Archived: Pin Point Health and Social Care

People’s experience of using this service:

At our last inspection the provider had failed to manage medicines safely; robustly assess the risks relating to people’s health, safety and welfare; adequately seek people’s consent to receive care, investigate complaints thoroughly and to have effective governance in place. This resulted in breaches of Regulations 11, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found sufficient improvement had been made and the provider was no longer in breach of these regulations. However, the provider had breached the registration regulations as they had not notified the Care Quality Commission (CQC) about significant events, such as allegations of abuse. This is being dealt with separately outside of the inspection process.

People and relatives felt the service was safe. Staff knew how report safeguarding and whistle blowing concerns.

People received good care from a consistent and reliable staff team. Staff were recruited safely.

People were supported to receive the medicines they were prescribed. Incidents and accidents were investigated and action taken to keep people safe.

Staff were well supported and received the training they needed.

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

People were supported to have enough to eat and drink and to access health care services.

People’s needs had been assessed to identify the care they needed; this was used as the basis to develop personalised care plans.

Complaints were investigated and action taken to address concerns. People knew how to complain; however, the people we spoke with were happy with their care.

The registered manager completed quality assurance audits to monitor people’s care. Staff described the registered manager as approachable and supportive.

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

Rating at last inspection: Requires improvement (the last report was published on 17 February 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our reinspection schedule for services rated good.

Pinpoint Health and Homecare is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes in the North East. The care offered varied from short support visits to 24 hour care. There were 28 people using the service at time of inspection.

The service did not have a registered manager in post. They had recently appointed a new manager who intended to apply to register with us. 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 service had recently recruited to a number of key posts and most senior staff had been in post for around two months. This meant that most of the new procedures and checks the provider had implemented had either just started, or were about to start.

We found that people’s medicines were still not being managed as required. We found that staff had undergone recent training and a new policy had been implemented, but that action was not taken where recording errors were found. This meant people may not have received medicines as prescribed.

People still told us that support calls were late or missed and that they were not told if there was to be any delay in support arriving. Staff and people told us that consistency and timeliness of staff support remained an issue.

Staff were now receiving regular supervision, but annual appraisal of staffs training and development needs had still not taken place for staff employed more than a year. We have made a recommendation about this.

People or their representative’s consent was still not being consistently sought or recorded in peoples care plans. Where people lacked the mental capacity to make decisions it was not always clear that staff followed the correct processes when making decisions on their behalf.

A new complaints process had been implemented and more recent complaints were being managed effectively. However some complaints made since our last inspection had not been completed and staff were not managing all complaints in line with the new process. We have made a recommendation about this.

A number of issues we found at previous inspections had not been acted upon, or completed in a reasonable timeframe; the leadership and governance of the service had changed a number of times in the last year resulting in intermittent progress. Information submitted to the CQC by the provider before inspection was inaccurate. A voluntary agreement with the CQC to suspend new work had been missed by staff and new people had been assessed and provided with a service. However the service had made improvements in a number of areas in a short time period following the appointment of new senior staff and care staff recruitment.

Risk assessment and contingency plans for the delivery of the service were now in place. Staff felt able to raise any concerns they may have about the safety of the service and felt these would be acted upon.

New staff had been recruited safely and staff had been subject to thorough checks and a revised induction programme. New staff felt supported and adequately trained before they started work with people. Supervision had started for all staff and they told us they felt supported by senior staff to do their jobs well. Staff told us they could seek support from office staff and felt this was responded to quickly.

Arrangements were in place to request support from health and social care services to help keep people well. External professionals’ advice was sought when needed.

People and relatives told us the staff were caring towards them and treated them with dignity and respect at all times. Staff gave us examples of how they helped people maintain their independence and choice through supporting them as they wished and working in collaboration with family carers.

Care plans were more person centred and detailed how best to support people in a manner of their choosing. Reviews of care had been conducted and people’s feedback sought as part of the review process.

People, relatives and long standing staff told us the service leadership had improved recently. They felt the service had ‘turned a corner’ following changes in senior management and other changes to how the service was delivered and managed.

Newly appointed senior staff were open and transparent with us about the issues affecting the service. Where action was needed they took this quickly and supplied us with information requested. The provider was willing to work with the CQC to help improve the service further.

We found breaches in relation to safe care and treatment, consent and good governance. You can see full details of the actions we have asked the provider to take in the full report.

Pinpoint Health and Homecare is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes in the North East. The care offered varied from short support visits to 24 hour care. The service did not have a registered manager. They had recently appointed a new manager in April 2016 who intended to apply to register with us. 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.

We found that the provider’s medicines policy and procedures were not implemented effectively to ensure that people’s medicines were handled safely. We found that staff competency in this area had been checked but that audits of records were not occurring.

Not all risks to people were assessed and managed by the service effectively. Some advice from external professionals on how to manage or reduce these risks was not being followed consistently.

Records did not show that the service safely recruited new staff to work with vulnerable people or that effective disciplinary action was always taken. There were known gaps in employment records and action was taken by the provider to address these after our inspection.

Some people, staff and commissioners felt the service did not always respond robustly to concerns they raised. They told us that in the past they had raised issues such as late calls, but that effective action had not always been taken. They told us this had improved under the new manager.

Staff had not received training support to ensure they were able to carry out their role effectively. Regular formal induction and supervision processes were not in place so staff did not receive feedback on their performance and help in identifying future training needs.

People’s consent, or their representatives, was not always obtained before care commenced. Staff lacked awareness and knowledge of the Mental Capacity Act 2005, which meant they could not support people to make choices and decisions where they did not have capacity, or had fluctuating capacity.

Arrangements were in place to request support from health and social care services to help keep people well. External professionals’ advice was sought when needed, however this was not always reflected in updated care plans or records.

People’s confidential information was not always protected as the service had sent out people’s names by error to other people using the service. People told us most staff were respectful and treated them with dignity and some told us they felt empathy and care from the staff who supported them although this wasn't always consistent across all staff. There were some concerns raised about changing staff teams meaning that staff did not always know people well.

People had their initial needs assessed but these lacked details of how to provide personalised care. Information as people’s needs changed over time were not always reflected in updated care plans. People were given information about the service and initial assessment and could contact the manager for support.

People could raise any concerns with staff, but the provider lacked a consistent process for investigating and responding to complaints. We saw that the new manager had responded well to recent complaints and taken steps to improve the service, learning from these events.

An action plan developed in response to the last inspection had not been acted upon or completed due to a lack of key staff and leadership. There had been a period of time where there had been a lack of clear leadership and quality assurance of the service was not robust.

The service did not have a process to seek feedback from people or staff, or learn from incidents and take action to improve the service. For example missed calls were not correctly recorded or consistent action taken to prevent re-occurrence.

The new manager had taken steps to improve the attitudes of existing staff and increase training and supervision support as well as recruit to new key roles to help manage and improve the service. New staff responsible for quality assurance and human resources were to be recruited to support the new manager.

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