Archived: Comfort Call Nottingham

Comfort Call Nottingham is a domiciliary care agency, providing personal care to people living in and around Nottingham City. 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 the inspection 240 people were receiving personal care as part of their care package.

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

Risks were not always managed effectively. Information about risks and the safety of people was not always comprehensive or up to date. People’s risk assessments were not always in place and guidance for staff on how to support people was not always clear and thorough.

Staff were not always given enough time to travel to people which resulted in some support calls being late. Staff training did not provide staff with all the skills they needed. As a result, not all staff felt confident in delivering all areas of support. For example when supporting people in distress. Not all staff felt supported, because they have not always received regular supervisions or attended staff meetings.

The leadership was not always reliable because the provider did not ensure appropriate cover for absent managers. As a result, we identified shortfalls in the governance of the service. The quality assurance processes were not always effective in ensuring risks were managed effectively. People did not always feel their complaints were managed effectively because the provider did not always follow their own complaint’s policy.

People’s mental capacity was assessed by staff who understood their responsibilities; however, the provider did not record the assessments in line with the legislation.

People’s prescribed medicines were mostly safely managed and administered by trained staff.

People were protected from abuse bullying, harassment and avoidable harm, by staff who understood their safeguarding responsibilities.

Staff had received training and ongoing information and guidance about how to reduce the potential spread of infections.

People were supported to have a healthy diet when this was identified as an area of support. People’s changing needs were monitored by staff who referred them to external health and support services when needed.

People were treated with kindness and compassion by staff who respected people’s dignity and independence.

The service was responsive to people’s needs, preferences, interests, and communication needs. People felt involved in the planning and delivery of their care. People were supported with activities of their choice when this was identified as area of support.

Staff worked in partnership with other services to support care provision, service development and joined-up care.

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

Rating at last inspection

The last rating for this service was good (published 17 December 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement and Recommendations

We have identified breaches in relation to risk management and good governance 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 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.

Comfort Call Nottingham is a domiciliary care agency, providing personal care to people living in and around Nottingham City. 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 the inspection 287 people were receiving personal care as part of their care package.

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

Improvements had been made to staffing; there were sufficient skilled and competent staff to meet people's individual needs. Staff received ongoing training and support. Whilst people had experienced late calls, the electronic data monitoring confirmed improvement had been made and current action was being taken to make further improvements.

The systems and processes used to assess, monitor and review the service had improved since the last inspection and was found to be more effective. The service was managed by an experienced registered manager. Recent recruitment of new experienced care coordinators had further strengthened the management team, who were supported by senior managers who had oversight of the service.

Risks associated with people's individual needs including the environment, had been assessed and staff were provided with guidance on how to mitigate risks. Staff had received safeguarding training and were aware of their responsibilities to protect people from abuse, avoidable harm and discrimination. Prescribed medicines were safely managed and administered to those people who required them. Staff had received training and ongoing information and guidance about how to reduce the potential spread of infections and to support them during the current Covid 19 pandemic. Incidents were reviewed to identify any themes from which lessons could be learned.

People received a responsive service that met their individual needs. Improvements were being taken to ensure people received care and support that met their individual care needs.

Electronic care records were used to provide staff with guidance of how to meet people's needs and care calls were monitored. People's care packages were being reviewed with them, to ensure call times met their care needs and preferences.

People had access to the provider's complaint policy and procedure. Complaints were reviewed and responded to in accordance with the provider's expectations.

People received opportunities to share their experience about the service. Staff worked defectively with external professionals. The provider had an ongoing action plan to further drive forward 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 Requires improvement (published 18 November 2020) and two 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.

Why we inspected

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 Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous 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 improved to Good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Comfort Call Nottingham 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.

Comfort Call is a domiciliary service providing personal care to vulnerable older people and younger adults in their own home. The service is run from an office located at Southglade Business Park on the outskirts of Nottingham.

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 start of the inspection 232 people were using the service. However, during the inspection period, the provider, after consultation with the local authority, reduced the numbers of people supported to 197. An alternative provider was found to support the remaining 35 people.

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

People’s support visits were not always on time and were sometimes cancelled with little notice. The provider did not always have enough care staff to support people safely; and that meant people were sometimes supported by care staff who did not understand their care needs. When people contacted the provider’s office about missed, or late, calls they did not always receive a response.

People were supported by care staff who were not always up to date with the necessary training to protect them from the risk of harm or abuse.

People did not always receive support at the time they needed it. That happened more frequently when the person’s regular carer was absent, because the provider’s staff rostering arrangements did not accurately reflect when people needed support.

