Archived: Mayfair Homecare - Islington

Updated 7 August 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by four inspectors, one specialist advisor, one pharmacy inspector

and six Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We used all of this information to plan our inspection.

During the inspection

We spoke with nine members of staff including the care director, the registered manager, two care coordinators and five care staff.

We reviewed a range of records. This included 22 people’s care records and multiple medication records. We looked at 12 staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We spoke with 42 people who used the service and 25 relatives about their experience of the care provided. We also spoke with further five staff members and received email feedback from four care staff. We received feedback from one professional who works closely with the service.

We continued to seek clarification from the provider to validate evidence found. We also looked at training data.

Updated 7 August 2019

About the service

Mayfair Homecare - Islington is a domiciliary care agency. The provider for the agency is Sevacare (UK) Limited. The agency provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, learning disabilities or autistic spectrum conditions as well as physical disability and sensory impairment. There were approximately 259 people using the service at the time of our inspection. The provision of personal care is regulated by the Care Quality Commission. 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

Some aspects of the service management and provision needed to improve. These included dealing with complaints, care calls scheduling and changes and communication with the agency’s office staff.

The agency needed to improve how they managed people’s PRN (as required) medicines. The agency introduced medicines audits. However, these were not always fully effective in identifying issues with medicines management. Improvements were made in how the agency managed people’s regular medicines.

The agency had not dealt with verbal complaints effectively and action was not always taken by the agency to address issues raised by people. We noted that formal written complaints were dealt with promptly and as required by the provider’s complaints policy.

Further improvements were needed to ensure staff were provided with sufficient and specific guidelines on how to manage and minimise risks to health and wellbeing of people who used the service.

The providers policy on dealing with people’s money had not always been followed and there was no managerial oversight of all monetary transactions carried out on behalf of people. Therefore, people and staff were not always protected from the risk of abuse. The registered manager acted on known safeguarding concerns. Appropriate referrals and notifications on safeguarding had been made to the local authority and the CQC as required.

There were sufficient staff to support people. However, the agency needed to further improve to ensure there was continuity of care and effective communication with people, when care staff or the time of a call visit had changed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice. Although staff involved people in making decisions about their care, often care was provided assuming that people’s routines were always the same.

General feedback from people showed staff were caring and friendly. Overall people were happy with regular staff supporting them. Some staff’s conduct suggested their understanding of professional boundaries needed to improve. The provider informed us that training in professional boundaries for all staff employed was due shortly.

Information about people’s preferred way of communication had been reflected in their care plans. However, these had not always been taken into consideration when communicating with people about their care.

Managers were provided with information about their roles and responsibilities. However, further work was required to ensure effective quality monitoring systems were in place for all aspects of the service delivery.

There were systems to protect people from harm. Staff were recruited safely, accidents and incidents were reported and analysed, and infection control measures were used by staff to avoid infection.

When people had the capacity, they had signed their care plans to show they consented to care provided by the agency.

People’s needs, and preferences had been assessed before they started using the service.

Staff received induction and mandatory training to help them to support people. Further support was provided in the form of spot checks, supervision and appraisal of staff work.

People were supported to live a healthy life. This included providing people with sufficient food and drink as well as enabling contact with healthcare professionals when required.

People’s privacy and dignity was protected when providing personal care.

Each person using the service had a person centred care plan. These plans included information about people’s care needs, their personal likes and dislikes and information on how people would like the care to be provided.

There were yearly service users and staff surveys carried out. People using the service and staff were encouraged to give their feedback about the service provided by the agency.

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 20 June 2018). This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected: This was a planned inspection based on the previous rating.

We carried out a comprehensive inspection of this service on 7 and 8 March 2018 (published 20 June 2018). and found breaches of regulations. We issued the service with a warning notice in respect of one breach we found. This was in relation to the assessment and management of risks to the health and safety of people using the service, poor management of people’s medicines and management of accidents and incidents. During this comprehensive inspection of the service we checked whether the service had met the warning notice.

We found some improvements had been made and therefore the agency had met the Warning Notice. However, some aspects of the service provision needed further improvements to fully meet the requirements of the Regulations.

We found four breaches of regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made three recommendations about handling people’s money, the Accessible Information Standard and effective quality monitoring of the service provided.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayfair Homecare Islington on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.