We carried out an announced inspection of Montecare Solutions in October 2016 and rated the service as, ‘Requires Improvement’. This was due to concerns regarding medicines administration and ineffective quality checks.

At this inspection, we checked that the registered manager had made the required improvements. Since our last inspection of the service, some improvements had been made, however further improvement was still required and the service continues to be rated as ‘Requires Improvement’.

Montecare Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for adults, some of whom may be living with dementia, have a physical disability or a learning disability. The service does not provide nursing care.

This inspection was undertaken on the 11, 12. 13 and 20 September 2018. At the time of the inspection, 63 people were receiving a domiciliary care service from Montecare Solutions. The Care Quality Commission only inspects the service being received by people provided with personal care; such as help with tasks related to personal hygiene and eating, and so did not look at the support being provided to the other people in the service. There were 28 people receiving personal care at the time of our inspection.

The registered provider was also the 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.

Staff knew how to recognise signs of abuse and were confident about what action to take if any concerns arose. Staff were mostly on time to provide people’s support.

People were treated with care, kindness, dignity and respect and received a good level of support that met their needs and preferences. Staff had a good knowledge and understanding of people’s specific care needs and how they wished to be cared for and supported.

Although there was no impact to suggest that people’s care and support needs were not being met, not all risks to people’s health, welfare and safety had been recorded and improvements were required to guide staff in the steps they should take to mitigate risks to ensure people’s safety and wellbeing.

Staff supported people to have enough to eat and drink and to make choices about what they ate and drank. People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance.

The application of the Mental Capacity Act 2005 (MCA) required further development. People received care from skilled staff who were able to meet their needs. Staff received supervision and appraisals to support them in their role and identify any learning needs and opportunities for professional development.

We received mixed feedback regarding the effectiveness of the management team. Although some auditing and monitoring systems were in place to ensure the quality of care was consistently assessed, they had not identified the issues we found during our inspection to ensure the service continuously improved. The management team were not always up to date with best practice.

We have made recommendations about the management of risk and the implementation of the Mental Capacity Act 2005.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 19 and 24 October 2016 and was announced.

Montecare Solutions is a domiciliary care service that provides personal care to people living in their own homes. They predominantly provide a service for older adults, some of whom may be living with dementia or may have a physical disability. The service does not provide nursing care. At the time of our inspection there were approximately 80 people using the service.

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 director of the company was the registered manager and there was also a general manager.

Procedures for supporting people with medicines were not always followed, so people could not be confident that they would receive their medicines safely. There were sufficient staff to meet people’s needs and to manage risk safely. Whilst we received feedback that staff were not always punctual, senior staff checked staff timekeeping regularly and had made changes to make rotas more manageable. The provider had a robust recruitment process which helped protect people from the risk of avoidable harm.

The service was run by a committed director and manager. There were systems in place to check individual performance but not to monitor themes across the service. There were not sufficient checks to ensure that all senior staff in the service were carrying out their roles effectively. As a result the director and manager had not effectively picked up and resolved the concerns which we had found during our inspection. The director and manager responded positively to address our findings and were pro-active about implementing improvements.

Staff were well supported. They received good quality training which they were enthusiastic about and which enabled them to meet people’s needs effectively. People were given choices about the care they received, and care plans were being updated to clarify that the service was meeting its responsibilities under the Mental Capacity Act. People were supported to consume food and drink of their choice. Staff worked well with people to help them maintain good health and to access health care professionals, where necessary.

People were treated with compassion by staff who knew them well and developed positive relationships with them over time. Staff treated people with respect. Staff communicated well as a team about people’s needs. Care plans were in place which outlined people’s needs and these were being revised so that staff could receive more personalised and clearer information about people’s needs and preferences. People received a detailed response when they made a complaint and their concerns were dealt with effectively.

The people who used Montecare were very happy with their care and support. They spoke highly of the staff and said they were kind and caring, usually punctual, friendly, courteous and respectful. People felt involved in their care arrangements and knew who to call if they needed to speak to someone. They felt safe with the carers and had no complaints about the service. One person said: “I don't really have to ask them anything. We have a routine and they just get on with their job. If I need something else done I just ask and they will attend to it. "

The staff told us that Montecare was a good company to work for. The management was flexible and approachable and provided good opportunities for training.

At the time of our inspection on 18 June 2013, we saw that monitoring systems for involving and caring for people and managing the service were in place. Effective staff support systems including supervision and annual appraisals were in place.

We noted that there were processes in place for the reporting of safeguarding incidents and that these procedures were followed.

The people who used Montecare were very happy with their care and support. They spoke highly of the staff and said they were kind and caring, usually punctual, friendly, courteous and respectful. People felt involved in their care arrangements and knew who to call if they needed to speak to someone. They felt safe with the carers and had no complaints about the service. One person said "I find things very difficult sometimes and they help me a lot. They ask me how I would like something and do their job well, I have no complaints".

The staff told us that Montecare was a good company to work for. The management was flexible and approachable and provided opportunities for training.

At the time of our inspection on 11 March 2013, we saw that monitoring systems for involving and caring for people and managing the service were in place. Effective staff support systems including supervision and appraisals were in place.

We noted that the reporting of safeguarding incidents and the following of appropriate procedures required improvement.