Archived: Tynedale Care - Unit 1 Burnhaugh Estate

We asked the provider to send us an action plan to tell us how they would address these concerns and we returned to check the service was now meeting all of the regulations. This announced inspection took place on 16 February and 3 and 6 March 2017.

We confirmed the provider had made improvements to the issues we had raised but we considered further measures were required in other areas of governance.

At the time of our inspection Tynedale Care - Unit 1 Burnhaugh Estate provided home care and housing support (including shopping and sitting services) across Northumberland to 140 adults living in their own homes and meant staff covered over 1900 care and support hours per week to help these people. These figures will fluctuate due to the nature of the service.

The service had 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.

There were safeguarding policies and procedures in place. Staff knew what actions they would take if abuse was suspected. The provider had dealt with any previous safeguarding concerns appropriately.

The provider had invested in a new medicines management system to the majority of people who used the service. This included the introduction of an electronic recording system for staff to use when administering people with their medicines and was seen as an improvement on the previous paper records used. People told us that staff managed their medicines well and they received them on time. Staff supported people to store and dispose of medicines safely.

Accidents and incidents were recorded and dealt with effectively by the provider. Where issues (including complaints) had occurred, actions had been taken and lessons learnt. Risks were identified and assessed to ensure people and the staff who supported them remained as safe as possible.

Staffing levels were maintained by timely and safe recruitment procedures. The provider had a system in place to ensure rota allocations were monitored so people received their care ‘call’ on time and staff were kept safe. The registered manager told us they tried to ensure people were visited by the same care staff but that was not always possible due to sickness or holidays. Since the last inspection the provider had reduced the number of people they supported to ensure they had enough staff to support people fully.

Staff received an induction in line with the Care Certificate and completed appropriate training. The provider had spent time checking to ensure that all staff had received what they perceived as their own mandatory training programme and any additional training they thought was required. Staff told us they felt supported and had been provided with adequate supervision and had received annual appraisals, although we have made a recommendation about this.

The registered manager was fully aware of the Mental Capacity Act 2005, particularly in relation to the court of protection and lasting power of attorney. There were policies and procedures in place and staff had been trained. We saw one person had previously required the support of an advocate and the provider had supported this process.

Some people received support with eating and drinking as part of their care package and they told us staff supported them effectively. People were provided with meals they had chosen and preferred, and staff ensured drinks were left between visits for people if they required them. We saw that where people’s nutrition and hydration was closely observed, that staff had completed monitoring charts to ensure correct levels were maintained.

Staff promoted people’s independence and treated people with warmth and kindness in a respectful and dignified manner. People’s likes and dislikes had been recorded and staff, including office staff, knew the people they supported. Care plans and associated documents were tailored around the individual and involved them, their family and professionals as necessary.

Yearly surveys were undertaken and we saw that this was due to take place in the near future.

There was a complaints procedure in place and people and their relatives told us they knew how to access it and said they would have no hesitation to use it should they need to.

People were supported to ensure they were not socially isolated, which included staff chatting with them during visits. Where activities were part of people's care package, staff supported them with activities they chose and enjoyed doing.

People knew how to complain and told us they would if they needed to with no hesitation.

The service had a dedicated registered manager in place, who was committed to providing a good service. The provider was open to improvements which could be made and had invested in new technologies to enhance the running of the service.

The provider told us they monitored missed calls and medication errors but we found this was not always easily evidenced and needed to be improved. We have made a recommendation.

This inspection took place over five days. We visited the office on 27 May 2016 and 27th June 2016. We visited people who used the service in their own homes on 8, 14 and 17 June 2016.

The service was last inspected in June and July 2015 where we found the provider was not meeting the regulation relating to the management of medicines. At this inspection we found that improvements had been made and people were supported with managing their medicines in accordance with their individual care and support needs.

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.

There were detailed safeguarding and whistleblowing policies in place which provided information about how to recognise the signs of abuse, and how to respond to any concerns people may have. Staff were aware of the agency’s whistleblowing policy and told us they would not hesitate to raise any issues they had.

People had individual risk assessments to support them with promoting their independence and safety. In addition to individual risk assessments, the service also had a range of environmental risk assessments in place. There were systems were in place for reporting and recording accident and incidents but limited evidence of any follow up in relation to accident and incident prevention.