People’s care was not well monitored by the provider, because the quality monitoring processes in place were not being carried out consistently. That meant the provider would not always be able to identify if people were receiving appropriate care.

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

Rating at last inspection

The last rating for this service was requires improvement (published 8 January 2019).

Why we inspected

The inspection was prompted, in part, due to concerns received about increased risks; because of low staffing levels and an increase in missed, or late visits, to vulnerable people. A decision was made for us to inspect and examine those risks.

We received concerns in relation to the management of staffing. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No new areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

Since the inspection visit the provider has reduced the number of people it supports. This was following a discussion with the local authority who reallocated some people’s support arrangements to an alternative provider.

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

Enforcement

At this inspection, we have identified a breach of regulations in relation to the provision of sufficient numbers of suitably qualified, competent, skilled and experienced staff. We also identified a breach of regulations in relation to the provider’s systems and processes for ensuring the quality of the service provided to people. 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Not everyone using the service received a regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection there were 216 people using the service.

The service had a registered manager. 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

At our last inspection in June 2016, the service was rated as Good. At this inspection, we found the service rating as Requires Improvement. This is the first time the service has been rated Requires Improvement. This was because the provider had not operated effective governance and quality monitoring arrangements to ensure people were consistently protected from risks associated with unsafe or ineffective care. People had not always received safe or timely care and their medicines had not always been safely given when required.

Risks to people’s safety had not always been identified or managed in a timely way to keep people safe. The provider had also not told us about safeguarding concerns relating to some people’s care when required, to help us ensure people’s safety when they received care from the service. Following local authority safeguarding investigations, care improvements were now being made at the service, with revised management monitoring and provider oversight arrangements established, to fully ensure this. However, the provider had not yet demonstrated their ability to fully ensure and sustain the service improvements required for people’s care.

Staffing and deployment arrangements for care calls had not been effectively managed, monitored or acted on, which had resulted in late or missed care calls. This placed people at risk of unsafe or ineffective care. Management safety checks, including for people’s medicines, were also revised to help ensure people’s safety at the service.

Risks to people’s safety from their health condition, environment or any care equipment they needed to use, were assessed before people received care, but not always consistently reviewed to help inform any care changes needed when required. Remedial action was in progress to address this in consultation with local care commissioners. Staff knew how to keep people and themselves safe and to report any related safety concerns or health incidents. Relevant systems, procedures, training and equipment were in place to enable this. This helped to protect people from the risk of harm or abuse.

People’s care plans had not always been maintained or reviewed with them in a timely manner, to help accurately inform people’s care. The provider’s remedial actions in progress helped to fully ensure this. Recent introduction of an electronic care planning system was imminently due to go live, to enable staff to ensure the timeliness and effectiveness of people’s care.

People often spoke positively about their care experience and felt most staff understood and followed their care needs and knew what they were doing. Staff supported people to help ensure their healthy nutrition and hydration and followed any instructions from relevant community health professionals concerned with people’s care when needed.

Staff understood and followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent or ensure people received care that was rightly agreed, in their best interests when required. Staff had not always received training or supervision in a timely manner, but were satisfied this was now being addressed by the provider, which related records showed.

People received care from staff who were kind, caring and ensured people’s dignity, choice and rights when they provided care. Staff often knew people well and had established good relationships and supported people to be as independent as possible when they provided care. All of the staff we spoke with understood the importance of and how to ensure this. Action was either completed or in progress to improve staffing continuity and to consistently ensure timely care calls and people’s involvement in their individual care plan reviews.

People were provided with service information before they received care, to help them understand what they could expect from the service. Service improvement planning showed the provider planned to fully ensure this information was provided in a way that people could understand.

Complaints and concerns were accounted for. Although not without some delay complaints, and also recent feedback the provider has obtained from people regarding their care experience, was being used to inform and help make service improvements needed.

The provider’s care policy, systems and related staff training helped to ensure people would receive timely consistent and co-ordinated personal care as agreed with them at the end stage of life, when needed.

People, relatives and staff felt the service had not always been well managed or led. Most now felt more confident this was improving, following management structure changes. This had resulted in increased visibility and access to registered and senior managers; and their subsequent consultation with all parties, to help inform and improve people’s care experience.

Partnership working was often sourced and implemented by staff at the service, to help further and improve people’s care experience and to support their independence and wellbeing.

Safe and lawful information handling and data management systems were operated to protect the confidential personal information of people receiving care and staff employed at the service.

The provider had visibly displayed their most recent inspection rating of the service where required to do so.

