Maycare provides a domiciliary care service to enable people living in Basingstoke and the surrounding areas to maintain their independence at home. At the time of our inspection there were 106 people using the service, who had a range of health and social care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions and mental health diagnoses. At the time of the inspection the provider deployed 34 staff to care for people and meet their individual needs, providing 1000 hours of commissioned care.

The inspection was conducted between 18 December 2017 and 5 January 2018 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

The service had an experienced registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported by a an experienced home care manager, a business excellence manager, a coordinator and six senior staff.

At our last inspection in December 2016 we found people were not protected from the risks associated with unsuitable staff being employed by Maycare. The provider’s failure to operate safe recruitment procedures, and ensure that all staff were of good character prior to being employed, was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan detailing the improvements they were going to make to ensure they were meeting the requirements of this regulation.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. Staff had undergone relevant pre-employment checks which had assured staff suitability for the role, before they were allowed to support people in their own homes.

During our last inspection we found the provider had failed to ensure there were sufficient staff deployed to meet people's needs at all times was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan detailing the improvements they were going to make to ensure they were meeting the requirements of this regulation.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. The registered manager completed a daily staffing needs analysis which ensured there were sufficient numbers of suitable staff, with the right mix of skills to provide safe care which met people’s assessed needs.

During out last inspection in December 2016 we found that some people experienced inconsistent care from staff who did not know them or their needs. The provider had failed to ensure that the care and support people experienced was appropriate and met people’s needs at all times. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider had made the necessary improvements to meet the requirements of this regulation. People consistently experienced care from staff who knew them well and how to deliver the support they required.

At our last inspection there was a quality assurance process in place, but this was not always effective in monitoring and improving the quality and safety of the service. At this inspection the provider’s quality assurance process now ensured people received visits for the full time allocated and people were protected from the risk of receiving care from staff whose suitability had not been fully assessed.

Since our last

Maycare provides domiciliary care services to people living at home. They currently provide a total of 1000 hours of personal care to 96 people. Each person received a variety of care hours from the agency, depending on their level of need.

The inspection was conducted between 1 and 13 December 2016 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we made two recommendations. These related to way staff monitored people’s nutritional needs and the training staff received in supporting people who are living with dementia. At this inspection, we found the service had acted on these recommendations.

However, we identified fresh concerns that compromised people’s safety. Pre-employment checks, to make sure staff were suitable for their role, were not always completed before new staff started working at Maycare. There were not always enough staff to meet people’s needs at the time they required support, particularly at weekends, and staff did not always stay with the person for the allocated length of time.

There were no plans in place to deal with foreseeable emergencies, such as extreme weather. The system used to check staff had arrived at each call was not robust and did not protect staff who worked alone. However, the provider had tested the use of technology to assist with this and was researching the use of other solutions to monitor staff attendance at calls.

People told us their regular care staff were skilled at supporting them and meeting their needs. However, they said fill-in staff, who covered when their regular care workers were absent, were not always able to provide them with effective care and support.

There was a training programme in place. However, the induction procedures did not follow the standards of the Care Certificate (a learning programme designed to enable staff new to the role to provide safe and compassionate care to people). Also, there was no clear process in place to check that new staff were able to support people safely and effectively, for example when administering their medicines.

Staff felt supported in their role by their managers, although arrangements for one-to-one meetings to discuss their progress and raise concerns with managers were ad hoc and not organised.

The provider did not have a duty of candour policy to help ensure staff acted in an open and honest way when people were harmed. Not all of their policies and procedures were up to date or reflective of the type of service they provided.

The quality assurance procedures had brought about some improvements, but were not always effective in identifying and addressing improvements to the quality and safety of the service. Spot checks to assess the performance of staff were not conducted regularly. However, staff were happy and motivated in their work and described managers as “supportive” and “approachable”.

Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. The care manager conducted effective investigations into allegation s of abuse. Risks relating to the environment or the health and support needs of people were assessed and managed effectively.

Staff were caring and compassionate. They took care to be discreet and unobtrusive when working in people’s homes. They protected people’s privacy, involved them in decisions about their care and developed positive relationships. Staff also followed legislation to protect people’s rights, by seeking con

We inspected Maycare in January 2013 and judged they were not meeting the essential standards of quality and safety in relation to the care and welfare of people who used the service, support for workers and complaints. During our latest inspection we found they were now meeting the required standard in these areas. We also conducted this inspection in response to concerns about the quality of care being provided, the suitability of staff and the quality of their training. On the day of our inspection we found no evidence of the concerns raised.

Positive comments were made about the quality of care received by people using the service. One relative told us, “The staff are fantastic. They’re always making him laugh but are so kind and careful". Some people said the quality of their care was good but were critical of the support from the office. One person said, “The carers are absolutely brilliant. They are so good with my wife and always go the extra mile. I just wish the office staff were as good”.

People who used the service were protected from the risk of harm because the provider had taken reasonable steps to identify and prevent abuse from happening. We saw that people were cared for by qualified staff, who had received effective training and supervision.

The range of self auditing ensured the manager effectively assessed and monitored the welfare and safety of people using the service. Complaints were effectively recorded, investigated and resolved.

