This inspection took place on 15 March 2018 and was unannounced. At the last inspection in December 2016 the provider was found to be requiring improvement in three out of the five areas we looked at; safe, responsive and well-led. At this inspection we found that some improvements had been made. However further improvements were required as people were still not consistently receiving care that was safe, responsive or well led. We found that the provider was in breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of our report.

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care and nursing care services to people living in their own homes. It provides a service to people of all ages including children, adults and older adults living with physical, learning and/or mental health conditions, such as dementia. At the time of our inspection Mach Care Solutions (Birmingham) was providing care to 122 people, including two children. They were not providing any nursing care to people at this time.

Mach Care Solutions (Birmingham) is required to have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

Some people continued to raise concerns about late, rushed or short care calls particularly when their regular carer [staff] was absent from work. This meant that some people did not always receive the care and support they required when they required it. The provider’s quality assurance practices had not always identified or addressed these issues in a timely manner. They had also failed to recognise or address other shortfalls that we identified during our inspection, including the lack of robust recruitment practices and poor information governance systems. We continued to experience a delay in receiving the information we requested as part of our inspection and some of the records we received could not always be relied upon for their validity. This meant that this inspection was the fourth consecutive inspection whereby improvements were required to the governance of the service and therefore the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we have taken at the end of our report.

People were supported by sufficient numbers of staff who had the skills, knowledge and competencies to keep people safe and to meet their needs. People were protected from the risk of abuse because staff understood their responsibilities and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

Most people were pleased with the consistency of the staff that provided their care and reported staff to be kind and caring. People were treated with dignity and respect and received their care with consent. People were also encouraged to be as independent as possible and staff were mindful of the need to involve people in making choices and decisions about their day to day needs.

People knew how to make a complaint if they were unhappy and felt that any complaints or issues raised were dealt with efficiently. However, further improvements to the management of complaints was required. The management team were compliant with the Duty of Candour regulation and were receptive to the feedback we provided at the time of our inspection.

This inspection took place on 15 December 2016 and was an announced inspection. At the last inspection in February 2016 the provider was found to be requiring improvement in four out of the five areas we looked at; safe, effective, caring and well-led. Therefore we re-inspected within 12 months to check that improvements had been made.

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care and nursing care services to people in their own homes. At the time of our inspection Mach Care Solutions (Birmingham) were providing care to 155 people. They were not providing any nursing care to people at this time.

Mach Care Solutions (Birmingham) is required to have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

We found a clear leadership structure within the service, however, the leadership style was not always supportive to staff.

People’s safety was not always protected because risks assessments did not always identify risks that were specific to their needs and care plans were not always individualised. Quality monitoring systems had not always identified when people’s needs had changed or where shortfalls in service delivery were evident.

People were supported by sufficient numbers of staff who were kind and caring. Most people were pleased with the consistency of the staff that provided their care.

Most people knew how to make a complaint if they were unhappy; however, not all complaints were identified, recorded or investigated reliably.

People were supported by staff who had the knowledge and skills they required to fulfil their roles and responsibilities effectively. People were protected from the risk of abuse because staff understood their responsibilities and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

People were treated with dignity and respect and received their care with consent. People were also encouraged to be as independent as possible and staff were mindful of the need to involve people in making choices and decisions about their day to day needs.

The management team were compliant with the Duty of Candour regulation and were co-operative throughout the inspection process.

This inspection took place on 17 and 18 February 2016 and was an announced inspection. At the last inspection on 22 and 23 April 2015 the provider was found to be requiring improvement in four out of the five areas we looked at, safe, effective, responsive and well-led. Therefore we re-inspected within 12 months as standard set by CQC.

Mach Care Solutions (Birmingham) is a Domiciliary Care Service which is registered to provide personal care services to people in their homes. We were told that since our last inspection improvements had been made and they were now providing personal care services to more people. At the time of our inspection Mach Care Solutions (Birmingham) were providing care and support to 157 people including three children. The provider also offers other services to people such as support with shopping or household tasks that we do not regulate.

Mach Care Solutions (Birmingham) is required to have a register manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

People we spoke with told us they felt they received a safe service. However, we found that the systems and processes in place to monitor people’s safety were not always effective in detecting late or missed calls; leaving people at risk.

People’s safety was not always protected because the provider did not have robust recruitment processes.

People were supported by sufficient numbers of staff who understood their responsibilities to keep people safe from abuse and avoidable harm; they knew how to raise concerns if needed.

People were supported to have their prescribed medication safely.

People were supported by staff that understood their responsibilities to protect people’s rights. However, the provider had not always fulfilled their responsibilities to ensure care was provided with lawful consent.

People were supported by staff who had received the training they needed to do their job effectively.

Staff felt supported in their role and knew who to contact for advice or information should they require it.

People received enough food and drink and were supported to have food that they enjoyed.

People were supported to maintain good health and to have access to other health and social care agencies when required.

People were treated with kindness, dignity and respect by staff that knew them well and knew what was important to them.

People were involved in planning and reviewing their own care.

People were encouraged to maintain their independence.

Care was delivered in a way that met people’s individual needs and preferences.

People knew how to make a complaint if they were unhappy and were confident that their concerns would be acted upon responsively.

We saw improvements had been made to monitor the quality and safety of the service since our last inspection. However some of these were not always effective.

We found a clear leadership structure within the service which was supportive and transparent to staff and to most of the people who used the service.

However, sometimes people found the management team to be inaccessible and other professionals reported them to be un-cooperative and defensive when trying to address service deficiencies.

This inspection took place on 22 and 23 April 2015 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care and we wanted to make sure staff would be available. The last inspection on 10 and 11 September 2014 was a follow up to check the provider had implemented actions to improve the service provided. We found the provider was meeting the requirements of the regulations inspected.

Mach Care Solutions (Birmingham) is a domiciliary care agency registered to provide personal care to people living in their own homes. The service currently provides care and support for 97 people, ranging in age, gender, ethnicity and disability. There was a registered manager in post. 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.

Staff knew how to reduce the risk of harm to people from abuse and unsafe practice. The risk of harm to people receiving the service was assessed. However, not all the risk assessments were accurately completed. Where people required support with taking their medicine, there were improved procedures in place to ensure this was done safely. Although, the provider’s process did not always pick up where inaccuracies had been recorded or information omitted. Therefore, there were insufficient procedures in place to ensure people received care, support and medication in a safe way.

There were sufficient numbers of staff available to meet people’s needs. There had been improvement in the procedure to recruit suitably trained staff. Though the provider had delayed in completing full and proper checks for one staff member, before they had started to work with people.

People felt safe and secure with staff coming into their homes and that they had the skills and knowledge to care and support them in their homes. Staff were trained and supported to care for people. Where appropriate, people were supported by staff to access other health and social care professionals when needed. The provider was taking the appropriate action to protect people’s rights, but not all the staff was aware of how to fully protect the rights of people.

Staff were caring and treated people with dignity and respect. People’s independence was respected and promoted and staff responded to people’s support needs. Most people felt they could speak with staff about their worries or concerns and they would be listened to and have their concerns addressed.

The provider had improved the internal quality assurance systems to monitor the care and support people received. Although, the systems were not always effective in identifying errors and putting action plans in place, to maintain and continue to improve the quality of the service people received.

Mach Care Solutions (Birmingham) is currently suspended from receiving any new services by the local authority. This is in relation to the number of safeguarding alerts and incomplete audit systems. The provider had drawn up an action plan, which is in place and the provider is in the process of addressing the issues identified.