Archived: Comfort Call Northampton

Updated 27 May 2016

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 unannounced inspection was carried out on 12, 13 and 14 April 2016 by five inspectors, one of which was a pharmacy inspector.

We reviewed information we held about the provider including, for example, statutory notifications that they had sent us. A statutory notification is information about important events which the provider is required to send us by law. We contacted the health and social care commissioners that help place and monitor the care of people receiving personal care in their own home that have information about the quality of the service.

We undertook general observations in people’s homes, including interactions between staff and people. We looked at how people’s medicines were administered and spoke with staff about their knowledge and understanding of managing medicines.

During this inspection we spoke with six people who used the service and eight relatives. We looked at the care records of 23 people, the medicines charts of 21 people and the care rotas for 20 people and 31 staff. We spoke with the nominated individual, the manager, and 16 staff including 14 care staff, one senior staff and an auditor. We looked at two records in relation to staff recruitment as well as all the training records and files related to safeguarding, complaints and quality monitoring of the service by the provider and manager.

Updated 27 May 2016

This unannounced inspection took place on the 12, 13 and 14 April 2016. Comfort Call Northampton provides personal care to people in their own homes, there were 112 people receiving care during this inspection.

Following our inspections in April 2015 the service was rated as ‘Requires improvement’ and we placed conditions on their registration that prevented the service from taking on any new packages of care. Following our inspection in December 2015 the service was rated as ‘Inadequate’ and placed into special measures due to concerns about the safety and well-being of the people receiving care.

The service is required to have 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.’

The previous registered manager left the service in August 2014 and their registration has now been cancelled. Since our last inspection the provider has employed a manager; they are undergoing the application process to be registered with the Commission.

At the time of this inspection we found that many of the systems that had been implemented to improve the service were ineffective. There were still significant concerns in the way that the service operated and in relation to the way in which care was being provided.

People were at risk of serious harm as there were inadequate systems and processes to manage their medicines appropriately. People did not always receive their medicines safely. There was no system in place to ensure that staff recorded all of the medicine they administered. Staff had received updated training in managing medicines; however, the training had not provided staff with the required competency to manage the medicines effectively. This had led to people not always receiving their prescribed medicines, or receiving medicine too frequently, resulting in potential harm. Although there were systems in place to audit the medicines charts, these audits had failed to identify that people had not received their prescribed medicines.

People were at risk of harm as staff did not always report their concerns to the manager. Although staff had received recent training in safeguarding of vulnerable adults, when they reported their concerns to the on-call staff they failed to recognise the significance of what they were being told and issues such as missed calls were not escalated to the manager. There was not a reliable process of ensuring that all concerns reported to the on-call staff were analysed for further action.

People continued to not always receive their planned care because staff did not always turn up at the time planned or spend enough time with them to provide the care. Staff had been allocated to more than one person at a time and travel time had not been accounted for when planning calls. The manager was unaware of the number of calls that were not carried out as planned as there were no effective systems in place to identify this. There was a failure to allocate time to provide people’s planned care.

Processes designed to monitor the quality of the service were not always effective. Internal audits and checks did not identify issues which could affect people’s safety and well-being.

People did not always receive adequate food to maintain their well-being. Some people required assistance with preparing their food and drink, staff received training in food hygiene but not in the preparation of food. Some people did not receive regular or nutritious meals.

People’s preferences and choices were not always listened to and there was no provision in the system to allow people to choose when they wanted care. People received care from staff that had undergone the appropriate employment checks. New staff underwent an induction period where they received training and shadowed experienced staff during their first calls.

People’s experiences were dependent upon having regular care staff. Where people had regular care staff they spoke highly of them and valued their therapeutic relationship. However, the system for allocating care staff did not always ensure that people received the same care staff at the same time every day. Where people did not receive care from the same staff every day, they expressed their dissatisfaction.

Verbal complaints had not always been responded to and there was no record of these verbal complaints. Where people had made a formal written complaint there was a system in place to deal with the these; complaints had been responded to in a timely way and actions had been taken in response to people’s concerns.

We identified that the provider was in breach of seven of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.

The overall rating for this provider is ‘Inadequate’.

During our previous inspection in December 2015 we found the rating for the provider to be inadequate and the service was placed into Special Measures at the time.

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.

As the service was placed into special measures we inspected again to see if sufficient improvements had been made. This inspection showed that there remains a rating of inadequate for four key questions and gives an overall rating of Inadequate. This means we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.