Mulholland Care Limited was rated Good across all five key questions at this December 2017 inspection, with well-led improving from Requires Improvement at the previous inspection. Key areas for improvement included risk assessment recording, medication management systems, care plan consistency, and mental capacity documentation, all of which the registered manager was actively addressing.
Concerns (7)
moderate
Record keeping
: “not all of these had been recorded in people's care plans and we identified these needed improvement”
moderateMedication management: “10 medicine errors had been made in the last 12 months... the system in use was not safe or robust, particularly for people with a dementia related illness”
moderateCare planning: “this information was not always kept together which made it difficult to follow... made it difficult for staff to follow the care plan to seek guidance to ensure consistency in care”
minorInfection control: “we saw two staff who had very long pointed false nails and a selection of varied rings on their fingers... both an infection control concern and an unnecessary risk of skin damage”
minorConsent / capacity: “Whilst staff were aware which people did not have capacity to make specific decisions for themselves, mental capacity assessments were not recorded”
minorSupervision / appraisal: “the registered manager was aware these were behind schedule... 'I think I have only ever had one appraisal in four years'”
minorComplaints handling: “The service had a complaints policy and procedure. This did not include the up to date contact details for all the alternative organisations to contact.”
Strengths
· People felt safe and spoke positively about care workers, with meaningful relationships developed between staff, people and relatives
· Safe recruitment practices in place with comprehensive checks before staff were employed
· Staff well trained with induction, Care Certificate, regular competency and spot checks
· Management restructure resulted in clear roles and responsibilities across the team
· Effective audit systems implemented covering medicines, care plans, staff files and complaints
Mulholland Care Limited was rated Good overall following a September 2015 announced inspection, with staff delivering kind, personalised care and working effectively with health professionals. The Well-led domain required improvement due to inconsistent quality assurance audits and record-keeping governance that had not reliably identified or addressed shortfalls.
Concerns (5)
moderateGovernance: “these were not always recorded and did not identify problems which needed to be addressed...there was not a consistent approach to provide complete assurance.”
moderateRecord keeping: “management had identified that improvements were needed for record keeping and care rotas but there was no evidence as to how this had been identified and the actions to address the problems.”
minorComplaints handling: “one person who said they had made a complaint but had not received an outcome of findings from management.”
minorSupervision / appraisal: “the registered manager team said they were not up to date with staff appraisals.”
minorConsent / capacity: “Whilst some staff had received training on the Mental Capacity Act (2005) (MCA), the majority had not.”
Strengths
· People felt safe and expressed high confidence in staff, with positive safeguarding knowledge demonstrated across the team.
· Staff delivered personalised, compassionate care and consistently went 'above and beyond', attending to individual preferences and the 'little things' that mattered to people.
· Effective partnership working with a wide range of health and social care professionals, who gave very positive feedback about communication and staff competence.
· Robust recruitment and pre-employment checks were in place and confirmed by staff records.
· Medicines were managed safely with appropriate MAR charts and processes for reporting errors.
Quality-Statement breakdown (17)
safe: Safeguarding and protection from abuseGood
safe: Risk assessment and managementGood
safe: Staffing levels and deploymentGood
safe: Recruitment practicesGood
safe: Medicines managementGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act complianceGood
effective: Nutrition and hydration support
Good
caring: Kindness, dignity and respectGood
caring: Involvement in care decisionsGood
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
well-led: Quality assurance and audit systemsRequires improvement
well-led: Record keeping governanceRequires improvement