Archived: Comfort Call Bristol

Updated 14 September 2017

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.

This inspection took place on 21, 22 and 23 June 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available to talk with us. It was carried out by an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service before the inspection visit.

During the inspection we spoke with 11 people, seven relatives, seven staff, one company trainer, the manager, the regional director and the regional manager. We looked at seven staff files, five staff rotas, the registered manager’s file, 10 care plans and associated records, complaints, quality assurance, policies and procedures, training records, minutes of meetings and other management records. The provider had a protection plan in place, which identified areas for improvement. The protection plan was used to record when actions had been completed.

Updated 14 September 2017

This inspection was carried out on 21, 22 and 23 June 2017 and was announced.

When the service was last inspected on 31 March 2016 we found two breaches of the Health and Social Care Act 2008. Breaches of legal requirements were found where medicines were not always managed safely and up to date, accurate records were not maintained. These breaches were followed up as part of our inspection, however we found the required improvements had not been made.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Comfort Call, on our website at www.cqc.org.uk

At the time of this inspection, the service was providing care and support to 133 people in their own homes.

There was not a registered manager in post. A manager was in post who was going through the registration process. 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 there were not enough staff to meet their needs. Staff often arrived late to provide care and support to people, or missed visits altogether. Staff rotas showed staff were sometimes expected to be in two places at once, and were not always given sufficient travel time between people. People told us they had to rely on family members for their care. Managers had not identified the shortfalls with the rotas and had prioritised other things.

Not all risks to people had been assessed. Risk assessments did not always inform the plans of care. Staff did not have guidance in care plans what to look for if people with health conditions, such as diabetes, were to become unwell. Staff told us they had not received training to support people with complex needs.

People did not always have their medicines in a timely way. The manager had identified some people could not be guaranteed to receive their medicines at specific times, so had informed the local authority, who were in the process of transferring their care to other providers.

Where people had consistency in staffing, staff knew the people they supported and provided a personalised service. Some people did not benefit from consistent staffing and had different staff for many of their visits. People and their relatives had mixed views about the skills and caring nature of staff. We observed some positive interactions between staff and people they supported, however we also observed some staff were rushed.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work with the service. Staff received training in manual handling, safeguarding and infection control. Staff had not received specific training for conditions such as pressure ulcers or epilepsy and told us the training they were given wasn’t enough.

Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care. Although people had been involved in writing their care plans, most people told us they were not involved in regular reviews of their care. People were supported to eat and drink.

People told us their complaints had not always been responded to. The manager explained complaints had not been logged prior to them joining the service. People’s feedback was regularly obtained via telephone calls and quality assurance visits.

The staff understood their role in relation current legislation around helping people to make decisions where they lacked capacity. People told us staff respected their choices.

The manager and provider undertook audits to review the quality of the service provided and made some of the necessary improvements to the service.

We found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during our inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.