Morecare Services(UK)Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 3 breaches of the regulations. The registered manager did not always ensure their safeguarding systems were used effectively to investigate and follow the provider's procedure after becoming aware of concerns or issues. When incidents or accidents happened, we were not assured the registered manager fully investigated those, and there was little evidence of any lessons learned from these events. The registered manager did not always ensure effective recruitment processes were in place to ensure, as far as possible, that people were protected from unsuitable staff being employed. The registered manager did not ensure clear plans of care and risks were in place for staff to minimise the risks to people’s health and wellbeing and take timely action to support people. Not all staff were up to date with, or had received, their mandatory training and competency checks to ensure they had the right skills and knowledge to provide effective care to people. The registered manager did not ensure they, and staff managed people’s medicine safely and properly. Staff were not fully trained and assessed as competent to support people with medication. The registered manager did not ensure staff attended people’s visits on time, stayed the right time and consistently communicated with people and relatives regarding any issues with visits. People, relatives and professionals were not always happy with the way the provider and staff communicated with them, and the care and support they provided to people.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were not always protected from harm, neglect and discrimination because we received mixed feedback from them about feeling safe and being supported. People said, “I don’t feel unsafe with the care, but I don’t always feel comfortable with [staff] either. [The staff] who came today didn’t seem to want to be here at all” and “Sometimes they do dash off and that makes me feel uncomfortable”. Relatives added, “[The person] is not unsafe but it is not ideal either, there are always dirty clothes lying around and sometimes [the person] looks dirty too. We are never really sure what they actually do and they never write anything down or say what’s been done” and “No, I am not very happy with [the staff]. They rush too much to be safe”. Some people and relative were positive about the provider and staff support. People said, “I am more than happy with them, I am very very happy with them all. Yes I feel very safe with, them assisting me” and “The care is essential for my well-being and I would highly recommend them. I most certainly do feel very safe with all the staff who care for me”. Some relatives added, “We have only two or three carers, no more and know them well. It is very safe yes no worries and never had a safeguarding issue” and “There is nothing that really worries me about [person’s] safety. [The person] feels quite safe and their help means [the person] is safe and able to live at home so we are thankful”.

The registered manager was able to explain about making sure people who use the service were kept safe from improper treatment. However, they needed prompting to ensure they followed the correct process in accordance with the local safeguarding adults’ policy and procedure and worked with the local authority and police where necessary regarding people’s safety. The registered manager told us they supported and encouraged staff to share any concerns with them, so it was addressed without delay. The registered manager told us how they worked with staff to ensure people were supported to raise concerns when they did not feel safe and regularly monitored or any changes in the safety of people. The registered manager told us the staff completed induction, training, and read the policies, as well as, they discussed the safeguarding and whistleblowing process during meetings and supervisions. The registered manager also noted they called people weekly to check how the staff supported them. Any issues were recorded and reported to the management team to address it. They told us about the system in place for recording accidents and incidents and the registered manager explained how these were managed. The registered manager noted they talked about the incidents as part of learning lessons process to reduce the risk of recurrence. Staff explained how to recognise abuse and protect people from the risk of abuse. Staff told us how to report concerns both at the service and to external authorities such as the local authority safeguarding team and were confident the registered manager would act on any concerns reported to ensure people's safety. However, evidence obtained during the assessment process did not reflect feedback given by the registered manager and assistant managers, and the assessment process showed that staff and leaders did not always meet their safeguarding responsibilities.

The provider had a safeguarding policy that noted processes and practices to follow that would make sure people were protected from abuse and neglect. However, the provider, the registered manager and staff did not always demonstrate there was a commitment to taking action to keep people safe from risks, abuse or neglect. The registered manager did not ensure incidents, accidents, complaints, and actions taken and outcomes for those were recorded and reported timely and consistently to support and protect people from risk of harm, neglect or abuse. We raised our queries regarding those events and records for it. We identified further discrepancies such as still no clear outcome of actions taken or noted and wrong dates for those events. This meant the registered manager could not be sure they had clear and accurate records to support their oversight of incidents, accidents, complaints and take action to address those. The registered manager could not ensure that the concerns related to people or the service were shared with external agencies and addressed appropriately following provider’s policy. This did not support effective review of such events and discussions with staff as part of lessons learned to reduce risk of recurrence. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. The registered manager noted there was no one under such restrictions. If they received information people were being restricted or deprived of liberty, they would raise this with professionals accordingly.

