Niche Care Wakefield

Niche Care, Wakefield is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Wakefield area. 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. At the time of this inspection 61 people were receiving support with personal care.

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

Some significant improvements have been made by the new provider since our last inspection, however we need to see these improvements fully implemented and then sustained. In particular, people’s risk assessments and the provider’s quality assurance systems need to be further developed. We have also made two recommendations regarding recording capacity to consent to care and responding to feedback.

Safe recruitment procedures made sure staff were of suitable character and background. Staff had received training in safeguarding vulnerable adults. There were enough staff deployed to meet people’s care and support needs. People received their medicines as prescribed.

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. Staff were provided with an induction and relevant training to make sure they had the right skills and knowledge to support people. Staff told us the manager was approachable and they felt supported in their jobs. People were supported to maintain good health and have access to health and social care services.

Positive and supportive relationships had been developed between people, their relatives and staff. People told us they were treated with dignity. People’s care and support was planned and delivered in a way that ensured it met their needs and reflected their preferences. Care records were being updated to reflect this. There were systems in place to respond to complaints. People told us they knew how to complain, and the manager and office staff were responsive to any concerns they raised.

The provider had a comprehensive set of policies and procedures covering all aspects of service delivery. People using the service, their relatives and staff told us they could see improvements were being made at Niche Care, Wakefield.

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 inadequate (published 26 April 2021). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

We met with the new provider and they have completed an action plan with the local authority to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the new provider was in breach of one regulation.

This service has been in Special Measures since 26 April 2021. During this inspection the new provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the new provider had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective, responsive and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to 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 Niche Care, Wakefield on our website at www.cqc.org.uk

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 monitor the service.

We have identified breaches in relation to risk assessments and quality assurance processes 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 updated action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Niche Care Wakefield is a domiciliary care provider based in Horbury, Wakefield and provides personal care to adults and older people in their own homes. At the time of our inspection the service supported 120 people. 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 had unreliable visit times, which meant their care was not consistent. Calls to people were sometimes cut short and staff did not have enough time to travel to the next person. Visits were frequently late or sometimes missed. This impacted negatively on people's wellbeing and safety.

There were not enough staff to meet people’s needs in a timely manner, and staff turnover was very high. Staff were not always safely recruited, inducted, trained or supervised, which put people at risk of harm.

People did not always receive their medicines when they needed them.

There was not always sufficient assurance infection prevention procedures were followed.

People and relatives felt care staff were kind and caring, although they had little confidence in the management of the service.

Care plans were not detailed or risks to individuals sufficiently identified. Care was not person centred or delivered in line with people’s needs and preferences.

The service was not run safely or effectively. The provider failed to assess, identify and mitigate the risks involved in the delivery of care to people. This put people at risk of harm and poor care.

There was a new manager who was working alongside senior managers to prioritise aspects of the service in need of immediate improvement.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

This service was registered with us on 14 October 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s calls being late or missed, people receiving unsafe care and a lack of effective management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We met with the provider soon after the inspection and asked them to submit an action plan detailing what changes they will make to ensure people receive safe, reliable care. The provider has said they will stop taking any further care packages, until they can provide assurance about quality and safety.

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 people receiving appropriate, safe and reliable care, staffing, the handling of complaints and weaknesses in the management of the service, at this inspection.

Follow up

We will request an updated action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.