Archived: Right at Home Tyneside

Not everyone using Right at Home Tyneside receives regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The provider had employed a whole new management team to support them since the last inspection, including a registered manager and a deputy manager. A registered manager is a person who has registered with the CQC 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 registered manager had been registered since December 2017.

At the last inspection in August 2017, we asked the provider to take action and make improvements to risk assessments, medicine management, staffing and the governance of the service. We found these actions had been completed at this inspection.

Staff fully supported people to maintain their health and safety within their own home. Risk assessments were comprehensively completed to manage any risks faced by individuals. We saw risk assessments and support plans were now regularly reviewed and updated to reflect the current situation following any changes in people’s needs.

The management of medicines had much improved. People told us medicines were received safely and on time. New systems were in place to ensure that medicine administration records were accurate and up to date. This included regular auditing of medicines and the associated documentation. Competency checks were carried out with care workers to ensure they remained able to do this task.

Staff recruitment was safe and robust. Vigorous pre-employment checks were now in place to ensure new staff were suitable to work with people who required social care. New staff had received a robust induction. Staff training was up to date. Records showed and staff confirmed that they now received regular supervision sessions, an annual appraisal and that staff meetings took place. Staff told us they felt very valued by the new management team. There was a much-improved positive culture in which staff were confident to discuss anything with the management team and they felt certain it would be acted upon.

There were enough staff employed to look after people safely. Care workers told us that they did not feel rushed with tasks. People told us that on the whole, they had regular care workers who arrived as they expected. Staff were reliable and rotas were consistent.

Monitoring of the service was now thorough and robust. We saw an internal review had been carried out and an external consultant had been sought to provide guidance on improving the service and achieving compliance with regulations. New audits had been implemented and sustained. These audits identified any issues and tracked actions through to completion. This demonstrated that checks on the service were now routinely undertaken and where issues were identified, the management team acted. Regular unannounced spot checks on service delivery were conducted to ensure that high standards were achieved.

People told us they felt safe and were happy with the care staff who visited them on a regular basis. Policies and procedures were in place to help staff protect people from harm and the staff we liaised with understood their responsibilities to protect people. Incidents of a safeguarding nature had been appropriately recorded, investigated, reported and reviewed. The two local authorities who commissioned services to Right at Home Tyneside told us that they had no current concerns about the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff encouraged people to maintain a healthy and balanced diet. People told us their care workers made meals and drinks of their choice. External health and social care professionals were involved with people’s care to ensure their ongoing well-being.

People told us their care workers were nice and friendly and that they respected their home. People felt their dignity and privacy was upheld by care staff. All staff we spoke with displayed a kind and compassionate attitude.

There was a complaints policy in place; a system was in place to record all complaints and to ensure matters were escalated to the registered manager or provider as necessary. We saw all complaints and minor issues had been logged, investigated and resolved in a timely manner. People we spoke with had no complaints about the service.

Telephone courtesy calls were carried out to check customer satisfaction and an externally commissioned survey was issued annually. The results showed that people who received care at home were very happy with the service. The provider planned to complete a ‘you said, we did’ action plan to feedback the results and actions taken to people.

At the last inspection in June 2015 the provider was meeting all of the regulations and had an overall rating of good.

Right at Home Tyneside provides personal care to people in their homes across Newcastle, North Tyneside, Gateshead and Northumberland. The service is based in South Gosforth and provides general care but also specialises in supporting people with complex health needs and palliative care, including supporting people who are living with dementia. The service can also provide companionship and an enabling service to support people with daily tasks, for example, shopping or visiting the hairdressers. At the time of our inspection there were 47 people using the service, some of whom were receiving 24 hour care. Right at home Tyneside is a franchise of the organisation ‘Right at Home’.

The service did not have 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.

A new manager had been appointed at the end of 2016 and was in the process of applying to become registered. There had been a delay in their application and we are dealing with this outside of the inspection process.

People told us they felt safe and comfortable with the care workers who visited their homes. Policies and procedures were in place to safeguard people from harm or abuse and staff understood their responsibilities. Records were kept regarding safeguarding concerns and investigations had taken place in a timely manner. The provider had reported all incidents of a safeguarding nature to the local authority safeguarding team but had not always notified the Commission.

Medicines were administered by staff who had been trained to do so, however, we found issues with the management of medicines which needed to be addressed.

Risk assessments were in place and individual needs had been assessed with control measures put in place. However, records were in need of review to ensure they still mitigated all risk. Not every person had a current care plan in place, although the provider was in the process of updating these.

The provider's recruitment processes were not robust which had meant some issues in vetting had not been addressed appropriately. This meant people were put at potential risk unnecessarily.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. We have made a recommendation about reviewing care records to ensure this is adequately demonstrated.

People were supported to maintain a balanced diet. People told us care staff made them meals they preferred. One relative told us that their family member had put weight on since starting to use the service. We confirmed staff had undertaken training to support them with people’s nutritional and hydration needs. We observed appropriate meals being prepared to support people with particular dietary needs.

Most staff felt supported by the provider and management team, though a number of staff felt unsupported and undervalued. They said that communication had been poor, but that this was gradually improving. More staff meetings were being held and the provider and manager were in the process of ensuring that all staff received regular support sessions. This included annual appraisals as these had not been provided as they should have been.

Staff received a range of training to support them in ensuring that people’s needs were met.

From observations, staff displayed caring and compassionate attitudes and people told us that care staff were kind, caring and often went the extra mile for them.

The manager held information relating to complaints, accidents and incidents. There was a complaints policy in place and evidence showed complaints had been dealt with appropriately and in a timely manner. People told us they knew how to make a complaint and would have no hesitation in contacting the provider or manager should they need to.

The provider monitored the quality of the service. However, they had not always identified the issues we found during our inspection, including for example, with medicines and staffing records.

Most people spoke highly of the provider, the manager, office and care staff who supported them to live at home. However, a small number of relatives pointed out that as the organisation had grown, it had become stretched and did not feel as good as it once had. The provider was aware of their limitations and had recently introduced new roles to support the running of the service, including a human resource and a new training lead. There was a constant recruitment process in place to ensure the service had enough staff to meet the needs of people. The provider was passionate about providing quality care as was the new manager.

We found four breaches of regulations relating to safe care and treatment, fit and proper person's employed, staffing and governance. You can see what action we told the provider to take at the back of the full version of this report.

We found people were given appropriate information and were involved in making decisions about their care and treatment. People told us staff treated them with politeness and respect.

Staff spoken with said it was a good organisation to work for and there were training opportunities. One person said: "Training is ongoing."

Staff said they were well supported to do their job. All staff spoken with said they thought communication was effective and they were kept informed of people's care and support needs.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received