We carried out a comprehensive inspection of Maksanus Care Services Limited on 29 November 2016 at which a breach of legal requirements was found. This was because the provider had not carried out quality assurance audits of care records nor analysed feedback received from people in order to improve the service.

On 1 March 2017 we undertook a focused inspection to check that the service had taken action in order to meet legal requirements.

This report only covers our findings in relation to the well led topic area. You can read the report of our last comprehensive inspection, by selecting the 'all reports' link for Maksanus Care Services Limited on our website at www.cqc.org.uk.

At our last inspection on 29 November 2016 we rated the home good in the four topic areas safe, effective, caring and responsive and good as the overall rating. The home was rated requires improvement in the well led topic area.

Maksanus Care Service Limited is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection, there were 60 people living in the London Borough of Brent who received care from the agency.

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 of the Health and Social Care Act and associated Regulations about how the service is run.

At our focused inspection on 1 March 2017, we found that the provider had taken action to ensure that legal requirements were met. A system for reviewing records and monitoring quality of the service had been developed. Monitoring reviews had taken place during January and February 2017. However we were unable to identify whether actions had been put in place in respect of issues identified through this monitoring. This meant that we needed to see a track record of improvement over time in order to change the rating for well led from requires improvement.

The results of a recent service user satisfaction survey had been analysed and an action plan put in place to address any concerns. We saw that progress had been made towards completing the actions identified within the plan.

We carried out an inspection of Maksanus Care Service Limited on 29 November 2016. This was an announced inspection where we gave the provider notice because we needed to ensure someone would be available to speak with us.

Maksanus Care Service Limited is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection, there were 60 people who received personal care from the agency.

The service was last inspected on 18 June 2014 and was meeting the required standards at the time of the inspection.

The service had 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.

Risk assessments had not been completed in full to reflect people’s current needs and did not take into consideration their health needs. After the inspection, the registered manager sent us the completed risk assessments.

There was a decision making section on people’s care plans. Care plans documented if people were able to make decisions. Staff told us they requested consent from people before providing personal care. People and relatives confirmed this.

The management team understood the principle of the Mental Capacity Act 2005 (MCA) and the decisions made in relation to the Act were being followed by staff. However, care staff had not received MCA training and were not able to tell us the principles of the MCA. The registered manager told us that training would be arranged for all staff.

Audits were not being carried out on people’s records such as risk assessments that would have helped identify the issues found during the inspection.

People were protected from abuse and avoidable harm. People and relatives we spoke to told us they were happy with the support received from the agency and they felt safe around staff. Most staff we spoke to knew what abuse was and who to report abuse to. However, one staff member was not aware of the different types of abuse and who to report abuse to and another staff member did not know the different types of abuse.

Staff told us they were supported by the management team and had received supervision and spot checks. Records confirmed this.

Staff meetings were being held and recorded.

Aside from training in MCA, staff had regular training to ensure knowledge and skills were kept up to date.

People and relatives we spoke to told us that staff communicated well with them and with relatives. People’s ability to communicate were recorded in their care plans.

Pre-employment checks had been undertaken to ensure staff were suitable for the role.

People were encouraged to be independent and their privacy and dignity was maintained.

We identified breaches to regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, relating to audits and analysing feedback from people that received personal care. You can see what action we have asked the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who used the service, two relatives and three care staff. We also reviewed records relating to the management of the care service which included the care records of three person who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. People’s care files contained risk assessments including moving and handling, environmental and medication risk assessments. We saw that risks to people and ways to reduce the risks were identified in order to ensure that their needs were met as safely as possible. We also saw that people health needs and medical conditions were recorded.

There were adequate arrangements in place to deal with foreseeable emergencies.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Is the service effective?

We spoke with two people and two relatives of people who used the service. They said they were satisfied with the service that Maksanus Care Limited provided. Their comments included “They are very nice, very good”, “They’re brilliant” and that “Everything goes well.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at three people’s care records that showed their needs were assessed and a care plan was written prior to the commencement of the service. We saw that all files contained a detailed care plan which included information about people's preferred daily routines, interests, likes and dislikes.

People’s individual needs, choices and preferences were reflected in their care plans and a full weekly schedule of people’s visit including their required support was also part of people’s care records.

Is the service caring?

We spoke with two people and two relatives of people who used the service. They said the staff were “very polite, respectful and professional” and that there were “no problems.” People we spoke with did not raise any concerns with us regarding their well-being and safety.

