Date of assessment 7 August 2024 to 9 October 2024. This assessment was in response to CQC receiving information of concern. Improvements had been made since the last inspection and people received safe care. Care plans and risk assessments were in place and reviewed. Medicines were managed safely. There were enough safely recruited staff who had the knowledge and skills to support people. The environment was safe, and infection control was considered. The care people received was delivered in line with their care plan and in a person-centred way. The principles of The Mental Capacity Act were considered. People were treated in a kind and caring way by staff who knew them well. There were systems in place to monitor the quality-of-care people received. Staff felt involved with the service, supported and listened too. Improvements were needed to ensure people’s end-of-life wishes and plans had been considered.
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Majestic Healthcare LTD's first inspection identified widespread failures including breaches of five regulations covering person-centred care, safe care and treatment, nutrition, staffing and governance, with medicines management, absent care plans, and inadequate auditing posing the most serious risks. While individual carers were praised for kindness and safeguarding referrals were made appropriately, the Inadequate well-led rating reflects systemic governance failures that left people at risk of harm.
Concerns (11)
criticalMedication management: “we could not be assured people had received all their medicines as prescribed. For example, we found gaps on MAR, no one was able to confirm if people had received these medicines.”
criticalCare planning: “When people had individual risks such as epilepsy, sore skin or a health condition there was not always care plans or risk assessment in place identifying this.”
criticalStaff training: “When people had individual needs or health conditions, staff had not always received training. This included epilepsy, oxygen therapy, colostomy care and management of skin.”
criticalGovernance: “Audits in place were insufficient to check the quality of the service. A medicines audit was being completed monthly it had not identified any of the concerns we found with medicines.”
criticalPerson-centred care: “People did not always receive consistent care in line with their preferences. This placed people at risk of harm. This was a breach of regulation 9.”
moderateMissed or late visits: “Sometimes they are late, and I am left waiting...in July of this year the carers didn't turn up for the last two calls one day, we were told someone would get back to us they never did.”
moderateComplaints handling: “I phoned the office to complain about staff turning up late, there is always some excuse...I phoned again and they tried to blame me.”
moderateRecord keeping: “There were no individual plans in place for people stating how they may choose to communicate and the level of support they may need with this.”
moderateStaffing levels: “The provider acknowledged over the previous few months there had been some concerns with staffing...records showed people received calls, however these were sometimes later than planned.”
moderateSupervision / appraisal: “There were no systems in place to ensure staff had received adequate training to support people.”
minorEnd-of-life care: “There was no one currently using the service who was end of life care. There were no plans in place to consider this for people.”
Strengths
· Safeguarding procedures were in place and concerns were appropriately referred to the local safeguarding team when identified.
· Staff suitability checks (pre-employment) were completed before staff started working in people's homes.
· Infection control procedures were followed and staff wore appropriate PPE.
· People's privacy and dignity was encouraged and promoted, with positive feedback from people and relatives.
· The service worked with other agencies (district nurses, physios, GPs) to support people's health needs.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
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 lawRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
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 preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsRequires improvement
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 requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement