JM Healthcare

Updated 3 February 2018

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 took place on 6 and 7 December 2017 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that people would be available to speak with us. The inspection was carried out by one adult social care inspector.

Before the inspection we reviewed the information we held about the service. This included previous contact about the service and notifications we had received. A notification is information about important events which the service is required to send us by law. The provider also completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We sent questionnaires to 50 people receiving a service, 50 relatives, and 23 staff to gain their views on the quality of the care and support provided by the service. Of these questionnaires, we received 21 back from people using the service, three from relatives and three from staff.

We used a range of different methods to help us understand people's experience. We looked at care records for eight people to check they were receiving their care as planned. We looked at how the service managed people’s medicines, the quality of care provided, as well as records relating to the management of the service. These included four staff personnel files, staff training records, duty rotas, and quality assurance audits. We visited six people in their own homes and spoke with two relatives. We also spoke with four staff, an office administrator, and the registered manager. Following the inspection, we received feedback from one healthcare professional and the local authority’s quality team.

Updated 3 February 2018

This inspection took place on 6 and 7 December 2017 and was announced. The provider was given 48 hours' notice because we wanted to make sure the registered manager and staff would be available to speak with us.

J.M. Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using J.M. Healthcare 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 this inspection, 60 people were receiving personal care from the service.

The service had 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.

J.M. Healthcare was previously inspected on 16 December 2016. At that inspection, we identified breaches of the legal requirements. These related to the management of medicines and the accuracy of records regarding the care people were receiving. The service was rated as 'Requires Improvement'. Following that inspection, the provider contacted us outlining the steps they would take to meet the relevant legal requirements.

At this inspection December 2017, we found improvements had been made in the way the service managed people’s medicines; risks associated with people’s care and support were now being identified, and regular reviews of people’s care were now taking place. However, further improvements were still required. We looked at the care and support plans for eight people with varying healthcare needs. We also met with them to review how well the service was meeting their needs and minimising risks to their health, safety and well-being. We found each person’s care plan contained a risk management plan that identified risks to their health and safety. Whilst some were detailed and contained specific guidance for staff to follow others were not and lacked guidance for staff to demonstrate that risks were being effectively managed and/or mitigated.

We have made a recommendation the provider and registered manager ensure the risks associated with people’s care are documented and kept under review.

At our inspection in December 2016, we had found reviews of peoples care were not taking place and the information contained within people’s records was focused on tasks and was not person centred. At this inspection, we found although some improvements had been made, improvements were still required.

We looked at the care and support plans for the eight people. We found, two of eight care plan we reviewed did not contain information about the person’s hobbies or interest that would enable and support care staff to engage meaningfully with this people. We discussed what we found with the registered manager who agreed the information contained within people’s care and support plans was not as person centred it could be.

We have made a recommendation the provider seek advice and guidance from a reputable source in developing care and support plans that are person centred.

We looked at the services’ quality assurance and governance systems to ensure procedures were in place to assess, monitor, and improve the quality of the services provided. These included a range of audits and spot checks. We found that although some systems were working well others were not. Quality assurance systems had not fully identified that some people’s risk management plans lacked guidance for staff to demonstrate that risks were being effectively managed or that some people’s care and support plans were not as person centred as they could be.

We have made a recommendation the service reviews its quality monitoring processes and record keeping procedures. Following the inspection the provider wrote to us to tell us what action they had taken to address our concerns

At the time of the previous inspection in December 2016, we found some people’s medication administration records showed there were gaps and we could not be assured people received their medicines as prescribed. At this inspection we found improvements had been made; people received their prescribed medicines when they needed them and in a safe way. Medication administration records (MARs) were maintained accurately. MARs were audited by field care supervisors each week and monthly by the registered manager. This helped ensure any potential errors were picked up without delay. However, we found the audits undertaken by field care supervision were not recorded formally. We therefore unable to tell if these had taken place.

We asked people whether they felt safe with the care, staff provided. All the people we spoke with told us they felt safe and had confidence in the staff supporting them. One person said, "I’m very happy, all the staff are very nice and I look forward to them coming." Another person said, “I do feel safe.

People were protected from the risk of harm and abuse. Staff had undertaken safeguarding training to enhance their understanding of how to protect people. People were protected as the service had in place safe recruitment processes.

People confirmed staff always stayed for the allotted time and said their visits were never cut short. The service employed sufficient staff to meet people's needs. There was an on call system for people and staff to ring in the event of an emergency outside of office hours. People told us they always knew who was coming to them as they received a weekly rota.

Staff displayed a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS). People were encouraged to make choices and were involved in the care and support they received.

People told us staff had the knowledge and skills they needed to carry out their roles. One person said "They know what they're doing, their very professional”. Records showed newly appointed staff undertook a comprehensive induction and there was a system in place to support staffs personal development, which included regular one to one supervision, competency checks, and annual appraisals. Staff confirmed they received regular training, these included infection control, fire safety, moving and handling, food hygiene, safeguarding adults and dementia awareness

People were supported to attend or make appointments with a number of healthcare professionals including; GP's and district nurses. People who used the service consistently praised the service and staff for their support and the standard of care they provided. One person said, “I have nothing bad to say to about them. People felt their views were listened to, they said staff always treated them with dignity and respect.

People knew whom to contact if they needed to raise a concern or make a complaint and were confident their concerns would be taken seriously. People, relatives, and staff spoke positively about the leadership of the service and told us the service was well managed. People told us they were encouraged to share their views and the provider annually sought people’s views by asking people and relatives to complete a questionnaire.

The registered manager was aware of their registration responsibilities in ensuring the Care Quality Commission (CQC) and other agencies were made aware of incidents, which affected the safety and welfare of people who used the service.