People using the service had their human rights respected and taken into account. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Most of the people we spoke with praised the quality of care provided by experienced care staff they knew. One person spoke highly of one of the care staff who pointed out a skin inflammation to the district nurse, ensuring proper treatment was given.

However, strong concerns were raised by people using the service regarding the regularity of missed calls and with the level of competence and training of new care staff. One relative said, “It’s chaos, absolute chaos. I get more stress worrying if they are coming. Some carers are good. Some just don’t know what they are doing.”

Staff had a good knowledge regarding the medicines being taken by the people they supported and knew what medicines were required, the times they needed to be taken and how to support people taking them safely.

There were effective recruitment and selection processes and appropriate checks were undertaken before staff began work. The provider did not ensure that staff were properly supervised or appraised.

People using the service had not had their complaints listened to or acted on effectively. People said they did not feel supported to make complaints. One person said, “All they do is say we’ll look into it, then nothing happens.”

People were happy with the service. They said that the care workers were very good, and one person said “I hope you say that the carers are brilliant”. They said that the agency always tried to send the same care workers although this was not always possible at the weekend.

They said that staff came mostly on time and that they did what was needed. When staff were running late, people said that they were generally contacted by the agency to inform them of this. People knew who to contact if they had a concern or complaint. People confirmed that they were involved in the planning and review of their care.

This inspection took place on 6 and 9 March 2015 and was announced. The service was given 48 hours’ notice of the inspection to ensure that the people we needed to speak with were available.

Maycare provides a domiciliary care service to enable people living in the Basingstoke, Tadley, Whitchurch and Hook areas to maintain their independence at home. There were 88 people using the service at the time of the inspection, who had a range of physical and health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, multiple sclerosis and sensory impairments.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection on 12 June 2014 the provider was not meeting the requirements of the law in relation to people’s care and welfare, requirements relating to workers, supporting workers and assessing and monitoring the quality of the service. Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 31 September 2014. During this inspection we found improvements had been made to meet these requirements.

Care plans documented what support people required in relation to nutrition and hydration. However, people at risk of poor nutrition and hydration were not always sufficiently monitored, managed or encouraged to eat and drink enough. This increased the risk to their health and well- being.

The provider had quality assurance systems in place but these were inconsistently applied. People’s feedback on the quality of care they received was sought. Action was taken by the provider if specific issues were identified. However there was no analysis to identify overarching trends for learning to take place to enable improvements of the service.

The provider had taken action to ensure staff received supervision, appraisals and required training. People’s care was provided by staff who received appropriate training and support. Staff had received an induction into their role which met recognised standards within the care sector. Senior staff completed checks of staff competence to undertake their roles safely.

People told us they felt safe and trusted the staff. One person said “I trust the carers because they treat me like their own” and “they make sure I am safe and well and have everything I need.” Staff had completed safeguarding training and had access to the provider’s policy and local authority guidance. They were able to recognise if people were at risk and knew what action they should take. People were kept safe because safeguarding incidents were reported and acted upon.

Needs and risk assessments had been completed and reviewed regularly with people and where appropriate, their relatives. Where risks to people had been identified there were plans to manage them effectively, such as moving and positioning, pressure area management, epilepsy and safe catheter care plans.

Staff responded flexibly to people’s individual wishes and changing needs and sought support from healthcare specialists when necessary. People’s dignity and privacy were respected and supported by staff.

The registered manager completed a weekly staffing analysis to ensure there were sufficient staff available to meet people’s needs. The provider did not take on extra care packages if they did not have staff available to meet people’s needs safely.

Care staff had undergone appropriate recruitment checks as part of their application and these were documented. These included the provision of suitable references and a Disclosure and Barring Service (DBS) check. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

People told us staff had sought their consent before delivering their care. Where people lacked the capacity to consent the principles of the Mental Capacity Act 2005 (MCA) had been followed to make best interest decisions on their behalf. The MCA provides a legal framework for acting and making decisions on behalf of people who lack the mental capacity to make particular decisions for themselves. Staff demonstrated an understanding of the principles of the act and described how they supported people to make decisions in accordance with them.

People told us care staff were caring and treated them with dignity. One person said “Nothing is too much trouble for them. The carers are so kind and considerate.” We observed staff provided people’s care in a warm, friendly and compassionate manner. People told us they experienced good continuity of care from staff whom they had grown to know and trust and from newly recruited care staff. One person told us, “New carers come with the regulars and read my care plan first but they always ask me what I want and how I like things done.”

Senior staff, including the training manager, confirmed that they worked alongside staff which enabled them to speak with people, observe staff interactions with people and to seek staff feedback. There was an open and transparent culture in the service and people felt able to express their views freely.

The provider’s values focussed on treating people with dignity and respect whilst providing high quality care. People were cared for by staff who understood and practised the values of the service in the provision of their care.

People and staff were experiencing concerns regarding the local authorities’ tender process for new contracts beginning in April 2015. The provider had shown clear and direct leadership by writing to people and staff to keep them informed and reassured.

The manager had improved people’s care plans and ensured they had been reviewed. People had accurate care plans and these were stored securely in the office.