Metro Homecare Ltd received an overall rating of Good across all five key questions at its September 2023 inspection, demonstrating sustained improvement from a Requires Improvement rating in 2019 and full resolution of previous breaches of regulations 12 and 17. The service delivered safe, person-centred care with robust governance, well-trained staff, and strong partnership working with external agencies.
Strengths
· Medicines managed safely with competency checks, risk assessments, and monthly audits; previous breach of regulation 12 resolved.
· Reliable staffing with electronic call monitoring; relatives confirmed visits were never missed and timekeeping was good.
· Staff received induction, Care Certificate, regular supervision, appraisal and refresher training including specialist topics.
· Care plans detailed, personalised and regularly reviewed with involvement of people, relatives and other professionals.
Quality-Statement breakdown (24)
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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: Staff working with other agencies to provide consistent, effective, timely care; supporting people to live healthier livesGood
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: Supporting people to develop and maintain relationships to avoid social isolation; support to follow interests and activitiesGood
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, understanding quality performance, risks and regulatory requirements; continuous learningGood
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 staff, fully considering their equality characteristicsGood
Metro Homecare Ltd was rated Requires Improvement overall at its first inspection in April 2019, with two regulatory breaches identified: Regulation 12 for inadequate risk assessment detail and unsafe medicines recording, and Regulation 17 for insufficiently robust governance systems. Caring was rated Good, with staff widely praised for kindness and dignity, but weaknesses in person-centred care planning, consent/capacity recording, and quality assurance systems undermined the overall rating.
Concerns (7)
criticalCare planning: “Risk assessments lacked the detail required to effectively mitigate risks.”
criticalMedication management: “There was insufficient information about people's medicines in people's care records to ensure they were supported to take them in a safe way.”
criticalGovernance: “The registered persons failed to effectively operate systems to assess, monitor and improve the quality and safety of the services provided.”
moderateConsent / capacity: “Mental capacity assessments were not always accurately completed and did not clearly demonstrate if the person had capacity to consent to care and treatment.”
moderatePerson-centred care: “Support plans we reviewed were mostly brief and did not contain sufficient information such as detailed likes and dislikes, choices, and preferences.”
moderateRecord keeping: “Some people's care records stated they lacked capacity to make decisions... people's care files did not always have required documentation to confirm that relatives were legally appointed.”
moderateStaff competency: “Weekend staff and staff who were not regular to them did not always know the needs of the person.”
Strengths
· People and relatives consistently reported feeling safe and that staff were caring, kind and respectful.
· Staff demonstrated good understanding of safeguarding responsibilities and appropriate referral pathways.
· Safe recruitment practices were followed with all required pre-employment checks completed.
· Staff received a broad range of training including the Care Certificate, and felt well supported by management.
· The service worked effectively with external health and social care professionals to deliver joined-up care.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
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 lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Requires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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 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 supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with openness; duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improving careGood