Archived: Comfortcare

At our last inspection of December 2017, we rated the service as inadequate overall and placed into special measures. We had concerns about all areas of the service. The provider had not ensured people received safe care in line with their needs and preferences. We found the provider to be in breach of regulation 9, 10, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked them to complete an action plan to show what they would do and by when to improve the service to at least good.

This comprehensive inspection was completed on 30 October and 7 November 2018 and was announced.

Since our last inspection the number of people being supported had reduced from 30 to 10 and many of the people who we had been concerned about due to their complex needs were no longer supported by the service. There were also less staff due to the number of people being cared for. The registered manager and care manager had worked with the Local Authority to address our concerns and started improving the management and quality of the service. They had made significant progress and we found the service was no longer in breach of regulations. However, we found some of the new systems were not yet fully implemented or well-coordinated.

The service had a registered manager. 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. There was also a care manager who had worked closely with the registered manager to implement improvements.

The registered manager had demonstrated a commitment to improving the service by investing in a number of new systems, such as an electronic monitoring system to track staff visits and a new training room. There were new audits in place to check the quality of the service and communication had improved with people, families and staff. There was a more open culture at the service. Communication with stakeholders such as the Local Authority was usually in response to concerns.

We made a recommendation that the registered manager develop more positive and pro-active relationships with outside organisations.

There were enough safely recruited staff to meet people’s needs. The registered manager had put new measures in place to improve people’s safety, though these had not all been implemented fully and further time was needed to ensure they were effective. Staff had been retrained in administration of medicines and there were new forms to record and monitor the support provided. Staff supported people to minimise the risk of infection.

Training had improved, though there was still a need to develop staff skills and guidance where people had more complex needs. Supervision of staff had improved, however the new systems to record and review how the service managed staff practice still needed improvement. The care manager was now able to check that people’s wellbeing and nutritional needs were being met because staff recording had improved.

Staff worked more closely with external professionals to meet people’s needs. Staff ensured support took into consideration people’s ability to make decisions about their care.

There was a more caring approach throughout the service, and an expectation of staff to treat people with respect and dignity. People had an increased say in the service they received. Support was more personalised and tailored to people’s needs. The new care plans and review process were still being implemented, but once in place they would enable staff to provide a more responsive service to people and families.

The complaint process had improved but the registered manager needed to ensure the system for recording complaints was functioning effectively. There was no one in the service receiving end of life care.

We made recommendations around improvements in developing staff skills in this area.

Comfortcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

Prior to the inspection we received a number of concerns from the local authority and relatives of people using the service about the quality of service being provided, missed and late visits, poor care and poor meal provision. Because of these concerns, the inspection was unannounced.

At our last inspections on 27 February 2015, we found the provider to be in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not effective systems in place to assess and monitor the quality and safety of care that people received. Following the last inspection, we asked the provider to submit an action plan detailing what they would do and by when to improve the key question to at least good.

At this inspection, we found that there continued to be a shortfall in the quality monitoring systems and additional multiple breaches of the regulations were also found. You can see what action we told the provider to take at the back of the full version of the report.

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.

At the last inspection on 27 February 2015, we asked the provider to take action to make improvements to how they assessed and monitored the quality of the service. During this inspection, we found the required improvements had not been made. There were widespread shortfalls in the leadership of the service. There was a lack of managerial oversight and the quality assurance systems in place were not effective in enabling the provider to continuously assess, monitor and improve the service.

The provider had not submitted notifications to CQC in line with statutory requirements.

A complaints procedure was in place. However, people were not always confident that the service would respond promptly or address the concerns and complaints raised.

The service sent satisfaction questionnaires to people who used the service and their relatives, asking them for their views and opinions of the service they received. Some of the responses were poor demonstrating that people had been dissatisfied; however, we were unable to see how this information had then been used to improve the quality of the service.

Risk assessments in relation to people's daily living lacked detail and were not always reflective of people’s current needs.

Staffing levels were not adequate to meet the needs of people. Both people who used the service and relatives raised concerns about irregular call times, stating staff were not always punctual and missed calls had also occurred. The provider had failed to recognise the impact of late or missed calls upon people.

There was limited monitoring of people's medicines and effective systems were not in place to record how and when staff administered medication.

There were insufficient systems in place for the induction, supervision and appraisal of staff.

Staff received training to support them in their role in areas such as; safeguarding, infection control, equality and diversity and moving and handling. However, some people using the service had spinal cord injuries and one person had a stoma bag. Staff had not received training in relation to these conditions and there was no evidence of staff competencies assessments after completing training sessions.

Staff supported people in line with the legislation of the Mental Capacity Act (MCA) and during the inspection, no unnecessarily restrictive practices were observed. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, wherever possible, people make their own decision. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible

Staff did not have the necessary skills to meet people’s nutritional needs.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.

Services placed in special measures will be inspected again within six months. If the service has made insufficient improvements 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.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.