Comficare Ltd

Comficare Ltd is a domiciliary care service providing the regulated activity of personal care. It provides support to younger adults, older people (some of whom have dementia), and to some people with sensory impairment or a physical disability. At the time of our inspection there were 35 people using the service. 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

People were sometimes exposed to the risk of avoidable harm. This was because some risks, for example, those associated with catheter care, were not always assessed, recorded or fully mitigated against.

Although the provider had good oversight of the service, improvements were needed to the auditing processes in place to monitor the quality and safety of the service. This meant the failings we found during the inspection had not been identified or action taken to address them.

People and their relatives told us they felt staff were knowledgeable and provided safe care, so they felt safe being supported by the service. Medicines were managed safely. There were enough staff to meet people’s needs. Staff were recruited safely and went through an induction process where their competencies would be checked before they worked on their own with people.

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. People were supported to access health care when they needed it.

Staff received training to ensure they could provide safe care for people. The provider checked staff were competent to carry out their duties. People’s needs and preferences were assessed when they started using the service, and care plans were drawn up in consultation with them. Care plans were reviewed regularly, if, and when, people’s needs changed or if they requested a review.

People were frequently asked for their views about the service and the provider had created an open culture where people could say if they weren’t happy with something. People and relatives told us concerns had been responded to well and in a timely way.

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 19 November 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Comficare Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk assessment and governance of the service at this inspection.

Comficare Limited is a domiciliary care service. At the time of inspection it provided personal care to 26 older people, some of whom had dementia or a physical disability.

People’s experience of using this service and what we found

People's capacity had not been assessed. Therefore, they were not always supported to have maximum control of their lives, in the least restrictive way, and in their best interests. People’s needs were assessed, and they were involved in creating their own care plans. People were supported to maintain good health and access healthcare services when required.

The registered manager had daily oversight of the service but there were no robust quality assurance systems. People and their relatives told us the registered manager was approachable and responsive. People’s views of the service were sought in annual surveys, during staff visits and in calls by the registered manager.

People’s individual risks had not always been fully assessed. However, staff knew people well and understood risks associated with their care. Staff understood their responsibility to protect people from the risks of abuse and infection, and supported people to take their medicines safely. Staff were recruited safely and inducted.

People were treated equally and with dignity. Diversity, privacy and independence were respected.

People’s care was personalised to meet their needs. People could access information in a format they were able understand, and knew how to raise concerns with the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 12th October 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the need for consent and governance of the service at this inspection.

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 from the provider to understand what they will do to improve the standards of the need for consent and good governance. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was undertaken on 22 and 23 November 2018.

At our last inspection of the service in March 2016 we rated the service 'Good'. At this inspection we found the evidence continued to support the rating of 'Good'. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

There was a registered manager 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.

Risks associated with people’s care were identified and measures were in place to reduce avoidable risks. Staff received training to ensure people were supported with managing their medicines. Processes were in place to protect people from abuse and neglect and staff were aware of how to raise any concerns.

There were enough staff to deliver the care planned and staff had been recruited safely to ensure they were suitable to work with people.

People’s liberty and choice was promoted. People were involved in decisions about their care and subsequent reviews. The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. This meant people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way.

The service worked in partnership with other health and social care professionals to ensure people received the care and support they required. Professionals said the service was pro-active, alert to any changes and worked well with them for the benefit of their clients.

People were supported by staff who were trained and supervised to do their job. People expressed total confidence in the staff who visited them. Comments included, “I can’t find any fault…”; “They are a very professional company” and “This company is wonderful. The care is superb…” Staff had received training relevant to their roles and were positive about the support provided.

Staff consistently demonstrated a kind and caring approach towards people. People told us, “This service had transformed our lives…” and “The standard of care is first-class…”

People’s needs were effectively assessed prior to the service commencing. Care had been planned with each person and their relative where appropriate.

There was an open and supportive culture at the service. The service sought feedback from people, relatives and staff to ensure the service continued to improve and develop. A range of checks were undertaken to help maintain the quality of the service and identify where improvements could be made.

Further information is in the detailed findings below

This inspection was undertaken on 14 and 21 March 2016.

We last inspected the service on the 10 & 11 September 2014. At that inspection we found the provider was not meeting all of the regulations we inspected. The need for improvement was identified in relation to the management of medicines and records. At this recent inspection we found improvements had been made.

There was a registered manager 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, who used the service, and their relatives, were complimentary about the standard of care provided. Comments included, “…I can’t praise the staff enough…some are exceptional”; “They (staff) are great friends to me…” and “The service is very good…there is never a problem…” Professionals were equally complimentary. One said, “…the service is very accommodating…” Another said, “…Comficare have found good solutions…”

People were treated with kindness, dignity and respect and they were supported to remain as independent as possible. Staff knew people well and ensured their preferred routines were met. People were involved with planning and reviewing their care. Care records were written in a sensitive and person centred way.

People and their relatives said the service was ‘reliable and flexible’; staff arrived when expected; stayed for the agreed length of time and visits were not missed. Since the last inspection two visits had been missed in error. The registered manager had apologised to the people affected.

People said the service they received was safe. Medicines were safely managed where staff assisted people, and procedures were in place to ensure people received their medicines as prescribed. Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and how to reduce them.

There were sufficient numbers of staff available to meet the needs of people who used the service. There was an effective recruitment and selection process in place and the necessary relevant checks had been obtained before staff were employed. Staff were suitably trained and received regular supervision and support.

Staff had an understanding of the Mental Capacity Act 2005 and when needed mental capacity assessments were completed. Staff understood the issues of consent and people confirmed staff enabled them to make choices about the care and support delivered. When people lacked capacity to make their own choices, decisions had been made on their behalf in their best interests.

A complaints procedure was in place, which people confirmed they were aware of. People’s concerns and complaints were listened to, addressed in a timely manner and resolved quickly.

People said the service was well managed. There were effective systems in place to monitor the safety and quality of the service. Regular feedback about the quality of the service people received had been sought. Where improvements had been identified there were on-going plans for improving people’s experience of the service.

The service had developed good links with other community professionals. One professional said there was good communication with the service and that they were always alerted to any concerns or problems. Another said, “We have been impressed with Comficare’s input…”