JM Healthcare

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.

The service is required to have a registered manager in post. At the time of our inspection there was not 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. A manager had been working in the service since May 2016. An application for the post of registered manager had not been submitted to the commission.

Staffing levels were being monitored and recruitment was still in place. Staff told us, “It’s been a difficult few months but things seem to be getting better now” and “We have all had to do extra to cover the gaps.” The service used a mobile phone based call monitoring system to ensure all planned care visits were provided each day. Contracted hours were being met but there were times when staff were late for calls or did not arrive. Staff were expected to call the office if there were delays. One staff member said, “Sometimes we can’t get through, it can be a problem.” The inspector noted that on the day of the inspection engineers were visiting the service to arrange installation of an extra line into the office to improve communication channels. Comments from people during a recent survey included concerns that staff had been late for calls or had arrived on the wrong day.

We have made a recommendation for the service to improve its communication system.

Care plans were in place but in most instances information was dated. For example, one file had an assessment from 2015 but no other evidence of reviews having taken place. Assessments from service commissioners were in place on two files seen but they were dated from 2012 and 2013. In one instance when visiting a person’s home the folder contained the original commissioner’s assessment from 2012. The most recent agency assessment was dated August 2015. There was no evidence of reviews taking place recording any changes in the person’s needs. The person told us they had been admitted to hospital since the latest assessment but there was no information to show care needs had changed or were being responded to.

Risk assessments were in place on all files seen. They covered areas of personal care, diet, health and safety, although where risk had been identified there was a brief overview but no plan of action to show how the risk would be managed. In one instance a stair lift had been fitted recently but the person’s risk assessment had not been updated to show the level of risk to the person using it.

Medicines were not always being recorded in people’s homes. Some records showed there were gaps where it could not be confirmed if a medicine had been administered. In other records staff were using letters from the index at the bottom of the medicine record. For example (D) which denoted dispensed, however on other days the staff member signed their signature to denote it had been administered. Staff told us (d) stood for medicines left for the person to take themselves after the carer had left the service. Some medicine records had recently been audited. One showed staff being prompted to sign for all medicines given. However there were still gaps where staff were not always signing. This meant people had the potential to be at risk because staff did not know if the medicine had been administered or not.

There were weekly meetings between the manager and directors to review the operational issues. The meetings looked at the use of staff hours and field managers had been designated eighty per cent of their time to work as a carer and twenty per cent for senior responsibility. This included carrying out reviews, updating assessment and care plans, audits including medicines and staff supervision. Field workers told us they did not have enough time to carry out responsibilities associated with their senior capacity. This was confirmed when looking at gaps in reviews, assessments and supervisory roles.

Recruitment systems had been reviewed and developed to ensure staff were suitable and safe to support people in their own homes. Necessary pre-employment checks had been completed.

All new staff received a basic office induction looking at health and safety issues, safeguarding, moving and handling as well as familiarisation of policies and procedures. Records showed recently recruited staff had received probationary supervision including spot checks and first review.

The service had used the care certificate induction standards for newly appointed staff. However none had yet completed the programme. The training record showed all staff had access to a range of training suitable for their development in a caring role. The training was dated and monitored so that all certificates were in date and where training updates were necessary staff were made aware of them.

There were systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.

The management team had systems in place to measure the service’s performance and look at ways of developing the quality of service they provided. There were processes in place to seek people's views on the service and monitor the quality of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

People's needs were assessed prior to JM Healthcare providing support to ensure people's needs could be met.

Staff received an induction when they started work for JM Healthcare and one to one meetings with the registered manager which supported them in their role.

We found an improved system to monitor the quality of service provision was in place and regular reviews of people's care had taken place.

We found that improvements had been made in relation to the recruitment procedures and checks which were conducted prior to staff commencing employment. Staff told us they felt, 'supported' and 'love my work.' The people we visited felt they were treated with respect, dignity and kindness.

However, we found that there were gaps in essential areas of staff training such as fire safety and manual handling. People also told us they felt some staff did not have the training to work with their specific needs including the equipment needed to move them safely. We found the agency did not have an emergency procedure in place to manage foreseeable situations such as staff sickness in some of the rural areas they covered. This had left people with out a visit and the care they needed on several occasions. We also found ongoing improvements were required to the monitoring of the service provided including the routes staff undertook to ensure sufficient travelling time and auditing of areas such as care plans.

People we spoke with told us the agency met their needs. One person told us the agency staff were like "Family" to them. Others spoke well of the kindness, friendliness and skills of the staff who attended them.

However, we found that staff training systems were not comprehensive enough to ensure that staff could competently meet people's needs for care. As an example we found that staff did not have training in first aid, and many did not have updated training in areas such as health and safety, infection control or the mental capacity act. Supervision and staff support systems had been inconsistent, but were being established.

We found some other systems were also inconsistent or not audited regularly.

Staff we spoke with told us that they enjoyed working for the agency and felt well supported. They told us they could contact the office or a senior at any time for advice or support if they needed this.