This inspection took place on 23 March 2016 and was announced.

Comfort Call Nottingham is a domiciliary care service which provides personal care and support to people in their own home in the city of Nottingham. On the day of our inspection around 200 people were using the service each week.

The service had a registered manager. 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

Staff took the necessary steps to keep people safe and understood their responsibilities to protect people from the risk of abuse. Potential hazards were identified and detailed plans were in place to enable staff to support people safely.

There were enough staff to ensure that people received their calls at the planned time and meet their care needs. Where required, people received the support they needed to safely manage their medicines.

Where people required support to eat and drink enough, this support was provided. However, the records were not always kept updated so people could not be sure if they had been given enough to eat and drink to maintain their good health.

People’s consent was sought before care was provided. The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) The provider was aware of the principles of the MCA and how this might affect the care they provided to people.

Staff were provided with the knowledge and skills to care for people effectively and received supervision of their work. Staff made sure that people had access to their GP and other health care professionals when needed.

Positive and caring relationships had been developed between staff and people who used the service. People were involved in the planning and reviewing of their care and making decisions about what care they wanted. People were treated with dignity and respect by staff who understood the importance of this.

People’s care plans provided comprehensive information about their basic care needs and were regularly reviewed and updated. However, care plans did not always contain such detailed information about any specific medical conditions people may have and the implications of this for the support being provided. People felt able to make a complaint and knew how to do so.

The culture of the service was open. People were supported by staff who were clear about what was expected of them and staff had confidence that they would get the support they needed from the registered manager, both during and outside of office hours. The registered manager undertook audits and observed practice to ensure that the care provided met people’s needs.

The most recent registered manager left the service on 11 July 2014 and has not yet completed the process to be deregistered. This means the previous manager's name shows on this report. A new manager has been appointed and takes up their position on 21 July 2014. The regional support manager said the new manager would be applying for registration with us during their first week of employment.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The local authority had investigated a number of concerns about people's care where they had been placed at risk of poor or inadequate care, such as visits being missed. Although not all the investigations had been completed the regional support manager said the majority of these concerns had occurred and the safeguarding investigations would be substantiated.

Some people said care workers had responded promptly when they had an accident. One person said, 'They called for the medics when I passed out.'

Medicine administration records had not been checked by another worker to ensure they had been written out correctly. Records about people's medication administration were not fully completed or accurate. One person said they had run out of tablets. They said, 'Nobody said the tablets had run out.'

Is the service effective?

We found staff were effective at respecting and involving people who used the service. A relative said, 'One lady carer had a really good way with him, she got him to have a routine.'

We found staff were not always effective at meeting the care and welfare needs of all the people who used the service. Rotas had mistakes such as calls missing, different calls planned for the same time and calls from another round included on the wrong rota. A person who used the service said, 'They don't know what they are doing half the time my carer was sent to the wrong place yesterday, it was on her rota.'

A recently appointed care worker told us they had a week long induction when they started which they had found to be 'Very good.' Care workers told us they felt the training was good and helped them with their work. People told us generally they felt care workers were suitably trained. One person said, 'Obviously some are better than others.'

Is the service caring?

Some people told us they felt the care workers understood their needs and met these in a sensitive and caring manner, but some people did not. A relative said, 'Some of the carers are good, others go through the motions.'

Some people who used the service told us care workers used their mobile phones during their visit.

Is the service responsive?

The majority of people who used the service and their relatives told us they felt respected by care workers, however there were some occasions when people did not. One person said, 'Generally yes, but it is person dependent. I am very happy with the good ones.'

People who used the service told us care workers encouraged them to do as much as they could for themselves and their privacy and dignity was respected. One person said, 'We work together.'

Care workers told us they did not always have enough time allowed to travel between calls which meant they arrived late. A relative said, 'The timekeeping is pretty erratic they come early or late.'

Is the service well-led?

We found people's care and support was not always planned and delivered in a way that ensured their safety and welfare. Some people told us their care plans had not been updated when their circumstances had changed. A person who used the service said, 'I am having more calls. The new care plan is not written yet.' There was no evidence to show completed care records were checked as part of the management of people's care and support.

People received calls over a wide time period of their planned call time and calls did not always take place for the length of time they were planned to. Half of the people we spoke with said on one or more occasions a care worker had not turned up for a planned call.

The regional support manager said they were currently based at the service to provide the support and leadership to rectify a number of problems that had been identified.

Care workers said they often had problems reaching the staff member on call as the phone was busy or the staff member was unable to answer because they were driving or carrying out a visit to people who used the service.