Archived: Comfort Call (Liverpool - Meadow Court)

The service is an Extra Care Living Scheme which means people were receiving care in their own homes in a complex which was staffed 24 hours per day. There were 47 people receiving a service at the time of our inspection. There was a scheme manager who was responsible for day to day management duties and a registered manager in post. The registered manager in post was also a registered manager at another location.

A registered manager is 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 service were still in Breach of Regulation 12 2 (g) Medicines as gaps were still found on Medicine Administration Records (MARs) on our recent inspection. Therefore it wasn’t clear if people had received their medicines as prescribed.

There was a breach of Regulation 19 on the last inspection. Out of the four staff files we looked at they included a reference from a family friend or neighbour and therefore, remained in breach of this regulation.

There was a breach of Regulation 17 on the last inspection due to audit systems not highlighting the issues found on inspection. We found the service remained in breach of this regulation as their quality control systems were still not effective and had not identified the concerns we found or appropriately addressed the concerns when they became apparent.

There were insufficient staffing levels to meet the needs of the people needing care. There was evidence of clashes on the rotas were staff were being required to visit different people at the same time.

Risks were not always identified with a risk assessment for staff to follow and risk assessments were not always being updated often enough.

The service was seeking consent at the point of the care package commencing but we could not see how the service was obtaining consent for times of calls. We were concerned the service was not always following Mental Capacity Act 2005 legislation and there was no record of a mental capacity assessment or best interest discussion having taken place for one person who did not have the ability to provide informed consent.

We were concerned people were not always receiving care calls at meal times due to a missed visit or a late visit. Therefore, we could not be sure people were having enough to eat or drink.

Staff were receiving an induction and training however we raised concern with the provider that we had not seen certificates to confirm staff had completed mental capacity training. We were provided with certificates following the inspection for two out of the four staff whos files we had checked. We could not see a system of competency checks being undertaken following training being completed.

Some staff were receiving supervision but not all staff. We did not see any appraisals being undertaken in the staff files we viewed. We were informed by the provider following the inspection that a small number of staff had appraisals due in August 2016 and November 2016 which had not yet been undertaken at the time of inspection. This was due to a new manager starting and there needed to be a period of familiarising themselves with the staff members before it was deemed appropriate for appraisals to be undertaken.

Staff were observed speaking with people in a caring way and were passionate about wanting to be able to deliver an improved caring service for people.

Staff morale was low due to low staffing numbers impacting on care delivery for people. Service users and staff were not always being listened to by the service.

Assessments were being completed and people's signatures were being obtained to agree to their plan of care but the care plans were lacking in detail such as the call times being agreed with the person.

All the care plans we viewed contained some person centred information but pertinent information such as the person’s preferred times to receive their care was missing. We viewed one person’s care plan who was living with dementia and found their plan of care was not detailed enough for staff to know how to provide them with person centred care.

We found a complaints system in place but not all concerns raised were being followed up. This was highlighted within an internal audit completed by the service.

There were ineffective governance and quality assurance systems in place to prevent a staffing crisis from impacting on service users and staff. Communication systems within the hierarchy of management had broken down.

The audits being undertaken were highlighting concerns such as the potential for some staff to be working over 60 hours per week but no checks were then in place to identify if this was occurring to ensure there was no negative impact on the quality of the care being delivered.

The rating of the last CQC inspection was not being displayed for members of the public to read it and to be aware of the overall rating of the service.

The overall rating for this service is 'Inadequate' and the service therefore is 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.

A registered manager was in post. 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 we spoke with told us they felt safe living in Meadow Court and receiving support from Comfort Call and we found that there were adequate numbers of staff available to meet people’s needs. Staff we spoke with had a good understanding of safeguarding and we found that appropriate referrals had been made to the local safeguarding team as required.

Risk assessments had been completed to monitor people’s health and safety, however not all completed risk assessments reflected consistent information regarding risks to people.

Medicines were not always managed safely within the service. There were a number of gaps in administration records and some hand written instructions for administering medicines were incorrect. A medicine policy was available to help guide staff.

Although a policy was in place regarding safe recruitment of staff, we found that this was not always followed. All staff had Disclosure and Barring service checks completed; however, the most relevant references were not always sought prior to a staff member commencing employment.

Staff were provided with personal protective equipment such as gloves and aprons, in line with infection control requirements.

People receiving support told us they were happy with the care they received from Comfort Call at Meadow Court and people told us staff knew them and their preferences, well. Staff we spoke with told us they were informed of any changes within the home, including changes in people’s care.

We found that people were supported by the staff and external health care professionals to maintain their health and wellbeing. People receiving support told us that staff were kind and caring, treated people with respect and protected their dignity.

Staff told us they always asked for people’s consent before providing support and care files contained completed consent forms in relation to care planning and medicines. Families were involved when people were unable to provide consent.

Staff were supported in their job role through induction, supervision and appraisal, as well as regular training to ensure they had the knowledge to meet people’s needs.

People we spoke with were happy with the support they received with their meals; however support provided was not always recorded.

Most care files we viewed were very detailed and specific to the person, reflecting their wishes, choices and preferences and people, or their relatives, had signed to confirm their involvement with the plan of care. We found however, that not all care plans contained sufficient detail regarding people’s needs.

People receiving care and staff, told us that the support was flexible due to the care service being based in Meadow Court. For instance, one person told us if the carers called in the morning and they were not ready to get out of bed, the staff would arrange to come back later in the morning.

Processes were in place to gather feedback from people and listen to their views. People had access to a complaints procedure within the service user guide provided to people when their support was arranged.

A range of activities were offered to people and a reminiscence room was also available.

Feedback regarding the management of the service was positive. Staff felt supported and had access to advice from managers at all times.

Staff were aware of the company’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

Processes were in place to monitor the quality and safety of the service. However, issues identified during the inspection were not all picked up through the providers audit processes.

We looked at processes in place to gather feedback from people and listen to their views. Resident and staff meetings were also held regularly and people told us they were encouraged to share their views and felt they were listened to.

The manager had not notified the Care Quality Commission (CQC) of all reportable events and incidents that occurred in the service in accordance with our statutory notifications, such as safeguarding referrals.

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