registered manager took immediate action to address an issue we identified in making sure staff, new to the service, followed an effective induction process. Some improvements were needed to make sure required documentation in relation to managing medicines was in place.

Staff knew what to do to make sure people were safe and the service managed safeguarding issues well. Staff felt there were enough of them to meet people’s needs safely. People told us they felt safe with staff and were complimentary of the care they received. One person was concerned that not all staff stayed for the correct amount of time.

Systems to audit quality and safety within the service at branch and provider level were in place but needed some improvement to make sure they covered all aspects of the service. Where auditing had identified issues, action had been taken to find the cause and address the issue. The provider used this process to learn lessons for future improvement of the service.

Whilst some people and their relatives told us they had been involved in their care planning, others were not aware of their current care plan or how to access the App used to view their or, where appropriate, their relatives care plan and care records.

Some people told us their opinions of the service were sought but others said not. People and staff felt they were listened to by the management team and some felt communication from them was good. All of the people we spoke with felt the service was well managed and many said they would recommend it.

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 good (published 01/01/2019). The rating has now changed to requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe and Well-led.

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 good 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 Medacs Healthcare PLC on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service: The management of medicines had improved which ensured they were administered as prescribed and staff had guidance to do this safely. Risks to people were assessed and records contained clear guidance for staff to follow. Staff knew how to respond to possible harm and how to reduce risks to people.

The provider had embedded quality assurance systems to monitor the quality and safety of the care provided. People and relatives were asked for their views and their suggestions were used to improve the service.

People were safe and protected from avoidable harm as staff knew how to recognise and respond to concerns of ill-treatment and abuse. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practice or the environment, to reduce the risk of further occurrences.

The provider followed effective infection prevention and control guidance when supporting people in their own homes. The equipment that people used was maintained and kept in safe working order and the provider undertook safety checks with people at their home addresses.

There were enough skilled and experienced staff to meet the needs of people who used the service. Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service. A comprehensive induction and training programme was completed by all staff.

A detailed needs assessment was carried out to assess people's needs and preferences prior to them receiving a service. People's personal and health care needs were met and detailed care records guided staff in how to do this. Where staff noted a concern they quickly involved healthcare professionals.

Where required, people were supported to have sufficient to eat and drink and their health needs were regularly monitored. Staff followed the advice health care professionals gave them. Staff had guidance if they needed to provide people with end of life care.

Staff showed a genuine motivation to deliver care in a person centred way based on people's preferences and likes. People were observed to have good relationships with staff.

People told us they felt well cared for by staff who treated them with respect and dignity. People told us they were listened to and were involved in their care and what they did on a day to day basis. People's right to privacy was maintained by the actions and care given by staff members.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People told us they were involved in making every day decisions and choices about how they wanted to live their lives.

A complaints system was in place and there was information so people knew who to speak with if they had concerns.

More information is in the full report below.

Rating at last inspection: Requires Improvement (published 1 January 2018)

Why we inspected: This was a planned inspection based on the previous rating of requires improvement. The overall rating has improved to good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good. If any concerning information is received we may inspect sooner.

There was a newly registered manager in post at the time of the inspection. 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 the last inspection in March 2017, the service was rated as requires improvement. The safe domain was rated inadequate. There were three breaches of regulation within this domain. These were regulation 9 Person centred care, regulation 12 safe care and treatment and regulation 13 safeguarding service users from abuse and improper treatment. There was also a breach of regulation 17 good governance within the well led domain. Following the inspection, the provider sent us an action plan telling us what actions they were going to take to ensure they met the regulations. At this inspection, we found that some improvements had been made.

We found the service was not working in accordance with the Mental Capacity Act 2005 and had not followed the correct process to make sure any actions taken were in people's best interests when this was required.

This represented a breach of Regulation 11 HSCA RA Regulations 2014 Need for consent. You can see what action we have taken at the end of this report.

We found issues relating to the management of medicines. Although the provider was responsive at the time of the inspection, the processes in place for quality assurance had not identified these issues.

Risk management plans did not always contain the information staff needed to support people safely and manage all risks identified.

People spoke positively about the staff that supported them and told us they were always treated with care, respect and kindness. Staff were respectful of people's privacy and maintained their dignity. Staff had developed good relationships with people and were familiar with their needs, routines and preferences.

People told us they felt safe and would speak to staff if they were worried about anything. The manager understood their responsibilities for safeguarding people and staff were trained to understand and recognise abuse. They knew who to report concerns about people's safety and welfare within the organisation and knew where to access contact numbers to external agencies if necessary.

Recruitment processes were robust to make sure staff were safe to work with vulnerable people.Staff had sufficient knowledge and skills to meet people's needs effectively. They completed an induction programme when they started work and they were up to date with the provider's mandatory training.

People were supported to access health and welfare professionals when they needed to. People were supported with their dietary needs in accordance with their care plan.

There was a complaints procedure in place at the service. The people we spoke with said they would speak with one of the staff or the manager if they had any concerns.

Satisfaction surveys were sent out by the provider to seek the opinions and views of people who used the service. Systems were in place to monitor

the quality of the service and people's feedback was sought in relation to the standard of care and support.

One breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection. You can see what action we told the provider to take at the end of this report.

Medacs Healthcare PLC Leeds is a domiciliary care agency that provides support to people in their own homes in the Leeds area.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service recently. A new manager had been appointed but was not in post at the time of the inspection. 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 and associated Regulations about how the service is run.

Medicines were not managed safely. We found one person was receiving doses of their pain relief medication too close together which put their health at risk. We saw gaps in the recording of medicine administration and found cream charts did not show people were receiving creams as prescribed.

A number of safeguarding concerns had been reported to CQC by the local authority. These indicated people who used the service had been put at risk of harm from missed calls, poor moving and handling techniques, issues with medication and agreed tasks not being completed. We found staff were able to describe different types of abuse and what they would do to report alleged abuse but we found the systems in place to safeguard people had not been followed at all times.

People told us they felt safe using the service and they overall received their calls on time. However, some people said they did not always know which care worker would be visiting them or receive the care they expected at the time they had agreed.

People told us staff were generally kind to them and treated them with dignity and respect. They said staff were well trained to carry out their role. People were supported by staff who had received induction training which included shadowing more experienced staff. Recruitment of staff was managed safely.

There were systems in place to ensure people’s nutritional and hydration needs were met. People’s physical health was monitored as required. This included the monitoring of people’s health conditions so appropriate referrals to health professionals could be made if needed.

People told us they were asked to consent to their care. However, the Mental Capacity Act 2005 legislation had not been fully implemented within the day to day delivery of care for people. The service had recognised this and had planned improvements in this area.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans included risk assessments. However, we suggested some improvements were needed to care plans and risk management plans to ensure they gave staff detailed guidance on meeting people’s needs.

The service had not been well-led as the system failures identified during the inspection had not been identified through the audit systems and quality control systems in place. A number of people who used the service said communication from the agency was at times poor and the agency had been slow to respond to concerns raised.

We found four breaches 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.