Maycare remains in breach of Regulations 9 and 17, as people were not consistently supported by two staff when assessed as needing this, and governance systems failed to identify the concerns found at inspection. While improvements were noted in medicines management, recruitment, infection control and staff culture, the service could not assure that people always received commissioned care in line with their assessed needs.
Concerns (7)
criticalPerson-centred care: “we could not be assured people consistently received support from two care staff where this need was identified... only one staff member attended the call”
criticalStaffing levels: “Some calls with two staff lasted as little as 9 minutes and should have been 30 minutes.”
criticalGovernance: “the provider had not identified the concerns we found during this inspection... no effective systems in place to oversee staff allocation”
criticalSafeguarding: “we identified one issue which the provider had not identified to be a safeguarding concern... not notified the commission of all the safeguarding alerts”
moderateRecord keeping: “Records showed people did not always get the visits as they were commissioned by the funding authority and which they were assessed as needing.”
moderateCare planning: “for one person the risk assessment had not been updated to show their care needs had changed and they needed the support of two staff”
moderateStaff competency: “they would engage the assistance of a family member. The provider could not evidence the family member was suitably trained and competent.”
Strengths
· Medicines monitoring improved; provider no longer in breach of regulation 12; competency assessments in place for medicines administration
· Recruitment improvements made; provider no longer in breach of regulation 19; correct DBS checks completed
· People reported staff were kind, caring and respectful of privacy and dignity
· Effective use of PPE and infection prevention and control practices in line with national guidelines
· Care plans detailed needs and preferences; complaints procedure in place and acted upon effectively
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choicesGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enoughGood
effective: Staff working with other agenciesGood
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 controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
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
well-led: Continuous learning and improving careGood
Maycare received an overall rating of Requires Improvement following a focused June 2022 inspection, with Well-led declining to Inadequate due to continued and new regulatory breaches across recruitment, medicines management, governance, and visit reliability. The provider remained in breach of Regulations 9, 17, and 19 from the previous inspection, and a new breach of Regulation 12 (safe medicines management) was identified.
Concerns (14)
criticalStaffing levels: “There were not enough staff deployed to consistently meet people's needs. The provider told us they were short staffed as it was difficult to recruit.”
criticalMissed or late visits: “one person was commissioned for four calls per day, we reviewed their call log for thirteen days, which showed a total of three calls were for the full time.”
criticalMedication management: “There were gaps in Medication Administration Records (MAR). This meant people may not have received their medicines as prescribed.”
criticalMedication management: “four staff had signed the records and had not received the training [for PRN medicine requiring specialist training].”
criticalGovernance: “the monthly audit had not been completed for the 'last few months, as we been so busy.' We asked for a copy of any previous audit for the last twelve months, but none could be found.”
criticalPerson-centred care: “People's care was not provided for the amount of time commissioned in order to meet their needs. Visits were consistently shorter than the scheduled call.”
moderateStaff competency: “staff were unable to demonstrate a robust system for assessing their competency [in medicines]. The provider had not followed national guidance which requires a formal assessment.”
moderateStaff training: “New staff had not completed safeguarding training. New staff had not received training for moving and handling before they started to support people.”
moderateSafeguarding: “The safeguarding policy was not specific to the service and did not include basic information such as the name and contact details of the multi-agency safeguarding team.”
moderateRecord keeping: “Some staff continued to log in and out of visits a distance away from the person's home, up to 4km which meant there was not an accurate record of when they arrived and left.”
moderateLeadership: “There was a lack of clarity about management roles. There was not a clear leadership structure and staff roles were not clearly defined. 'We are so short staffed our jobs have all merged. We're fire-fighting.'”
moderateIncident learning: “There was not a systematic approach to ensure learning was carried forward into practice. There was not a formal system to monitor, identify and respond to feedback, concerns and trends.”
moderateInfection control: “The provider confirmed staff had not been routinely testing twice a week... staff were wearing masks but not changing them for each new person they supported.”
minorCommunication with families: “They don't always let me know if they are late. Last time they were really late there was actually nobody in the office to call about it.”
Strengths
· The provider undertook reviews of people's care plans and sought their views on the care provided.
· Spot checks on some staff had been completed and where issues were identified, action was taken.
· Risk assessments covered people's home environments and any equipment they used.
· Where people had equipment such as hoists, these were serviced by relevant professionals on a scheduled routine.
· The provider completed annual appraisals for staff who had worked there longer than a year.