Archived: Frontline Care Limited

The inspection team was made up of a single inspector. The focus of the inspection was to check the service was compliant with the Warning Notices that had been served in May 2014. These were in regard to requirements relating to workers, supporting workers and assessing and monitoring the quality of service provision. We told the provider they must make improvements to ensure they would be compliant by 29 August 2014.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found there were systems in place to make sure that lessons were learned from any accidents and incidents.

Recruitment checks specified in the provider's policy and Schedule 3 of the Health and Social Care Act 2008 were being followed. The provider had not recruited any additional staff since the previous inspection but had put processes in place to ensure they had obtained reference checks for current staff. This meant appropriate checks had been undertaken and the provider's recruitment policy was followed

Is the service effective?

Effective recruitment and selection procedures were in place to ensure appropriate checks were undertaken before staff began work. Gaps in employment history had been explored and a new recruitment procedure had been implemented which took into account the shortlisting of applicants. This meant there were recruitment and selection processes in place to assess the character and competencies of applicants.

A health and fitness questionnaire had been developed for applicants to complete at the application stage. This meant procedures were in place to assess the fitness of applicants and confirm current staff were physically and mentally fit to work for the provider.

Most staff had received appropriate professional development to meet the needs of the people who used the service. Systems had been put into place to identify when staff required a supervision, work place assessment or appraisal. Records showed most staff had received a supervision. We found four members of staff had not received an appraisal or a work place assessment. However only one member of staff had worked for the company long enough to require an appraisal but this had not been completed. The registered manager showed us the supervision grid which identified this member of staff would be receiving their appraisal in October 2014.

Is the service caring?

We did not speak with people who used the service during this inspection.

Is the service responsive?

A compliments and complaints folder had been developed and we saw he provider had responded to the complaint received. We saw a compliment that had been received on the 10 July 2014 had been passed onto all staff.

Is the service well led?

There was a registered manager in place and improvements have been made to the service since our last inspection. Staff we spoke with said they felt supported by the registered manager and felt they were very flexible and accommodating.

The inspection team was made up of one inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they felt safe and one person told us, 'some carers have more experience than others.' A relative told us, '[The person] is very much at ease with the carer and the service.'

We found there was no system in place to make sure that lessons were learned from any, accidents and incidents. The provider told us they had not received any accident or incidents. However we found one incident that was reported but no outcomes or learning from this had taken place. At our previous inspection in January 2014 we found the provider was not meeting these requirements. At that time we found the provider did not have an effective system in place to regularly assess, monitor and manage the health safety and welfare of the service that people received. This concern was judged to have had a minor impact on people who used the service. At this inspection we found that the necessary improvements had not been made. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to learning from incidents and events that affect people's safety.

We looked at the recruitment records for staff. They showed that recruitment checks specified in the provider's policy and Schedule 3 of the Health and Social Care Act 2008 were not being followed. This meant people were at risk of being supported by staff that were not suitably qualified, skilled and safe to work with people. At our previous inspection in January 2014 we found the provider was not meeting these requirements. At that time we found the service did not follow its recruitment procedure to ensure staff employed to provide personal care were of good character and that checks as set out in Schedule 3 of the Health and Social Care Act 2008 for safe recruitment were obtained. This concern was judged to have had a moderate impact on people who used the service. At this inspection we found that the necessary improvements had not been made. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to the recruitment of workers.

We found the provider had ensured there were sufficient numbers of staff. However we found not all staff had received adequate training to be able to meet the needs of the people who used the service. We found there were areas of training with gaps where staff had not received training, for example training in Safeguarding and infection control. At our previous inspection in January 2014 we found the provider was not meeting these requirements. At this inspection we found that the necessary improvements had not been made. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to supporting workers.

Is the service effective?

People's care needs were assessed, and care plans reflected people's current needs. We found assessments were being updated and were clear on what people's needs were. We found risk assessments had been updated and identified risks to people who used the service. We found that the staff members we spoke with understood people's needs and were aware of the risks of the people they provided care for.

Is the service caring?

People told us the service is good and the best care company I have ever had. One person told us, 'The service is flexible and the office is very welcoming. Carers are good.' People told us they can contact the service at any time and they are open to suggestions.

Is the service responsive?

People told us they can change appointments and arrange the care they need on a weekly basis and the service always accommodates them. One person told us, 'Messages are always passed on.' A relative said the service was, 'Very flexible and accommodating'.

Is the service well led?

The service did not have an effective quality monitoring system in place. At our previous inspection in January 2014 we found improvements were needed. At this inspection we found the provider had not made the necessary improvements. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to having an effective operating system to assess and monitor the quality of service provision.

Two people who use the service gave us positive comments. One said, 'They put care first and treat you like a person, a personalised approach'. One relative commented 'I would like to thank Frontline for all their help and support that has been given to us over the past 12 months'

We were shown a number of different assessments that were carried out which reflected people's needs and preferences. However, we found that assessments were duplicated and we found hard it to identify the correct needs of the people who used the service. We also found that assessments were not always fully completed and dated by staff or signed by the person receiving the service.

Recruitment and selection procedures were in place but were not followed. Checks on the character of staff were not carried out by the provider.

We found that there were insufficient numbers of suitably qualified staff available to provide the service effectively. The registered manager confirmed this and said, 'I carry out support each week due to insufficient staffing levels'.

Policies and procedures were in place for supporting staff and induction training was provided by an external provider. We found that supervision and training records were kept but we identified that the supervision policy was not followed. Staff did not receive regular supervision or additional training to enable them to deliver care and treatment to people safely. One member of staff told us that 'I did a lot of training with my previous company but not with Frontline, they only checked to see if I have done it'.

We found that the service did not have effective monitoring processes in place to help regularly assess and monitor the quality of the service being provided