The Care Quality Commission
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Archived: Comfort Call (Salford)

Overall: Inadequate read more about inspection ratings

Barton Hall Business Centre, Hardy Street, Eccles, Manchester, Lancashire, M30 7NB (0161) 787 7567

Provided and run by:
Comfort Call Limited

Important: This service is now registered at a different address - see new profile
Important: This service was previously registered at a different address - see old profile

All Inspections

11 April 2016

During an inspection looking at part of the service

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

16 December 2015

During a routine inspection

This was an announced inspection carried out on the 16 December 2015.

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

There was a no registered manager in place at the time of our inspection. 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 branch manager who had only just been appointed confirmed their intention to register as manager with CQC. They were present throughout the inspection together with the regional manager.

At the last inspection carried out in July 2014, we did not identify concerns with the quality of care provided by the service.

During our inspection, we identified one breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), in relation to the safe management of medication. You can see what action we told the provider to take at the back of the full version of this report.

We looked at a sample medication administration records (MAR), which recorded when and by whom medicines were administered to people who used the service. We found that records supporting and evidencing the safe administration were not always complete and accurate. We looked at medication administration records for the four people we visited in their own home. We found repeated signatures gaps and omissions in these records, which covered the period October to December 2015.

We looked at the records of ten people who used the service, whilst at the office. We found repeated omissions/ signature gaps in three of these records. We looked at internal medication audits undertaken by the service and noted a theme of signature omissions during 2015. Though action was taken to address these issues with the individual staff concerned, we found that records failed to demonstrate that people had received their medication safely and in line with their prescription.

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.

The majority of people we spoke with who used the domiciliary care service told us they felt safe with their regular care staff and also felt their possessions were safe. However, some people told us they did feel safe at times when unknown care staff came to their house.

We found people were protected against the risks of abuse, because the service had robust recruitment procedures in place.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. Most people we spoke with told us that calls were generally on time, but several people also told us their calls were often late and that they were not informed by the office. Five people who we spoke with told us that they had experienced calls that were often significantly late.

People who lived in their own home told us they thought that their regular care staff were well trained, knew how to undertake personal care tasks and provided unhurried care.

New staff undertook an induction programme, which involved a period of classroom based training and shadowing of senior staff. New staff also enrolled on the ‘care certificate’ programme, which was a 12 week programme covering all aspects of adult social care.

We looked at supervision and annual appraisal records and spoke to staff about the supervision they received. We found that staff received regular supervision, which enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner. We saw that the service managed supervision effectively by both office based interviews and ‘spot checks’ to monitor competency of staff.

We found that before any care was provided, the service obtained written consent from the person who used the service or their representative. We were able to verify this by speaking to people and from reviewing care file records.

People told us staff were kind and caring.

People also told us that regular care staff respected their or their family member’s dignity and privacy.

Some people told us the care staff helped to promote their independence.

Some people we spoke with and their relatives felt that the care and support they received was not always responsive to their individual needs. A number of people who used the service told us they often did not receive support from regular care workers and they often had care from new or unfamiliar care staff, who didn’t know their requirements. A number of people told us that the service didn’t always contact them to say the care staff were late or had been changed.

Most people we spoke with confirmed having been involved in initial discussions about their personal care requirements and had been involved in subsequent reviews, which they found helpful.

We found the service had systems in place to routinely listen to people’s experiences, concerns and complaints. Most people we spoke with knew how to make a complaint.

The service sent out questionnaires to people who used the service and their relatives. We looked at the service quality survey for 2015, which received a response rate of 33 percent. The service also undertook ‘quality assurance telephone checks’ and ‘quality assurance visit checks,’ which enabled people who used the service to comment on the quality of services provided and raise any concerns.

We looked at care files to understand how the service delivered personalised care that was responsive to people’s needs. We found that initial assessments were undertaken to determine the needs of people. Care file records contained people’s life story details and considered issues such as communication, memory issues, sleeping patterns and behaviour.

Whilst people who used the extra care housing scheme told us they thought the service was well-led, some people who used the domiciliary care services did not hold the same view. This was because of poor communication and what they perceived were problems with staff leaving, unfamiliar care staff, late calls and call time requests that could not be accommodated.

We found the service undertook a comprehensive range of checks to monitor the quality service delivery. These included telephone service quality checks and unannounced ‘spot checks,’ where people were invited to comment on the quality of the service they received. However, we questioned the effectiveness of medication audits in view of the issues we identified.

Providers are required by law to notify CQC of certain events in the service such as serious injuries, deaths and safeguarding concerns. Records we looked at confirmed that CQC had received all the required notifications in a timely way from the service.

3 July 2014

During a routine inspection

Comfort Call Salford provided personal care to people within their own homes in the Salford area. At the time of our inspection the service had just moved to new offices located at Barton Hall Business Centre, Hardy Street, Eccles, Salford.

As part of the inspection we spoke to 15 people who used the service and six members of staff. We also visited five people in their own homes.

Our inspection was co-ordinated and carried out by an inspector, who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they had no concerns about their personal safety. We found safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us they felt their rights and dignity was respected.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff knew about risk management plans and we looked at examples within care files. We found people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice was identified and people are protected.

Is the service effective?

People's health and care needs were assessed with them and they were involved in writing their plans of care. People said that their care plans were up to date and reflected their current needs.

Is the service caring?

We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, comments included; 'No concerns they are helpful and friendly.' 'They are very kind and good. I'm very pleased with what they do.' 'I'm very satisfied with the service.'

When we spoke to staff it was clear that they genuinely cared for the people they supported.

People who used the service completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed by the service.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with and found that the responses had been open, thorough and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service had quality assurance systems to ensure high standards of care were maintained. Problems and concerns were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities.