We carried out a review of the data available to us about Age UK - Northumberland on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Age UK - Northumberland, you can give feedback on this service.
Age UK is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection, the service was supporting 651 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 and their relatives told us they were happy with the service, with the majority saying they could not think of anything the service could improve. Where a small number of people had concerns about changes to regular staff they had raised this with the provider who did their best to accommodate people’s preferences.
At our last inspection we found gaps in records relating to recruitment, the Mental Capacity Act (MCA), training and complaints. At this inspection we found significant improvements had been made in record keeping in all these areas.
There were safe systems in place for the administration of medicines, and staff received training specific to people’s health related needs before providing care to them.
Individual risks to people were assessed and staff were provided with guidance about how to keep people safe. Staff received regular training and supervision and had a named supervisor to support them.
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.
We received multiple positive comments about the friendliness, kindness and professionalism of staff.
A new registered manager had been appointed since the last inspection who had a clear vision for the service. New quality systems had been introduced which provided clear performance related information.
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 rated requires improvement (published 13 July 2018) and there was one breach 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 improvements had been made and the provider was no longer in breach of regulations.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Why we inspected
This was a planned inspection based on the previous rating.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in Northumberland. There were 943 people being supported by 408 staff.
The service was last inspected in October 2017 when we found two breaches of the Health and Social Care Act 2008. These related to Regulation 18: Staffing [training] and Regulation 17: Good governance. We rated the service requires improvement.
Following the inspection the provider submitted an action plan outlining improvements they planned to make. At this inspection, we found improvements had been made and the provider was no longer in breach of Regulation 18 but we found a continued breach of Regulation 17.
A manager was in post who was in the process of registering with the Care Quality Commission [CQC]. 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.
In December 2017, the provider took over the care of people and employed the staff of another domiciliary care provider that had closed. The transfer of people and staff had to happen with some urgency beyond the control of Age UK Northumberland who worked extremely hard to ensure the safety of people and staff at this time.
We recognised the significant burden this placed on the provider and have taken this into account when carrying out this inspection and reaching our judgement.
At our last inspection, we found gaps in recruitment records which meant the provider was unable to demonstrate safe recruitment procedures had been followed. At this inspection, we found gaps in recruitment records including references, vetting checks, and employment history. Some of these omissions were attributable to the transfer of staff but this was not always the case and showed systems were not fully in place to ensure staff records were accurately maintained..
Other gaps in records such as training, Mental Capacity Act [MCA] and complaints which were identified at our last inspection had been addressed and improvements had been made. Audits had also been strengthened to enable closer monitoring of the quality and safety of the service.
The principles of the Mental Capacity Act [MCA] were not always followed at our last inspection. At this inspection, we found improvements had been made. 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.
At our last inspection, we found staff were not always fully supported to undertake training, learning, or development to enable them to fulfil the requirements of their role. At this inspection, we found improvements had been made to the training supervision and appraisal provided to staff.
Recruitment was ongoing at the time of the inspection as it was recognised there was a shortfall in numbers required to ensure staff were not working excessively long hours, and to ensure consistency of care. Some people continued to experience difficulties with consistent and reliable staffing and we have made a recommendation that the provider keeps the satisfaction of people and their relatives under close review.
Medicines continued to be managed safely and the competency of staff to carry out this task was assessed on a regular basis.
Safeguarding policies and procedures were in place. Staff were aware of the procedures to follow in the event of concerns.
Risks related to individual people, the environment and the handling of people’s finances were assessed and plans were in place to mitigate these. There were clear guidelines in place for staff relating to the handling of money or valuables.
People were assisted with eating and drinking and were supported to meet their health needs by staff.
We received very positive feedback about staff. People and their relatives told us staff were very kind, caring, and respectful.
The equality and diversity needs of people were met and staff had attended local events celebrating difference and diversity in the local community.
We received mixed feedback about the responsiveness of the service. Most of this was due to the impact of the transfer of people and staff from the other domiciliary care provider. We were told there had been initial difficulties with missed and late calls, but this had since settled down.
A complaints procedure was in place and records were clear and well ordered. There was a peak in complaints following the transfer of people and staff to the service but we saw numbers had since dropped to previously lower levels. The views of people, relatives and staff were sought via surveys which could be returned electronically or by post.
There was mixed feedback about the support people, relatives and staff received from the manager and office based staff. Some people were critical of the communication between them and the office, and the organisation of the service generally. Plans were in place to recruit and train additional office staff to address some of these concerns. There were plans for coordinators and supervisors to attend leadership training to support them in their role.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. You can see what action we told the provider to take at the back of the full version of the report.
