Archived: Short Notice Care Services

Short Notice Care Services is a domiciliary care agency providing personal care to people in their own homes. The service was supporting 34 people with personal care in their own homes at the time of our inspection.

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

We found widespread shortfalls in the way the service was monitored at a provider level. Unpaid bills meant that services such as the rental of phones and printers had been withdrawn. This had negatively impacted upon the service provided.

The lack of governance and audits meant the provider did not know if staff met people’s needs or delivered safe and effective care. The registered manager had left the service in December 2020 and the provider had not implemented management support for the service in a timely manner. This meant there was a period of time where the service was not monitored and this had impacted upon the quality of the service provided, despite staffs’ best efforts.

Some people were supported by staff to take their medicines and although overall they did this safely there were occasions when people ran out of medicines and this was not immediately resolved. This placed people at risk of harm. Staff did not have all the information they required to ensure people’s medicines were administered safely and there was a lack of monitoring to ensure processes were followed and were safe. Following the inspection visit we raised a safeguarding after identifying a lack of medication monitoring could have negatively impacted upon one person’s wellbeing.

People told us they felt safe while being supported with their personal care and all commented that staff knew them well and ‘went the extra mile’ to ensure their calls happened and their needs were met.

Risks relating to people’s safe care and support had been considered by staff and the majority were documented. Not all information had been recorded to direct staff how to safely manage issues identified. For example, staff had no written direction for how to monitor pressure areas when a person was at risk of their skin breaking down. There was no evidence that the lack of recording had impacted on the quality of care provided.

Staff were safely recruited however documentation did not always reflect that required checks had been carried out, or documented, to reflect safe practice. These shortfalls had been identified by staff who were taking action to update records.

We have taken action to address issues identified.

Rating at last inspection

The last rating for this service was good. The inspection took place in April 2019.

Why we inspected

We had received concerns from social care professionals that suggested there were issues with the financial viability of the service, and this would potentially have an impact on the service provided. Our findings reflected the concerns shared with us.

We reviewed the information we held about the service. We did not inspect the key questions of effective, caring and responsive which were previously rated as good.

The overall rating for this service has changed from good to inadequate. 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 Short Notice Home Care on our website at www.cqc.org.uk.

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 safe care and treatment and in the governance of the service.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore 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 six 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.

People’s experience of using this service:

Records relating to medication administration required improvement. Staff required further guidance on how to administer ‘as and when’ required medication such as prescribed creams. The way in which the manager assessed people’s competency to administer required further development.

We spoke with the manager about the improvements that needed to be made to medication management. They told us they would address this without delay. Shortly after our inspection we received confirmation of the improvements the manager had started to introduce. At our next inspection we will check these improvements have been sustained.

The majority of people’s need and risks were properly assessed with sufficient guidance for staff to follow in the provision of safe and appropriate care. Information on people’s needs and skin integrity required improvement. The manager told us they would address this without delay.

Staff had person centred information on people’s preferences and choices with regards to their support and the support provided was personalised to them and their individual requirements.

People told us the support provided was good and that they felt safe with staff. They said staff members were kind, caring and respectful.

People’s daily records showed that people received the support they needed in accordance with their care plan.

People and their relatives confirmed that staff turned up on time and provided the support they needed in accordance with the people’s needs and wishes.

Records showed and people told us that where their needs or choices changed, the management team tried their best to accommodate these changes.

From the records we viewed and the feedback we received it was obvious that people’s care was planned and well organised.

Everyone we spoke with was happy with the care they received. No-one we spoke with had any complaints about the service. Records showed that any complaints that had been received were minor and had been responded to in a timely and appropriate way.

People’s visits records showed that people’s visits were rarely missed. Visits were made on time and staff told us that they had sufficient time to provide people with the support they needed. This indicated that staffing levels were sufficient to ensure people received the support they needed.

Staff were recruited appropriately with the required pre-employment checks undertaken prior to employment to ensure staff members were safe and suitable to work with vulnerable people.

Staff were sufficiently trained to do their job supported by the management team. Staff morale was good. Staff told us they felt supported and that the management team were approachable and open. Staff felt they provided a good service to people. The people and relatives we spoke with agreed with this.

The systems and processes in place to monitor the quality and safety of the service were adequate and appropriate for the size of the service. The management team demonstrated a good knowledge of their regulatory responsibilities with regards to people’s care and managed the service well.

Rating at last inspection and why we inspected: This was a scheduled inspection. At the last inspection the service was good. At this inspection, the service was rated good again.

