Maisy Care at Home Ltd is a domiciliary care agency providing personal care to 4 people at the time of the assessment. At our last inspection on 17 July 2023, we found a breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to carry out the required pre-employment checks for staff. We served the provider a Warning Notice for this breach of regulation and this assessment was carried out to check the provider was compliant. We found action had been taken to make the improvements needed, therefore the service was no longer in breach of regulation 19. Records demonstrated the provider had completed a Disclosure and Barring Service (DBS) check for all staff employed and references from previous employers had been obtained. The provider had a recruitment policy. Staff had an induction which included training and the opportunity to shadow more experienced staff. Staff told us they felt appropriately trained to be able to carry out their work safely. The registered manager carried out supervisions with staff and unannounced spot checks to observe staff practice. There were enough staff to support people's current packages of care. The registered manager told us they were hoping to grow the business but would make sure they had enough staff available to do this safely.
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Maisy Care at Home Ltd received an overall rating of Requires Improvement at its first inspection, with regulatory breaches identified in medicines management, risk assessment, recruitment checks, and governance systems. Despite these failings, people spoke highly of caring, reliable staff and the approachable registered manager, with Effective, Caring and Responsive domains all rated Good.
Concerns (9)
criticalMedication management: “Not all medicines being administered by staff were recorded on the MAR. For example, 1 person had recorded in their notes they were being given paracetamol and eye drops by staff. Staff had not recorded the dose given.”
criticalCare planning: “Risks to people's safety had not always been identified so management plans could be put in place. Where risks had been identified, management plans were not robust and did not provide clear guidance for staff.”
criticalStaffing levels: “The provider had failed to obtain full employment histories for all staff. The provider had failed to assess risks of starting staff working without a full Disclosure and Barring Service (DBS) check.”
criticalGovernance: “Governance systems in place were not effective. Shortfalls found in this inspection had not been identified by the provider. Audits being completed were ineffective and not identifying areas for improvement.”
criticalSafeguarding: “The provider had failed to notify us of all safeguarding concerns. We found 1 incident which had been reported to the local authority, but not notified to CQC as required by law.”
moderateRecord keeping: “Audits had not been carried out on daily records. This meant the provider had not identified staff were administering medicines which were not recorded on MAR. Some daily notes were not accurate.”
moderateStaff training: “There was no training provided for how to support people with Autism or a learning disability. Staff had also not been provided with practical moving and handling training.”
minorStaff competency: “Staff had been provided with training on medicines and had their competence checked. However, there were no dates recorded on the competence checks to demonstrate when staff had been assessed.”
minorIncident learning: “The registered manager had reviewed this incident and taken action to prevent recurrence, however, this had not been recorded in full.”
Strengths
· People told us they felt safe with staff in their homes and staff had never missed a visit: 'They have never missed a day. They are pretty good with timing.'
· Staff had received safeguarding training and understood their role; systems were in place to report concerns to the local authority.
· People consistently reported staff were kind, caring and respectful of dignity and privacy.
· People were assessed prior to care packages starting and had personalised care plans held in their own homes.
· Staff received induction including the Care Certificate and training covering dementia, diabetes and lone working.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood