Mears Care Limited - Maidstone was rated Requires Improvement overall and Inadequate for well-led, with four breaches of regulations relating to staffing, safe medicines management, person-centred care and complaints handling. Insufficient staff led to late and missed visits, medication recording errors went uninvestigated, and governance systems failed to identify or address shortfalls.
Concerns (10)
critical
Staffing levels
— “There were an insufficient number of staff to meet the needs of those using the service”
criticalMissed or late visits — “Missed calls - sometimes no calls at all for the whole day.”
criticalMedication management — “one person's MAR we reviewed, which covered August 2018, identified there were 13 gaps in recording, by seven different staff members.”
criticalGovernance — “Quality assurance audits of had not been effective in identifying the issues we found during our inspection.”
criticalPerson-centred care — “The failure to provide person centred care which reflected the person's personal preferences and needs was a breach of Regulation 9”
criticalComplaints handling — “improvements had not always been made as a result of complaints... steps had not been taken to learn lessons from the complaints received”
moderateIncident learning — “The registered manager had not taken sufficient steps to ensure lessons were learned when things went wrong.”
moderateCommunication with families — “people did not always know who was visiting and were not always able to choose who they were supported by.”
moderateRecord keeping — “we found there was insufficient auditing of people's care records.”
moderateLeadership — “the regional director did not have oversight of our concerns.”
Strengths
· Staff were trained to identify and report safeguarding concerns and people felt protected from abuse.
· Risks to people were assessed and staff took action to reduce risks and keep people safe.
· Safe recruitment practices including DBS checks and full employment history.
· Staff received induction and ongoing training, including specialist training where required.
· Staff worked with health and social care professionals (district nurses, OTs, GPs) to deliver joined-up care.
Mears Care Limited - Maidstone was rated Requires Improvement overall, with a continued Regulation 17 breach for care records not being consistently reviewed, updated or personalised, and unmitigated fire risks in an extra care scheme. Improvements since the previous inspection were noted in staffing, medicines, complaints handling and governance under a new registered manager, and the Caring domain was rated Good.
Concerns (6)
criticalRecord keeping — “The failure to maintain accurate, complete and contemporaneous records for each service user is a breach of Regulation 17”
criticalGovernance — “This is a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.”
criticalOther — “People's safety in the event of a fire within the extra care housing scheme had not consistently been assessed or mitigated.”
moderateCare planning — “Care records were not consistently personalised nor did they contain all the knowledge from staff working with them at each care call.”
moderateConsent / capacity — “Records to show how decisions were made on behalf of people who lacked capacity did not always evidence how particular decisions were made in their best interests.”
moderatePerson-centred care — “Two of the seven care plans we viewed contained out of date and inaccurate information.”
Strengths
· Staff were kind, caring and patient; people spoke highly of staff knowing them well
· People received their medicines safely from staff that were trained and competency assessed
· Improvements in staffing meant there were enough staff and calls were monitored via an online system, reducing late/missed calls
· Safe recruitment processes followed
· Staff received continuous training, supervision, observational assessments and annual appraisal
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safely; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires 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 experience
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Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlRequires improvement
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 requirements; Continuous learning and improving careRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with openness; and how the provider understands and acts on their duty of candour responsibilityGood
well-led: Engaging and involving people using the service, the public and staffGood