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

Short Notice Care Services is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our visit the agency was providing a service to 74 people. The frequency of visits and duration across the service varied dependent on individual needs and circumstances.

There was a manager in post who was present during our inspection. The manager had applied to become the registered manager of the service. 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 were confident that staff knew how to support them safely and protect them from abuse. Staff were able to recognise the different signs of abuse and who to report concerns to. Risks to people’s safety and wellbeing had been assessed and staff were aware how to protect people from harm.

There were enough staff to meet people’s needs. Staff were allocated sufficient time to meet people’s needs and people never felt rushed. The provider completed checks to ensure potential new employees were suitable to work with people who used the service before they started working with people.

People received support to take their medicines as prescribed. Staff monitored people’s health and reported any concerns to the relevant health professionals.

People were supported by staff who had received training relevant to their role. Staff felt well supported by the management team and were able to contact them for support at any time.

Staff sought people’s consent before supporting them. People were given information in a way they could understand to enable them to be involved in decisions about their care and support.

People were positive about the support they received. People felt staff were kind and considerate. Staff promoted people’s dignity and supported them to remain as independent as possible.

People receive care and support that was individualised. People felt listened to and their preference for care delivery was respected. People’s care plans were kept under regular review and the service was responsive to any change in people’s needs or circumstances.

The provider actively sought people’s views on the service and people were comfortable to raise any concerns with staff or the manager. The provider had a complaints process and where concerns had been raised these were dealt with appropriately.

There was positive working culture with open and honest communication. The manager had a number of checks in place to monitor and develop the service.

We spoke with seven people, including four people who used the service, three relatives, six staff and the registered manager.

Everyone we spoke with told us that they were satisfied with the care and support that they received. People shared positive comments about their care. They said, "Everything they do is very good." "I am perfectly satisfied."

We saw the agency had satisfactory systems to protect people and report allegations of abuse. All the staff we spoke with said training for this matter had improved and they were more knowledgeable their responsibilities about recognising and reporting abuse.

Improvements to care management systems meant that care plans fully recorded people's needs and had been reviewed promptly to make sure they were up to date. Detailed individual risk assessments had been introduced to make sure staff knew how to keep people safe.

Improvements to management systems meant that equipment used to care for people in their homes was safe for staff to use.

The agency had improved their recruitment procedure, which made sure new staff were checked thoroughly. Action had been taken so that existing staff records could demonstrate all personnel employed were fit to work with vulnerable people.

We saw the service had improved their range of training and development opportunities for staff. This meant they were kept up-to-date with current practice and the service could demonstrate how their care workers were competent to meet people's needs.

Further development of the management team had meant the service had been able to introduce systems to demonstrate that they listened and responded to the needs of the people they were supporting. We saw they demonstrated how they learned from feedback to show the service was run for the benefit of the people using it.

People shared a variety of comments abo their care. They said, "I am very happy we have a good rapport with the care workers.' 'The carers do a good job. It seems to be the office that isn't organised sometimes.' "Things have not been as good as they should be recently. They were very late on a couple of occasions over one weekend recently and never let me know why."

Care plans recorded most of people's needs but were not always reviewed promptly to make sure they were up to date. Individual risk assessments were not in place to keep people safe.

Systems set up during our last inspection visit to make sure that equipment was safe had not been sustained.

The agency had improved their recruitment procedure, and new staff were checked thoroughly. They had not taken action to ensure previous shortfalls were audited and corrected. This meant that vulnerable people could still be at risk.

Lack of monitoring of staff meant the service could not be sure their care workers were competent to meet people's needs. Staff expressed serious concerns about the conduct of some of their colleagues and the safety of people being cared for.

Slow progress to improve inconsistent management systems, meant the service was not able to demonstrate that people's welfare and safety was protected.

Care plans recorded most of people's needs but were not always reviewed promptly to make sure they were up to date.

Systems were not set up make sure that equipment was safe and maintained but they were put in place after our visit.

Measures were not in place to make sure that only suitable staff worked at the agency. This meant that people who used the service were not protected from the risk of abuse. Staff were provided with induction and ongoing training. The agency had only recently started to offer staff formal supervision. There were not enough management systems or time to support care reviews or supervision of staff in a timely way.

The agency had a complaints system that was given to people when they started using the service. Not all people who received a service felt they could make a complaint and be listened to.

Some systems were in place to find out what people thought about the service. Negative comments had not been addressed. Individual risk assessments were not in place to keep people safe.