Community Outreach

Community Outreach is a domiciliary care agency providing personal care to mostly older people living in their own homes in Sheffield. At the time of our inspection there were 8 people using the service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

There was a lack of oversight and governance by the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. Checks and audits were not effective or completed to monitor the quality and safety of the service.

Risks to people were not adequately assessed to keep them safe. Medicines were not safely managed. Medication administration charts were not audited correctly, and action was not taken to address errors promptly.

Staff did not always have sufficient guidance in place to ensure people's health needs were met in a consistent and safe way. Staff did not always receive sufficient training to help them carry out their roles. People had provided feedback to the manager; however, no action had been taken to analyse this or take any action.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

People were safeguarded from risk of abuse. The provider's recruitment processes helped to make sure they only employed suitable staff. People were usually visited by the same staff who they liked and knew their needs and how they liked to be supported. People were supported to eat and drink healthily. People were encouraged to remain independent and their privacy and dignity was respected.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 October 2021).

At our last inspection we recommended the manager consider current guidance on gaining consent where people lack capacity and to update people’s care records to evidence this. At this inspection we found the provider had made improvements.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Outreach is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Sheffield area. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection seven people were receiving support with personal care.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; in the main the policies and systems in the service supported this practice. However, we recommended the manager consider current guidance on gaining consent where people lack capacity and to update people’s care records to evidence this.

Safe recruitment procedures made sure staff were of suitable character and background. Staff had received training in safeguarding vulnerable adults. There were enough staff deployed to meet people’s care and support needs in a timely way. People received their medicines as prescribed.

Staff were provided with relevant training and ongoing support to make sure they had the right skills and knowledge to support people. Staff told us the manager was approachable and they felt supported in their jobs. People were supported to eat and drink to maintain a balanced diet, where required. People were supported to maintain good health and have access to health and social care services.

There were systems in place to monitor and improve the quality of the service provided. The provider had a comprehensive set of policies and procedures covering all aspects of service delivery. Improvements had been made by the manager since the last inspection. They had implemented a service improvement plan since the last inspection to further develop and sustain these improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 20 March 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 August 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We previously carried out an unannounced comprehensive inspection of this service on 4 and 5 February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve recruitment procedures, governance of the service, and staff training and support.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Outreach on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Community Outreach is a domiciliary care agency. The service changed its name since the previous inspection from ‘The Potergate, Ecclesall Road’. It provides personal care to people in their own homes in the community. At the time of inspection four people were receiving support.

People’s experience of using this service and what we found

People and their relatives were happy with the service and leadership. However, ineffective systems which measured the quality and safety of services provided put people at risk. The provider was open about the difficulties the service faced before we came to inspect and recognised the service needed to make significant improvements. During and after the inspection the provider showed they were committed to addressing our concerns and sent a list of actions they planned to take.

The service had marginally improved in areas relating to people’s health and safety since the previous inspection. Risks were assessed and managed, and people received their medicines as prescribed. People told us they felt safe and staff attended care calls on time and stayed for the duration of the call. There were continued issues with recruitment practices, which meant we were not assured staff employed by the service were suitable for the role.

Staff training and support did not promote safe and effective care. There were significant gaps in staff training and the support staff received was inconsistent. Despite these concerns, people consistently commented the care they received was good. Assessments were carried out to ensure needs could be met. Assessments captured people’s choices, preferences and personal support needs. People told us staff always asked for their permission before providing care and support. However, for people who lacked the mental capacity to make decisions about their care, the policies and systems in the service did not support people to have maximum choice and control of their lives.

People’s care records were personalised and contained information to support staff to get to know people and provide care in accordance with their preferences. However, the service did not keep accurate records in respect of changes or decisions about people’s care.

People told us staff were kind and they received support from the same core group of staff, which promoted good continuity of care. Staff provided personalised support and actively encouraged people’s independence whilst delivering care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 2 September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to recruitment, staff training and support, systems of governance and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.