Records within staff files demonstrated proper recruitment checks were being carried out. These checks included employment and reference checks, identity checks and a disclosure and barring service check (DBS). A DBS check is a report which details any offences which may prevent the applicant from working with vulnerable people. They help providers make safer recruitment decisions.

We checked the numbers of staff employed at the service. We found that people who needed the support of two care workers were not always provided with sufficient staff to meet with their care and support needs.

Staff told us they did not have opportunities for staff meetings and communication across the agency was poor. Staff told us and records confirmed that staff did not have access to regular supervision schedule did not demonstrate regular planned supervision sessions for staff.

People who used the service told us they felt that staff were well trained however staff told us and records did not demonstrate staff being offered regular training updates.

The manager and staff were aware of their responsibilities relating to the Mental Capacity Act 2005. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

Care records contained detail that related to the care and support needs for each person. People who used the service were supported with promoting and maintaining their health and wellbeing and with access to the local community. Where people needed support to eat and drink they were supported by staff that followed care planning guidance.

There was a system in place to ensure that people’s opinions and views were sought in order for the agency to make improvements. The provider had a complaints policy in place and we saw evidence of complaints being resolved in line with the agencies policy and procedure.

The manager had notified the Care Quality Commission (CQC) of reportable events and incidents in accordance with our statutory notifications, such as safeguarding referrals.

The service had a quality assurance process in place which covered areas of monitoring which included care records and risk assessments. Observations of staff practice were not carried out for all staff and other areas of the service including medicines management and accident and incident records were not subject to a systematic process of audit.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities Regulations 2014. These related to staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We made seven visits in total. Most of these were visits to people who used the service, living in their own homes. At the time of the inspection 201 people were using the service. We sent out 61 questionnaires to people who used the service at Tynedale Care. Each person was also sent an additional questionnaire to give to a relative, friend or advocate for completing. A total of 38 questionnaires were returned, 24 were received from people who used the service and 14 were received from people's relatives, friends or advocates.

We visited ten people in their homes across the geographical area covered by the agency.

In addition, our expert by experience spoke with 15 people by phone.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

The provider assessed risks to staff and people who received a service. The provider had taken action to ensure the service could be sustained in poor weather by providing 4x4 transport for staff to use. Mobile phones were issued to staff and an on call rota was in place. The provider had taken action to ensure that staff employed at the agency were suitable. However, staff were not suitably supported through training and supervision. We have told the provider that they must improve in this area. Also, office based staff did not have a clear understanding of when and how to raise safeguarding concerns. Information returned to us in three surveys led us to make two safeguarding alerts with the local authority.

Is the service effective?

Most people told us they were happy with the care provided. The staff we spoke with demonstrated a good understanding of people's care and support needs and worked well with other care providers. People and their relatives valued the support provided by their care staff. One relative said, "One of the girls who comes to my father is absolutely great, she is so organised, marvellous." One person said, "I wish I could adopt one of my carers she is marvellous. I don't know what I would do without them."

Is the service caring?

The majority of people we surveyed and their relatives/friends were satisfied with the service being provided by Tynedale Care. People were very complimentary about the staff who visited them. Those people who talked to our expert by experience were particularly complimentary about the way they were treated with respect by the care staff. These were some of the comments people made; "The carers are brilliant.' and 'They're very, very good. No complaints. Very nice to me, carers and office staff.' and 'Oh yes very good actually. Cannot say anything bad at all.'

Is the service responsive?

We saw that people's needs and any risks were assessed before their care was provided. The care records described people's individual routines, needs and preferences, but some people commented that the timings of the service could be unreliable, and communication within the agency and with people using the service needed to improve.

Is the service well led?

We found an on-going lack of effective systems to regularly assess and monitor the quality of services provided by regularly seeking the views of people, persons acting on their behalf and persons employed by the provider. We have told the provider that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

There was a manager in post at the service who was registered with the Commission in line with legal requirements.

Overall, people and their relatives/friends seemed relatively satisfied with the service being provided by Tynedale Care. Comments included, 'I don't know what I would do without them they shower me and come every morning' and 'No complaints at all. I am pleased with all the girls who come here. I am severely disabled and I appreciate what help I get.' We considered that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

There were effective systems in place to reduce the risk and spread of infection.

We found that appropriate pre-employment checks were not always fully completed before staff began work and staff did not always receive appropriate training for their professional development. In addition, an effective appraisal and supervision system was not fully in place.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.