Martworld Care Services Limited was rated Good overall at its October 2019 inspection, with people and relatives consistently reporting safe, caring, and responsive support from a consistent staff team. Well-led remained Requires Improvement due to gaps in recruitment records, incomplete staff file audits, and insufficiently robust governance processes, though the registered manager engaged openly and took prompt corrective action during the inspection.
Concerns (5)
moderateRecord keeping: “Recruitment checks had been completed but formal records to support the checks undertaken were not in place.”
moderateGovernance: “Audits had not been completed on staff files to ensure they contained all of the required information.”
moderateGovernance: “Audits of some records needed to be more robust to ensure they identified areas for improvement.”
moderateMedication management: “Audits...did not identify and explore the reason for gaps in medicine charts, or when staff had recorded an incorrect time on the daily records.”
minorCare planning: “Care records reviewed varied in detail with some being more person centred than others.”
Strengths
· People felt safe and relatives had no concerns; staff arrived on time and communicated delays.
· Risk assessments were comprehensive and covered individual needs including moving and handling, medicines, and environment.
· Staff were knowledgeable, well-trained, and received induction, supervision, spot checks, and annual appraisals.
· People and relatives reported staff were kind, compassionate, respectful, and promoted independence and dignity.
· Complaints were investigated and responded to appropriately, with trends analysed.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
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 candour; Continuous learning and improving careGood
Martworld Care Services Limited was rated Requires Improvement overall at its first CQC inspection, with shortfalls in risk assessment, medicines recording, staff recruitment, and governance audits. Caring, effective and responsive practice was consistently praised by people and relatives, with staff demonstrating kindness, good training and timely visits.
Concerns (9)
moderateCare planning: “a person who was noted in their care plan as having ulcerated skin did not have a related risk assessment in place. Another person who used a catheter, had no guidance in place”
moderateMedication management: “staff members did not consistently utilise the coding system for whether medicines had been given. For example, one person's medicine had been discontinued but this had not been recorded.”
moderateRecord keeping: “there were some gaps within the charts which had been left blank...details of complaints dealt with were not comprehensive and only included a brief detail”
moderateStaff training: “one [recruitment file] did not include two references to ensure that the employer had sufficient information to assess the employees suitability.”
moderateGovernance: “these audits had not identified concerns such as gaps in recordings...other audits had been recorded as completed when there was no related information within the file”
moderateLeadership: “There was not a registered manager in place and there had not been since July 2017.”
minorEnd-of-life care: “care plans did not include information related to people who wished to continue receiving care at home towards the end of their life. No discussions had taken place”
minorInfection control: “We did not see any information relating to infection control, particularly relating to areas where good hygiene was required, such as catheter care and food preparation”
minorComplaints handling: “The complaint was not dated, which made analysing timescales of action taken difficult and there was no information given on how the outcome of any investigation had been shared”
Strengths
· People felt safe in the care of staff and were happy with staffing levels; calls were carried out in a timely manner with no regular delays.
· Staff received an induction in line with the Care Certificate, ongoing supervision approximately every two months, appraisals, and adequate training tracked via a training matrix.
· Staff were described as kind, caring and patient, forming positive relationships and maintaining people's privacy and dignity.
· People were supported to make choices and be independent; cultural and religious needs were recorded in care plans.
· The acting manager was visible, responsive, and worked in partnership with external agencies; safeguarding concerns were reported to appropriate agencies as required.
Quality-Statement breakdown (15)
safe: Risk assessments not always in place to mitigate risks to peopleRequires improvement
safe: Medicines not always recorded correctly to show people received prescribed medicationRequires improvement
safe: Staff recruitment not always carried out safely (missing references)Requires improvement
safe: Staff understood safeguarding procedures and reported concerns appropriatelyGood
effective: Staff induction, ongoing supervision and training effectively providedGood
effective: Staff supported people in line with the Mental Capacity Act and gained consentGood
effective: Staff assisted people to access food and drink appropriatelyGood
caring: People felt staff were kind, caring and respectful towards them
Good
caring: People were involved in decisions about their care and staff maintained dignityGood
responsive: Staff were knowledgeable about people's needs and considered their preferencesGood
responsive: Complaints handling records not comprehensive; complaint details and dates missingRequires improvement
responsive: End of life care preferences not recorded or discussed with peopleRequires improvement
well-led: No registered manager in post since July 2017Requires improvement
well-led: Quality assurance audits not carried out comprehensively to identify gaps in care qualityRequires improvement
well-led: Provider worked in partnership with other agencies and gathered regular feedback from peopleGood