Background to this inspection
Updated
5 May 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection was carried out by two inspectors and an expert-by-experience who had experience of domiciliary care services. The expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
When MiHomecare - Bristol was last inspected in September 2014 we found breaches of the legal requirements. The planning and delivery of care did not always ensure people’s needs were met and the provider did not have sufficient staff to meet the needs of people who used the service. In addition, the provider had failed to notify the Commission of a significant event within the service as required by law. The provider wrote to us in October 2014 to tell us how they would achieve compliance with the regulations. During this inspection, we found that although some improvements had been made, the service was still not meeting all of the legal requirements.
Before the inspection we reviewed the information that we had about the service including statutory notifications. Notifications are information about specific important events the service is legally required to send to us.
On the day of the inspection we spoke with 15 people who received care from MiHomecare and six people’s relatives. We also spoke with five members of staff which included the person currently employed as the manager and a healthcare professional. We reviewed nine people’s care and support records.
We looked at records relating to the management of the service such as policies, incident and accident records, staff recruitment and training records, meeting minutes and audit reports.
Updated
5 May 2015
We undertook an announced inspection of MiHomecare - Bristol on Tuesday 10 March 2015. We told the provider on Friday 7 March 2015 that we would be coming to make sure that staff would be available in the office. When MiHomecare - Bristol was last inspected in September 2014 we found breaches of the legal requirements. The planning and delivery of care did not always ensure people’s needs were met and the provider did not have sufficient staff on duty to meet the needs of people who used the service. In addition, the provider had failed to notify the Commission of a significant event within the service as required by law. At this inspection we found that actions to improve the service had not been completed.
MiHomecare - Bristol provides personal care and support to people in their own home within the Bristol and Weston-Super-Mare areas. At the time of our inspection the service provided personal care to 142 people.
A registered manager was not in post at the time of 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. The provider had appointed a manager at the service who had been in post since December 2014. This manager was currently completing the application process to register as a manager with us.
People and their relatives did not feel completely safe with the care provided by the service. People spoke highly of the staff and their caring nature, however some people could not always rely on the service to deliver care at the time they needed it.
Staffing levels were insufficient at the service and people and their relatives gave examples of when calls were missed or late and how it impacted on their daily lives. The manager explained the service was currently recruiting and that new staff were completing an induction process.
When a risk to people was identified, the provider had not completed risk management guidance and some records were not stored correctly.
People were not fully protected from the risks associated with medicines as the provider did not have a system to monitor the administration and recording of medicines by staff. People’s medicines records had not always been completed accurately.
There were no effective systems in place to obtain the views of people who used the service and people did not feel the service had an effective complaints process.
People spoke highly of the staff at the service and told us they were treated with dignity. We received mixed comments about the communication people received from the service to keep them informed about information relating to their care.
Where required, people were supported to eat and drink sufficient amounts. We did receive a negative comment from a person who required their meal at a specific time for medical purposes who said their needs had not always been met.
People received care in line with their wishes and preferences and staff ensured their needs were met before leaving.
The provider had a safeguarding adult’s policy for staff that gave guidance on the identification and reporting of suspected abuse.
People spoke positively about the staff who provided their care, however negative comments were received about the level of experience of some staff. Staff received regular training and supervision from the provider.
Staff understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work.
People could see healthcare professionals when required and the service had made appropriate referrals when a concern had been identified.
We found multiple beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now correspond to 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 this report.