Archived: Comfort Call (Salford)

Updated 28 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced focused inspection at Comfort Call (Salford) on the 11 and 13 April 2016. This inspection was undertaken to ensure that improvements that were required to meet legal requirements had been implemented by the service following our last inspection on 16 December 2015.

We inspected the service against two of the five questions we ask about services during an inspection, which were not meeting legal requirements. These were specifically; ‘Is the service Safe’ and ‘Is the service well-led.’

The inspection was undertaken by one adult social care inspector and a CQC pharmacist. Before the inspection, we reviewed all the information we held about the service, including concerns that we had received. We reviewed statutory notifications and safeguarding referrals. We also spoke with several relatives of people who used the service, who had raised concerns about the quality of services delivered.

We also reviewed the action taken by the provider following our previous inspection, who wrote to us explaining what action the service had taken to meet legal requirements.

At the time of our inspection there were 511 people living in the Salford area that used the service. We were told that 307 people utilised the domiciliary care services the company provided where staff attended people’s own home to provide personal care. The service also operated four extra care housing schemes, which was used by 204 people. Each scheme was run by an extra care scheme manager and provided staff 24 hours a day on the premises.

Updated 28 June 2016

We carried out an announced focused inspection of this service on 16 December 2015. During that inspection we found the service failed to meet the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment. The service had failed to protect people against the risks associated with the safe management of medication. After that inspection, the provider wrote to us to tell us what action they had taken to meet their legal requirements in relation to the safe administration of medication.

Comfort Call (Salford) provides domiciliary care services to people living in their own home and manages four extra care housing schemes based in Salford. The service is registered to provide personal care. Care is provided for older adults, which some have deteriorating mental health. The office is situated in Barton Hall Business Centre, Eccles, which has adequate parking available.

There was no registered manager in place at the time of our inspection, though a new manager had recently been appointed. 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.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. Prior to this inspection we received a number of significant concerns as a result of safeguarding referrals made to the local authority and complaints made by people who used the service and their relatives regarding the service they received. This related to a high volume of missed and late calls, which impacted on the services ability to administer medication safely. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Comfort Call (Salford) on our website at www.cqc.org.uk.

During our inspection, we identified three breaches of Regulations of the Health and Social Care Act 2008(Regulated Activities) Regulation 2014 (Part 3), in relation to the safe management of medication, staffing and good governance. You can see what action we told the provider to take at in order to address these concerns.

At the last inspection, in December 2015, we found that medicines were not handled safely and we told the provider they must take action to improve the safe handling of medicines. We visited the service on 11 and 13 April 2016 to ensure that improvements had been implemented. During the inspection, we visited six people in their own homes who were prescribed medicines that were administered by Comfort Call staff.

We found concerns regarding the safe handling of medicines for all these people. We found that records could still not be relied on to demonstrate that people had been given their medicines as prescribed for them. We found that information about medicines in people’s care plans were incomplete and did not explain how staff should handle people’s medicines safely. Information recorded in people’s care files regarding their ability to look after their own medicines was confusing and contradictory.

We also found there was no information as to who was responsible for ordering medicines. One person’s records showed that the medication was ‘finished’ after 23 days, when only 21 days have been supplied, which indicated that their medication lasted two more days than it should have indicating medication had not been given each day.

Within care files, we found medication assessments had a space to be filled in if medicines were ‘time critical.’ We saw people prescribed medication that must be given at specific times, but there was no information which medicines should be administered at specific times. We saw people were not given these medicines at the correct times.

When people were prescribed medicines to be taken ‘when required,’ there was no information recorded to help staff decide when the medicines were needed.

During our visits we saw four people were prescribed Warfarin. This is a medication which required special monitoring to ensure that their blood is not too thick, placing them at risk of a stroke or too thin, placing them at risk of bleeding. We looked at Warfarin records for two people and saw they were either not given at the correct time or had not been given properly. Two other people had been given the wrong doses of Warfarin.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment, because the service had not protected people against the risks associated with the safe management of medication. CQC are currently considering their enforcement options in relation to the continued failure to meet the requirement of regulations in respect of the safe management of medication.

Both prior to the inspection and during this process we received information as a result of safeguarding referrals and complaints from relatives of people who used the service regarding consistently late or missed calls. The service was able to confirm from their own records that since February 2016 they had reported 10 missed calls. We found from speaking to people and from records supplied by the service that visits were often late and that staff often failed to undertake the full duration of the call. This was particularly noticeable for 15 minute calls, such as bedtime and medication, where staff were present for significantly less than the 15 minutes the service was being paid for.

We found that the service had insufficient numbers of staff deployed to ensure visits were undertaken effectively and within reasonable time scales.

We found repeated examples of when staff were significantly late for calls. We also noted that duration times, especially for 15 minutes calls were regularly of a shorter duration. We found that staff were sometime allocated two calls at the same time, meaning one call would be definitely late. We saw examples where travelling times between call had not been taken into consideration, meaning staff would always be late as a result.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to staffing. This was because the service failed to deploy sufficient numbers of staff to ensure visits were undertaken effectively within reasonable time scales. CQC are currently considering their enforcement options in relation to this matter.

We reviewed data provided by service, which included staff rotas and time sheets and found repeated examples of late calls being undertaken by staff. We saw examples of where staff had been allocated three or two calls at the same time, which meant calls were being scheduled in the knowledge they would be late. We noted that from the allocation of these calls, staff would invariably be rushing to meet scheduled times, which clearly impacted on the duration of time they spent with people who used the service.

Whilst the management team were very transparent and open about the current difficulties they faced as a service, we found no evidence that the provider had implemented any effective systems to assess, monitor and improve the quality and safety of the services provided in relation to the administration of medication and the scheduling of calls, given the concerns we found. The service was able to provide management data, which we were shown regarding scheduling, staff rotas, times and duration of calls. However, we saw no evidence that this data had been analysed to address the concerns we had identified.

We saw examples were individual members of staff were repeatedly late for calls and were not undertaking the full duration of the call. We found no evidence that the service had actively identified these concerns or taken any action with the individual member of staff to ensure calls were undertaken in a timelier manner.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. The service had failed to implement systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. CQC are currently considering their enforcement options in relation to this matter.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will 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 we will move to close the servi