A registered manager had recently been appointed and had completed the registration process with CQC just prior to our visit. After we had completed our inspection we found the registered manager had left the service and there were plans to appoint a replacement. 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 and their relatives told us they were happy with the service provided and that staff were caring and generally reliable. They described an overall impression that the reliability and efficiency of the service had improved of late but still expressed some concerns about some aspects of the quality of the management of the service. We observed staff to be caring and attentive during our visit.
A number of audits and quality checks were carried out but we found that records did not always reflect the accurate situation in people's homes and there were gaps in records related to recruitment, complaints and best interests decision making.
Staff received regular training, but the method of recording training was difficult to analyse to assure us of numbers of staff completing specific training. The organisational development director told us this was something they planned to change during a systems overhaul in the new year. Training considered to be mandatory by the provider was carried out on an annual basis. Staff confirmed they received regular training and one to one supervision with their care coordinators . Managers carried out spot checks of the service, where they visited staff to ensure they were carrying out their duties effectively. Not all staff had experienced these but knew they took place.
Records of competency checks and some training such as catheter care were not always recorded although we were told these had been carried out. A high number of staff had requested training in supporting people with dementia or mental health needs and we were told by the organisational development manager that this was planned for the new year. We judged that some priority should be given to providing training for staff providing care to people with complex mental health or dementia related needs.
Risk assessments were carried out in the homes of people cared for, which identified general environmental risks, and specific risks to people. These were up to date but we found some examples of where changes had occurred and this information had not always been passed back to office managers or records updated. People told us they felt safe in the care of Age UK and staff demonstrated a good understanding of issues related to the safeguarding of vulnerable adults.
Procedures for the safe management of medicines were in place and followed by staff. We visited four people at home and found that staff were aware of the procedures to follow. Staff had received training around specific conditions and equipment related to a medical need, to enable them to care for people safely. This training was carried out by visiting professionals whenever there was a need and was bespoke to the needs of the person using the service.
A recruitment drive was ongoing. The service was working towards a reduction in the number of people they cared for, as they had to be supported by other organisations on a sub contracted basis. We were informed there had been a significant reduction in this. There had been difficulties with staff working flexibly to meet the needs of the service, due to a majority of staff being employed on zero hours contracts and therefore able to turn down work at short notice. This was in the process of changing, and staff consultations were taking place to change contracts which would mean greater reliability and to enhance the working experience of staff. People told us that staff had time to attend to their care needs.
Recruitment checks were carried out to ensure staff were suitable to work with vulnerable people including checks by the Disclosure and Barring Service (DBS). Interviews were carried out and there was a scoring process to follow to help with recruitment decisions. We found that scoring and interview decision records were not always completed or the decisions to appoint people where concerns had been identified were not recorded or explained.
Training in the Mental Capacity Act 2005 (MCA) had been carried out. We were told no one was subject to any restrictions in their daily lives but we found this was the case for one person. Systems in the service had not identified and recorded this. We have made a recommendation about this.
People were supported with eating and drinking, and nutritional assessments were carried out. Appropriate advice was sought where people were deemed to be at risk of malnutrition or dehydration, and staff were trained to deliver nutrition via specialist equipment when required, such as via Percutaneous Endoscopic Gastrostomy (PEG).
People's needs were responded to by staff. We read call logs which demonstrated that staff had picked up on health problems and taken appropriate action or sought advice. Care plans had detailed outcomes and clear expectations of staff regarding the support people needed during their visit. Social needs of people were considered during care planning.
People and their relatives told us that their complaints had been responded to, and that when they had cause to complain, the service had improved. We read complaints records and found these varied in detail and format. Outcomes to complaints were not always recorded so it was not always clear what action had been taken. Complaints were not recorded in a way which supported audit and review of outcomes.
The newly registered manager had worked in the service for a number of years. New posts had been introduced to support managers and coordinators and these were called staff mentors. They were a source of support and advice for staff. This also provided greater opportunities for staff career progression. A number of people told us that the quality of support they received from 'managers' (including coordinators) varied depending on who responded to their issues. There were also concerns raised about the length of time that it could take to get through to the office by telephone despite the extended office hours.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.
This inspection took place on 17 and 20 July 2015 and was announced. This was so we could be sure that management would be available in the office as this is a domiciliary care service. We last inspected this service in September 2013 where we found the provider was meeting all of the regulations that we looked at.