We found that people who used the service expressed their views and were involved in making decisions about their care and support. We looked at three people’s care records that showed their needs were assessed and a care plan was written prior to the commencement of the service. People or their relatives signed these documents evidencing their involvement and agreement with the plans. We saw that the plans took into account people’s individuality and were personalised. People’s communication, mental health and cultural/spiritual needs were also assessed to guide and help staff to ensure people’s dignity and that appropriate choices were offered them.

People's diversity, values and their rights were respected. Records showed that issues around equality and diversity, dignity and privacy, rights and choice were discussed as part of the staff’s induction. Staff were also given a handbook that provided further details regarding what was to be considered when they provided support to people in order to ensure professional standards in providing care. Staff we spoke with confirmed they read the handbook and demonstrated their knowledge and understanding of the need to ask people’s consent prior to providing care and support to them. Staff also said it was important to offer choices to people regarding, for example what they wanted to eat or what clothes they wanted to wear.

Is the service responsive?

We found that spot checks had been implemented by the care coordinator to ensure staff provided care in line with people care plans. This involved checking people’s daily records that was written by staff at the end of each visit and talking to and visiting people and their relatives on a regular basis. Staff we spoke with told us they read the care plans of the people who they supported. They also told us they received a ‘rota’ for each week which included who and when they were to support that week. We looked at two of these rotas which also contained the required support to complete on each visit and key information about the person and their support needs.

We found that the service took account of complaints and comments to improve the service. For example, we found issues had been raised by a person’s relative when they were unhappy about their service. We saw that appropriate actions were taken and an agreement was written which clarified how the person’s relative would be involved in decision making regarding the care and support of their relative in the future.

Is the service well-led?

The service had a system in place to assess and monitor the quality of its service. The system included the completion of service user satisfaction surveys in order to get feedback regarding the service. The care coordinator was also in contact on the telephone with people who used the service and visited them regularly to ensure the quality of the service. People and their relatives were asked for their views about their care and whether they were satisfied with the support their received. We found that appropriate changes were made to the service following people’s feedback.

We asked staff how they felt about their job and they said “(I’m) very happy” and “Everything is ok, (there’s) no problem.” They also said the management was approachable and flexible and that they received all the support they needed to do their job.

We spoke with two people who used the service by phone. They told us that they had been treated with respect and dignity. One person told us “I am happy with my care and have no complaints”. Another told us “they are perfect”.

We spoke with two members of staff who were both aware of the importance of treating people with respect and ensuring that people were always given a choice. One member of staff told us that it was important for people to be as independent as possible whilst supporting them.

The care of people had been assessed and care plans prepared. These were signed by people receiving the care. People we spoke with were positive about care workers and indicated that they were reliable and competent.

Staff we spoke with told us that they felt supported by management and felt comfortable raising concerns with them.

We observed that the provider had an effective system to assess and monitor the quality of service that people receive.

People using the service spoken with told us that staff treated them with respect and carried out their support in a dignified manner.

We spoke with relatives who told us, that the agency looked after their relative extremely well and built up an excellent rapport and understanding of the person’s needs and wishes.

We asked people using the service if they were able to talk to staff and change care practices which they didn’t like or didn’t feel were suitable.

One person told us, “They call me regularly and ask me if I would want to have anything changed”.

We asked people if they felt that their care was tailored around their needs and if they were involved in planning their own care, treatment and support. People were very positive about the care provided by the agency and felt that the care was tailored around their needs.

We asked people if staff were providing meals and drinks for people. A relative told us that he was extremely happy with the meals provided and that as a result of the nutritious, healthy and well balanced diet the person’s health and weight has improved.

We discussed with people if the provider was passing on relevant information about their care to others who were involved in their care. A relative told us. “They arrange all GP appointments and attend appointments passing on relevant information to the doctor”.

People spoken with felt safe in the presence of carers supplied by the agency and raised no concerns in regards to unsafe or inappropriate care practices.

Every body spoken with confirmed that carers understood infection control procedures and followed appropriate hand hygiene procedures.

One comment made by a person using the service.

“The carers wash their hands and always use gloves”. “There are boxes of gloves in the house”.

We asked people using the service if they were satisfied and felt safe around staff. Everybody spoken to were full of compliments and praise in regards to the staff provided by the agency. Comments made by people using the service.

“Service provided by staff is excellent and is meeting my needs”.

People using the service told us that staff were experienced and knew what they were doing, when we asked them if staff were suitably qualified. Comments made by people using the service.

“Staff knows what they are required to do and are very helpful”. “They go the extra mile”.

We asked people using the service if they had any complaints and how they would raise any complaints they had about the service provided. None of the people spoken with had any complaints about the care and support provided. People also told us that they knew how and who to complain to.