The inspection site visit took place on 19 March 2018 and was announced to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. In addition to people living with dementia, sensory impairment, a learning disability or a mental health diagnosis. The service was created in 2016 when the provider took over three separately registered domiciliary care agencies in quick succession and formed Mayfair Homecare – Farnborough. The service had initially been based at a different office, but has been registered at the current location since April 2017. The service provided care to 98 people. However, just prior to the inspection, the provider had taken on a fourth domiciliary care agency and on the day of the inspection site visit, they took over responsibility for the 76 people previously cared for by that agency and their staff. This inspection considered the care provided to the 98 people receiving care from the service prior to 19 March 2018.
The service has a registered manager who was also registered to manage a second of the provider’s services. A full-time manager had been appointed for the service and they were due to commence work in April 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.
Staff had undertaken safeguarding training and relevant guidance was in place. Actions had been taken to improve the safety of people’s medicines management as a result of safeguarding investigations. Further time was required for the provider to be able to demonstrate that all staff understood and had consistently followed their financial safeguards.
Risks to people had been identified, assessed and relevant measures taken to minimise the risk of occurrence for the person. Processes were in place to minimise the risk of people acquiring an infection during the provision of their care. Processes were in place to ensure staff were informed of changes required to people’s care following incidents.
There were sufficient staff to provide people’s care and the provider had taken action to hand back packages they could no longer accommodate. The staff files for those staff who had transferred into the provider’s employment from the previous providers were not all fully complete. The registered manager has now audited these files and taken relevant action to ensure the required information is obtained.
Staff had undertaken work to ensure that people’s medicine records were robust and that they contained sufficient information to enable staff to administer people’s medicines to them safely.
People told us they received effective care. People’s needs had been assessed including those whose care had been taken on from the other providers. Processes were in place to ensure staff were updated and applied best practice in their work with people.
The provider had ensured that staff received an appropriate induction into their role and on-going training, support and supervision.
Staff had been provided with information about people’s food and drink needs and preferences. Staff ensured that people had been left at the end of their care calls with food and drink within their reach where needed.
The service had worked co-operatively with partner agencies. People’s records showed staff had worked effectively with a range of health and social care staff, to ensure people received well co-ordinated care. People had been supported by staff to ensure their healthcare needs had been met.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People told us staff had been kind and caring to them. People had been actively encouraged by staff to participate in decisions about their care. Staff had undertaken relevant training in relation to people’s human rights and ensured people’s privacy and dignity had been upheld during the provision of their care.
People received responsive care from staff who knew them well and understood their individual needs. People had been actively involved in planning their care and their care plans had been regularly reviewed with them. Staff supported people where commissioned to do so, to meet their recreational and social needs. Complaints had been actioned in accordance with the provider’s complaints policy to ensure people’s concerns were listened to and acted upon where possible. Staff were able to provide people with end of life care where required.
People told us they were very satisfied overall with the service provided, however, they would have liked more contact with management, to ensure they felt that they knew who managed the service. The registered manager and office staff had tried to get out and meet people, especially when they provided double up care calls with care staff. People’s views on the service had been sought and action taken in response to their feedback.
The provider had taken action to engage and involve staff in the service. However, the location had experienced issues with the three pre-existing locations taken on to create this service. The provider and the registered manager recognised this and a lot of work had been completed to create a new entity and to lift standards. The existing registered manager would be supporting the recently appointed new manager during their initial months to complete this work.
The provider needed to be able to demonstrate that their processes for monitoring that all notifications had been submitted to CQC as required were sufficiently robust.
Improvements had been made to ensure people had robust care plans and medicine records. Processes were in place to audit and monitor various aspects of the service. It will take further time for the provider to be able to demonstrate that the medicine administration record audits introduced are effective.