Age UK - Northumberland provides personal care and support to people in their own homes and enablement services for people to access the community. At the time of our inspection the provider delivered care and support to 739 people and employed 288 members of staff. The service supports people with mental health issues, physical disabilities, sensory impairments, learning disabilities or autistic spectrum disorders, younger adults, older persons and people living with dementia. The care and support provided ranged from 24 hour care packages to short visits where people were supported to access the community or complete domestic tasks.
There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since October 2010. However they were not at work at the time of our inspection and alternative, suitable management arrangements had been put in place. In the absence of the registered manager we were assisted throughout our inspection by the regional manager, quality manager and the nominated individual who had joined the organisation in recent months. A registered manager is a person who has registered with the 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 were happy with the care and support they received and they spoke highly of the staff who assisted them. They said their needs were met safely and they felt involved and informed about their care. Safeguarding policies and procedures were in place and there was evidence to demonstrate that the organisation reported matters of a safeguarding nature to the appropriate local authority for investigation. Staff were aware of their own personal responsibility to protect people from abuse.
People’s needs and risks they were exposed to in their daily lives were assessed, documented and regularly reviewed. Some care records were in need of further detail to make them more person-centred, however we noted that a program of replacing old documentation with more extensive newer care plans and risk assessments was already underway to address this. A business continuity plan was in place which provided guidance about how to deal with unforeseen circumstances, such as a fire at the provider’s office, which may hamper their ability to deliver care.
Staff supported people to manage health and safety risks within their own homes and refer matters on to third parties if necessary. Recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled and physically and mentally fit. Medicines were managed safely and appropriately and staff competencies in relation to the administration of medicines were carried out to ensure that staff followed best practice guidelines. Staffing levels were determined by people’s needs and the number of people using the service. We had no concerns about staffing numbers.
Staff told us and records confirmed that training in a number of key areas such as safeguarding and moving and handling was up to date. Staff told us they had the skills they needed to meet the varying care needs of the people using the service. Supervisions and appraisals took place although in some team areas these were outstanding. Despite this, staff told us they felt supported by management and could approach them at any time. Staff meetings took place bi-monthly and provided an avenue through which staff could feedback their views. Communication between care staff ‘in the field’ and more senior staff was under review at the time of our inspection, as staff had already highlighted to the nominated individual that improvements were needed in this area.
CQC monitors the application of the Mental Capacity Act 2005 and deprivation of liberty safeguards. There was evidence to show the service understood their legal responsibility under this act and that they initially assessed people’s capacity when their care commenced and then on an on-going basis if necessary. Decisions that needed to be made in people’s best interests had been appropriately referred to their care managers so that a communal decision with multiple parties could be made.
People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and they had continuity of care from the same members of the care staff team whenever possible, which they appreciated.
People were informed about their right to complain and about how to do so, if they wished. Records showed that historic complaints were handled appropriately and records were kept of each individual complaint received and any associated paperwork or correspondence with the complainant. People’s views and those of staff were gathered through annual surveys.
Care records demonstrated that the provider was responsive when people’s needs changed and the care and support they received was adjusted accordingly. People were supported to access the services of external healthcare professionals if they needed assistance to do so.
There had been recent management changes within the organisation and a period of change that was still on-going at the time of our inspection. The newly appointed nominated individual told us that they were keen to promote an open culture. She had clear visions and values and future plans about how she wanted the business to develop. Auditing and quality monitoring of the service delivered was extensive and on-going. Records showed that where any issues were identified these were promptly addressed or investigated so that measures could be put in place to reduce the chance of repeat events.
People and staff told us that consent was gained before care was delivered and we found that the provider acted in accordance with people's wishes.
We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.
We saw that the provider had a safeguarding policy in place which detailed the actions to be taken should staff have concerns about care or witness a safeguarding incident.
There were enough qualified, skilled and experienced staff to meet people's needs.
The provider had an effective system to regularly assess and monitor the quality of service that people received.
As part of this review, we visited four people in their own homes and spoke with them, and their relatives, about their experiences of the support they had received from this service. We spoke with senior managers, administrators and two senior care workers at the time of our visit to the office. We spoke over the telephone with 22 people who were using this service, three relatives and three care workers.
People we spoke with were positive about the care and support they received. Comments included, 'I get good care', 'It's very good, they do everything they can to help me' and 'They're very good, I'm fine'.
Comments from relatives included, 'They do everything they can to help me look after him', 'On the whole we're quite satisfied, our main carer is second to none' and 'The carers we've got are brilliant, I've got peace of mind when I go home'.
People told us they felt comfortable and safe with their care workers. Where any concerns or complaints had arisen, people had had no hesitation in contacting the office staff to discuss them. They told us their concerns were acted upon, and that they were kept fully updated whilst the issues were being resolved.