This inspection took place on 12, 19 and 21 February 2018 and was announced. This was the first inspection of the service since the registration changed in December 2016. This service is a domiciliary care agency based in Newcastle. It provides personal care and other additional support to people living in their own homes throughout Newcastle and North Tyneside. Services were provided to adults with a wide range of health and social care needs including physical disabilities, sensory impairments, learning disabilities, mental health needs and people living with dementia. At the time of our inspection there were 104 people receiving a service.
Not everyone using Positive Life Choices (Newcastle) 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 service had a registered manager in post. The registered manager has been in post since the service registered on 9 December 2016. 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.
Medicine management had some areas to improve upon, including ensuring the full completion of medicine administration records and ensuring that any support given by others was correctly recorded and monitored. The provider needs to ensure guidance in the National Institute for Health and Care Excellence (NICE) guidelines if followed by all staff.
Risk assessment were not always in place, fully completed or regularly reviewed for people. This included, for example, people who were at risk of having an epileptic seizure or those at risk from diabetes. This meant people were not always protected from harm as much as they could have been because staff did not always have the written guidance to keep people safe. Accidents and incidents were recorded and monitored for trends and any learning was discussed through meetings and quality monitoring procedures. Emergency plans were in place should an unpredicted event occur, for example, very poor weather conditions.
There were enough staff employed at the service, however further improvement needed to be made on rostering systems and continuity of staff to fully meet the needs of people who used the service. People and relatives told us that they had, on occasions, too many different staff attending to their needs and that rota’s changed with little or no notice. We also saw evidence of positive responses taken by the provider to change people’s care calls when asked, because of hospital appointments or days out.
A continuous programme of staff recruitment was in place to maintain and grow numbers of care staff. Induction, training and continuous support procedures were in place and people thought staff were well trained to help them, but a small number felt they needed to remind some staff regarding moving and handling instructions. New Care Coaches were in place who gave additional support to newly appointed care staff. We found some gaps in areas of support, for example supervision and appraisal procedures, however, staff still felt supported.
The provider monitored missed calls, however was not able to do this robustly as they relied on staff reporting missed calls or the people themselves ringing in to report this to the office.
People felt safe with staff who visited them at home. We observed staff who knew people’s needs well. One person said, “Safe as I can be, yes.” People and their relatives told us that staff listened to them, were caring and often went the ‘extra mile’. Staff were respectful of people and treated them as individuals. The provider had organised a Christmas party for people to attend at a local venue. Staff told us the provider had several incentives in place, including recognising staff that go ‘out of their way’ to provide good quality care.
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 were able to support people whose communication needs were diverse, including those who spoke other languages other than English and we saw examples of this.
People’s needs were assessed and care planned in an individual and person-centred way, which included detail of people’s likes and dislikes and personal circumstances. People received suitable nutrition and fluids based on their own care needs and were happy with this as were their families.
A variety of health care professionals, including GP, dietitians or specialist consultants were involved in people’s care as and when this was needed and staff supported people with any appointments as necessary.
Complaints had been recorded and investigated by the provider in line with their policies and procedures. Although people and relatives knew how to complain or raise concerns, a small number felt they were not always listened to by office staff. We have asked the provider to review their processes regarding this.
The provider had received many compliments from a variety of people and families.
People and their relatives we spoke with felt overall that the service was well run and positive comments were received regarding management. Although we received some less positive comment on the communication systems within the office environment, including inability at times to pass messages on.
Audits and quality assurance checks had been completed at the service. Including checks of medicine procedures. These checks had not always found the issues we had during our inspection.
People had been given the opportunity to feedback through surveys send out and analysed on return. Feedback was also sought through care plan review meetings. Management had taken action where this was required, although needed to ensure actions were fully recorded in all cases, including due completion dates. We noted that the issues people had raised in surveys matched the issues we had found during the inspection.
We found two breaches; Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Good governance.
We made a number of recommendations (four), in relation to rostering and missed call procedures, moving and handling procedures and office procedures.