Northern Community Careline Services

Northern Community Care Line is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection the service was providing personal care to 50 people.

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

Improvements were needed to the management of people’s medicines to ensure they were safe. Risk assessments were in place, but we noted staff were not always recognising or recording potential risks to the people they supported. Peoples usually received their calls on time. Staff had received safeguarding training and were aware of the action they needed to take in the event they had any concerns.

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. New staff were supported, and staff received supervision and checks on their performance. Staffs’ compliance with training was improving but improvements needed to be made to the training matrix to ensure it was accurate.

People and their relatives told us staff were caring and kind. Staff maintained people’s right to privacy and treated them with dignity and respect. People felt able to express their views and be involved in decisions about their care and support.

Care records were person centred and included relevant information to ensure staff could provide care and support which met their needs. Care records included information about how people communicated. People were aware of how to complain. We saw complaints were recorded and responded to.

Feedback about the service from both people, relatives and staff was positive. The registered manager had continued to make improvements to the service, but we identified systems of governance were not sufficiently robust or effective to ensure the service was fully compliant with all the regulations. Although the service did ask people and staff for feedback, improvements needed to be made to ensure the system and method provided everyone with the opportunity to engage in the process.

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 17 December 2018). 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. The service remains rated requires improvement. This is the second consecutive inspection the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines and governance. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We rated them as inadequate and placed the service in special measures. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. On the day of our inspection 45 people were receiving care and support from Northern Community Careline Services.

The service had a registered manager in place. 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 told us they felt safe. Risk assessments were now in place and there was a system in place to ensure equipment was routinely checked for safety.

There was a system in place to reduce the risk of people receiving late or missed calls. Improvements had been made to recruitment procedures to make it safe.

Risks associated with the management of people’s medicines were not always identified which meant appropriate measures were not always in place to ensure safety. Records relating to the management of people’s prescribed topical creams needed to be improved.

New staff received an induction. Since the last inspection staff had received supervisions and checks on their performance. A significant amount of training had been undertaken by staff although some staff had not received training in all the topics recorded on the training matrix.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had signed their consent to the care and support they received although where people lacked capacity to manage their own medicines, a formal assessment of capacity had not been completed.

People told us staff were caring and kind. Staff respected people’s privacy, confidentiality and maintained their dignity.

Since the last inspection people’s records had been reviewed and updated. Records were person centred and provided sufficient information for staff to ensure people’s needs were met. Although further work was needed to ensure all aspects of people’s care and support included enough detail.

Staff spoke positively about the management of the service. Changes to the systems of governance had been made including the implementation of audits. However, they were not yet sufficiently robust to ensure they would drive the improvements required for all people to receive a consistently high level of service.

At this inspection we found sufficient improvement had been made to meet the regulation relating to complaints and staffing. The service is no longer in Special Measures. This is the first time the service has been rated Requires Improvement. Further improvements were needed to safe care and treatment and good governance to ensure the regulations were fully met.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found sufficient improvements had not been made.

Northern Community Careline Services provides personal care and support to adults and children living in the North Kirklees area of West Yorkshire. It is registered to provide a service to children 4-12 years, people with dementia, older people, and people detained under the Mental Health Act, people who misuse drugs and alcohol, people with a physical disability and younger disabled adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection they were supporting approximately 80 people.

There was a registered manager who had been registered since 15 March 2012. 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.

Although people told us they felt safe, we found aspects of the service that were not safe. Risk assessments were not accurate or up to date and did not contain all the information required to reduce the risks to people using the service.

We found concerns about the way staff recorded the administration of medicines. Medicines policies and procedures to guide staff were not up to date to evidence the registered provider was following best practice. There was evidence not all staff had their training to administer medicines refreshed or their competency checked by a person with the necessary skills.

Staff recruitment was not robust. The reason for a gap in a candidate’s employment history had not been recorded, there was only one reference in one candidate’s file and another candidate’s second reference did not match the referee on their application form, with no reason recorded for this. There was no evidence recent recruits had undergone an interview prior to taking up their post to ensure people with the right values and behaviours were employed to work with vulnerable people.