People were not always protected from risks associated with their health, wellbeing and care. People and relatives were not always positive about the support and care people received. One relative added, “[Staff] don’t really point anything out, risks or otherwise. [The person] will point out if there are bruises. [The staff] are not proactive”. One person said, “Sometimes there is quite a language problem between us. We had such a bad day today and I had to do things myself and [the staff] did nothing but take the rubbish out”. For one person, we only identified in the daily notes they were being transferred with a hoist. However, their risk assessment did not include guidance for staff supporting this person to ensure safe transfers with the hoist. There was an incident when staff moved this person without equipment not considering any risks of such practice. Other people and relative were happy with the support and care provided helping people to manage their care and risks. The relatives and people said, “[Staff] notice if [the person] has any sores or rashes and have been great. [The person] was not good when got out of hospital so [the staff] have been a great help. There has been no incidents or accidents at all”, “I have no concern for [person’s] safety in their company what so ever. [Staff] do warn [the person] about things such as trip hazards and electric cable being in the way that sort of thing. There have been no incidents or accidents” and “[Staff] are very very good, they police me and make sure I am using my stick and help me to remain as independent as possible”.

The registered manager explained how they completed and reviewed people’s care including risk assessments and care plans. The registered manager said they involved people, their families and staff to gather information about people that would inform plans of care and risks including preferences and specific requests. The registered manager said they reviewed the care records yearly as part of the review of people’s care or if anything had changed regarding people’s needs and support. The registered manager said they communicated with staff about people, their care, any changes and what action to take to address it. They said, “We support people where they are comfortable. We let people know we are here to achieve independence as much as possible. We give people informed choice and some don’t want to use equipment but we encourage them to use it for safety, and not to fall again”. The registered manager added they communicated with social services if people needed more support including any equipment. The registered manager told us all staff completed mandatory risk assessment training and during induction and shadowing there was emphasis on risk assessments. New staff worked with senior staff and learned from them. The registered manager told us they supported and protected people safely without any restrictions or use of restraint. Staff told us risk assessments and care plans contained information to help them support people safely and effectively. Staff shared information about people within the team and other professionals as and when needed. Staff told us how they supported people when they were upset, distressed or anxious. However, evidence obtained during the assessment process showed that staff and leaders did not always manage and recorded risks appropriately to ensure people’s safety.

The registered manager did not ensure clear and effective risk assessments and mitigations were in place. People’s records such as care plans and risk assessments were not updated as and when changes happened. Risk assessments were not always clear, reflective of people’s changing needs, or accurate to help guide staff to mitigate any risks. Risk assessments were not consistently followed to ensure it met the needs of people. For example, one person’s risk assessment for malnutrition, dehydration and choking noted the person required support and monitoring while eating and drinking to mitigate risk of choking, malnutrition and scalding. Review of daily notes demonstrated this person was left alone eating on multiple occasions. This did not reflect the staff supported the person to remain safe and to reduce the risk of preventable harm. People’s risk assessments for moving and handling were basic and did not include details of steps to take for individuals that would ensure people’s safety and reduce the risk of harm or injury. For example, we found for at least 5 people, where it was not clear what kind of equipment they would need for their transfers. For one person, we only identified in the daily notes they were being transferred with a hoist. However, their risk assessment did not include guidance for staff supporting this person to ensure safe transfers with the hoist. There was an incident when staff moved this person without equipment not considering any risks of such practice. Another person’s risk assessment only noted they needed help with transfers and ensure staff were trained to use the equipment provided. The registered manager told us the person used specific zimmer-frame. When we asked how the staff knew how to use it, the registered manager told us they taught each other how to use it. This meant people continued to be at risk of harm or neglect due to staff not having appropriate training to use equipment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives did not always experience timely care. They told us they were not always informed of late or missed visits. People and relatives said staff did not always arrive on time and that this affected peoples’ care and support. They also told us the staff did not always stay the right time. They said, “[Staff] seem to be in and out withing ten minutes too. Sometimes [staff] are so late [the person] does not think that they are coming at all. They have, on occasion, been 2 hours late and [person] is left worrying if they are going to turn up at all”, “[Staff] should be here at 8am and [staff] turns up at 9.40 and then rushes off but they never let me know when they’re going to be here. They never tell me when they’re running late so I have no idea if they will actually turn up” and “My only concern is their timings. [Person] gets up early and has to wait around for them to arrive and they never give [the person] a call. The call should be 8am and they often don’t arrive until after 9.30”. Also some people and relatives told us the staff’s support did not demonstrate they were trained well and had the skills to support people. One person told us, “Yesterday, [the staff] was new and didn’t know what to do. [The staff] hadn’t received any training at all, so I didn’t feel that safe. Sometimes they are just clearly not trained”. A relative added, “We are not impressed at all…[staff] should do [person’s] personal care, but [staff] don’t bother much. There are too many different [staff members] in and out and there is a huge language barrier and they simply don’t understand them”. Other people and relatives also told us the staff were on time, stayed the right time and provided support according to what they needed. They told us staff had the skills and knowledge to support the people.

