This inspection took place on 17, 18 and 24 October 2018 and was announced. Our last inspection was in March 2018 where we rated the service ‘Requires Improvement’ and identified one breach of the legal requirements in relation to staffing.

This inspection found a continued breach of the legal requirements in relation to staff training as well as further breaches in relation to the safety of care, staff deployment, person centred care, complaints, governance and statutory notifications.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, and children.

Not everyone using Medacs Healthcare - Croydon receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our visit 648 people were receiving personal care from Medacs Healthcare – Croydon.

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.

The care people received was not safe. Records relating to risks people faced were inconsistent and inaccurate. People’s medicines records were not kept up to date and we identified instances where medicines records showed a potential overdose. The majority of people’s care calls were not delivered at the time they were expected and people gave us examples of where this had impacted significantly upon them and the safety of the care that they received.

Improvements to staff training had not been implemented and we found gaps to staff training records. One to one supervision meetings and spot checks were not taking place as planned. People’s consent was not sought in line with legislation and there was a lack of information about people’s nutritional needs. Assessments of people’s care were not always carried out and lacked information. Where people received ‘reablement’ support, the provider did not identify and plan for them to achieve their goals. Records showed a lack of communication with health and social care professionals.

The service was not always caring. People did not always receive support from a consistent staff team. Records contained no evidence of people having been involved in their care planning and there was a lack of information about how to promote people's independence. The service did not consider the impact people’s religious beliefs, cultural background, sexual and gender identity had on their care preferences. We have made a recommendation about this.

Care was not planned in a personalised way. Care plans lacked information about how to provide support to people in a way that responded appropriately to their needs. Care plans did not identify what was important to people. The provider’s systems for monitoring care delivery and reviews was not robust enough to identify and respond to changes in needs. People’s wishes regarding end of life care were missing from records, despite them having conditions that would require this information to be in place. People and relatives told us their complaints were not responded to and we saw that numerous concerns about staff punctuality and care delivery had not been picked up through monitoring.

There was a lack of governance at the service. The provider’s systems had not adequately identified and addressed the numerous concerns identified at this inspection and improvements following our last inspection had not been implemented. Record keeping was not up to date and there was no robust system for management to

Medacs Healthcare - Croydon is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, and children. At the time of our inspection 503 people were receiving a service. Approximately 50 of these were younger people under 18 years old. Personal care was not provided to this group and therefore we did not look at this aspect of the service at this inspection.

Medacs Healthcare – Croydon provides home care across a number of London Boroughs. This includes long term domiciliary care packages as well as short term reablement packages and support to people receiving end of life care in their own homes.

At our last inspection in December 2015 and January 2016 we rated the service ‘good’ overall and for each key question. At this inspection on 6 & 7 March 2018 we found the service’s rating had deteriorated to ‘requires improvement’.

Since our last inspection a new registered manager had been appointed in January 2018. 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.

There were not sufficient numbers of staff to meet people’s needs. We heard occasions of missed visits or only one staff member attending when two staff were required to keep people safe. Scheduling difficulties meant people often experienced late calls and at times people felt staff were rushed to get to other appointments which impacted on the quality of care provided.

Staff told us they had good access to training opportunities, however, the training matrix showed staff were not up to date with their annual refresher training. Staff received regular supervision and annual appraisals.

People told us they were supported with their medicines, however, accurate medicines administration records were not always maintained. The service quality assessors and in-house trainer were working with staff to help improve the quality of medicines records.

Staff were knowledgeable about the risks to people’s safety and how these were to be mitigated, and staff followed safeguarding adults’ and children’s procedures. Staff followed best practice in regards to infection control.

Staff provided people with any support required with nutritional, hydration or health needs. Staff adhered to the principles of the Mental Capacity Act 2005.

People were complimentary about the support they received from their regular care workers and the caring relationships they had built with them. Staff assessed people’s needs and detailed records were maintained about how people wished to be cared for. Staff were respectful of people’s privacy and dignity, and supported them to maintain, and regain where possible, their independence. People were empowered to make choices about their care and staff were aware of any sensory impairments people had which impacted on their ability to communicate their choices.

A complaints process was in place. We heard that previously people felt their complaints were not listened to and responded to in a timely manner, however, we also heard that this had much improved recently.

The management team had recently been restructured to provide stronger management and leadership across all areas of the service. The management team had regular meetings with the local authorities they had contracts with to ensure consistent and coordinated care.

The provider’s quality monitoring processes had identified areas requiring improvement and new systems had been introduced to address some of these concerns, including in relation to scheduling and out of hours arrangements. It was too soon to assess the impact of these new systems and we will look at this at our next in

This inspection took place on 9 and 10 December 2015 and 20 January 2016. The provider was given 48 hours’ notice of the inspection because the service provides domiciliary care and we needed to be sure the manager was available.

Medacs Healthcare - Croydon is a domiciliary care agency that provides care and treatment to approximately 400 people of all ages and with varying needs in their homes across a number of London Boroughs.

The service has a registered manager. 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.

People told us they felt safe and secure with staff from this service. Staff had attended safeguarding training. They recognised different types of abuse that may take place and understood how to report it. Risk assessments reflected people’s needs and supported their goals and supported staff to provide safe and appropriate care and support. There were sufficient numbers of suitable staff to meet people’s needs. People told us staff generally arrived on time and remained for the allocated period. If there were any delays the service informed people. Staff went through an appropriate recruitment process before being employed. People’s medicines were administered safely.

Staff received regular training and management support. Training included an induction process for new members of staff and refresher training for existing staff. Training, management supervisions and appraisals took place in the areas where staff worked including e-learning. Some training that required the practical use of equipment was delivered in the service’s training room. Staff were supported on occasions to obtain further, relevant qualifications. Staff had completed Mental Capacity Act training and the service was working within the principles of the Act. People consented to their care and support.

People told us staff were kind and treated them and their relatives with dignity and respect. Care and support was delivered by staff in a patient, friendly and sensitive manner. The service supported people to express their views and to be involved in planning their care and support. Staff respected people’s dignity and privacy and encouraged people to be as independent as they wanted to be.

The service was responsive to people’s needs. People’s needs were assessed before the service started providing care and support. Care plans were person centred and identified needs, goals and preferences. The service encouraged feedback from people and their representatives about their experiences of the service through monthly monitoring telephone calls, quarterly visits and annual surveys. The service had an appropriate system for dealing with complaints.

Staff told us they felt valued and appreciated. There were systems to obtain feedback from staff which included regular staff meetings and surveys. Any adverse incidents or incidents of note, including safeguarding and other statutory notifications were reviewed by the provider’s clinical lead to identify and implement any learning or improvements. There were systems and processes to monitor and assess the quality of service provided and identify any risks to the health, safety and welfare of people using the service and staff. Records were accurate, up to date, accessible and were fit for purpose.