The registered manager told us no one at the service lacked capacity to consent to their care. Staff had not been trained in the Mental Capacity Act 2005 and were not aware of the principles of the act. Policies and systems did not provide guidance to staff to ensure people were supported to have maximum choice and control of their lives. Staff had very limited knowledge about mental capacity when questioned. There was no written consent form in place to evidence people had agreed with and consented to care outlined in their care plans.

Not all staff had received the required training; supervision and appraisal records were of poor quality and did not follow nationally recognised best practice. Informal supervision was not recorded as had been agreed by the registered manager in their action plan following the last inspection.

Some people and their relatives told us care workers were kind and caring although we were told that this had not always been the case. People said care workers were respectful and mindful of their privacy and dignity at all times.

Care records in the office were kept in a locked drawer to ensure these remained secure and confidentiality had been discussed at induction. However, the registered provider used members of staff own personal mobiles to disseminate confidential information which the staff confirmed to us was not guaranteed to remain confidential. We recommend the registered provider follow recognised guidance in relation to ensuring information is kept confidential whilst using mobile devices.

The registered manager was not yet meeting the Accessible Information Standard and we have made a recommendation, the provider takes steps to meet this standard.

People's care plans, although updated and reviewed at least annually did not contain person-centred information and were missing essential information.

Records and information from people and their relatives showed not all complaints had been recorded. The registered manager lacked oversight of all the complaints and the recording and outcomes of complaints did not detail learning had taken place.

Most staff felt supported by the management team and they described the service as friendly.

There was a lack of systems and processes including regular audits which meant the registered provider was unable to identify where quality and safety needed to improve. Up to date nationally recognised guidance had not been implemented by the registered manager.

There was no evidence to indicate the registered provider had the oversight of quality at the service and we were not provided with any records of meetings between the registered provider and manager.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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

Northern Community Care Line provides personal care support to people living in the North Kirklees area of West Yorkshire. At the time of the inspection they were supporting 77 people.

There was a registered manager in post and we spent time with them. 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 and relatives said they felt safe when with staff from Northern Community Careline as they knew what they were doing and saw regular staff. Rotas were planned around continuity of care provision which meant people were able to build relationships with staff.

Medicines were administered safely and staff knew how to respond to any concerns.

Staff had regular contact with the office and informal discussions took place around workloads and practice issues but there was little formal supervision. All staff had received training in the main skill areas and some of these were due for a refresher. This is a breach of Regulation 18 Health and Social Act 2008 (Regulated Activities) Regulations 2014 as staff did not receive regular supervision and some training had expired.

People had support with nutrition and hydration where this was part of their care plan and staff knew when to request additional external support from other health and social care providers.

The registered manager understood the principles of the Mental Capacity Act 2005 and staff were aware of the importance of seeking a person’s consent before undertaking any tasks.

People spoke positively of the staff saying they were caring and kind. Reviews took place but these needed to be more detailed and to show who had been involved.

The service had a reputation for supportive end of life care and was spoken highly of by other agencies in this regard.

Care records were person-centred and showed how people’s needs were to be safely met and in their preferred way. The service was flexible and accommodated additional requests as much as possible as long as they had the capacity to do so.

The registered manager was spoken highly of and staff felt supported. People told us they had seen the registered manager delivering care themselves and felt able to approach them. The quality assurance systems were in existence but needed further development to ensure that changes and improvements to the service were evident.

You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with made comments such as: 'Staff know my needs, they never rush me and I'm happy with the service' and 'I feel respected'.

We saw staff respected and involved people in their care. Staff were seen to be kind and friendly. They cared for people in a sensitive and personalised way.

We looked at seven care records and saw people's needs were clearly outlined. People knew they had care records and had signed them.

People told us they felt safe and staff we spoke with said they knew how to safeguard people from abuse.

We found staff were recruited and vetted effectively to make sure they were suitable to care for people.

People and their relatives mostly knew how to complain if they were not happy with the service but we found there had been no complaints since the last inspection.

We spoke with three care staff who were complimentary about the manager and the support they received. They told us they had competed training for their role which included a National Vocational Qualification (NVQ) in care at level 2. This meant they have been assessed as competent in their caring role. However, we found that not all staff had received fist aid training which meant they may not have the knowledge and skills to deal with unforeseeable first aid situations.