The registered manager explained how they managed staff induction, training and staff’s support, supervision and development. This also included completion of the care certificate but the registered manager and the assistant managers were not fully aware of how the process should have been managed. Therefore the required checks of knowledge and observations were not completed. The registered manager told us they organised staff and visits to people according to care packages, people’s and staff’s preferences, including protected characteristics, geographical area and the needs of the people. The registered manager and assistant managers were also part of the team supporting people when needed. The registered manager explained they monitored the staff visits such as calling the staff to check if they arrived on time and contact people and relatives if the visit was to be late. They said there were no missed visits. However, this was not always the case from the evidence and feedback received. The registered manager told us about how the recruitment and selection process were completed and recorded such as gathering information about candidates, competing checks and then assigning staff for induction. The registered manager and assistant managers were not aware of the regulation and its requirements thus we discussed it during the site visit. Staff told us there were enough suitably trained staff to meet peoples’ needs and they were able to attend people’s visits appropriately. The staff felt they could seek support or advice from the management team. Staff told us they had induction, shadowing and training needed to deliver care and support to people using the service. Staff told us the management team checked their practice and how staff supported people. Although feedback from leaders and staff was positive, evidence found during this assessment identified a number of concerns relating to safe and effective staffing.

The registered manager did not ensure the required information according to the regulation was gathered before staff started work which put people at risk of being supported by unsuitable staff. 7 staff files were missing information such as police checks, full employment history and unexplained gaps in employment, health checks, evidence from previous employments regarding staff's conduct and verifying the reasons for leaving. The registered manager did not use their scheduling system effectively to organise and ensure people were visited according to their plans of care. We reviewed numerous daily notes for people regarding care and support provided. The notes were missing entries and it was not clear if the required visits were completed at agreed time to ensure people received the care they needed. The assistant manager completed an audit for all people they supported daily to check the notes. However, we were not assured the management team had good oversight of visits, timings and length of visits to address any issues promptly. The registered manager did not always ensure staff were appropriately trained to support people with specific needs. For example, during the period of 1 month, staff who were not trained in catheter care support, attended and supported people with this aspect of care. People needed support with moving and handling. However, staff’s competencies in moving and handling were not completed. One person was supported by staff who did not have training to administer specialised medication to manage the condition. We reviewed the training matrix and all the dates for all 20 topics were of the same date. The registered manager did not provide any further competency checks to support adequate learning for different topics. The provider’s policy did not have a clear and defined process for appropriate completion of the care certificate including observations and assessing staff’s knowledge for each standard.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We could not be assured people’s medicines were managed safely at all times due to the lack of clarity in people’s records regarding their support needs with being prompted to take their medication or staff to administer medication. One relative noted the staff would not support the person to take pain killers. Other people and relatives told us they had no issues with medicine management.

The registered manager told us how they supported people with medicine management including checks during reviews or spot checks. The registered manager said if people’s health changed, they would communicate with people, families, their GP and ask for review. The registered manager told us about their responsibilities regarding stock checking and reordering of prescriptions on behalf of some people. The registered manager told us this was a manual counting process, which was then followed by a telephone call from the carer to the registered manager to request more medication, including controlled drugs. There were no policies or audits available to reflect this process. Staff were able to explain how they supported people administration of medicines and demonstrated a basic understanding of the principles of medicine management and safety. However, we found concerns relating to management of medicine that did not reflect the feedback we gathered from the management team and staff.

The registered manager did not ensure people’s medicine was managed properly and safely. People’s care plans did not clearly identify and record what support people needed, prompting or administering medication. Provider’s policy did not have a clear description of those processes. The registered manager was not able to clarify such support differences clearly. Thus, staff provided the support inconsistently putting people at risk of not receiving their medication as prescribed. Where people were taking specialised medication, there was no risk assessments in place to ensure safety. The registered manager did not ensure they followed provider’s policy for managing homely remedies such as confirmation with GP or pharmacist for clinical guidance, update of the care plan and instructions for usage. We found the staff were not following correct medication administration process. For example, staff recorded they have left medication with people to take when the care plan noted people could be forgetful thus at risk of not taking their medication. Another person had their medication left with them because they ‘agreed with the family member’. Another daily record entry noted the staff asked the person to show them their medication pack through the window to evidence if they have taken it. This was not part of the plan of care. The provider did not ensure all staff administering medicines were trained and had their competency checked according to provider’s policy and process. We received competency assessments for only 19 staff out of 52. Staff members had to have 3 successful assessments before administering medication independently. But this was not completed for the 19 staff either. The staff assessing the competencies were not trained either to be able to carry out this task to ensure they were able to check staff’s practice and identify any improvements needed.