Community Careline

Community Careline is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 38 people were accessing the service. 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 were positive about the support they received from the service. Comments included, “They can't do enough, they are friendly amazing people.” And, “I always felt good knowing that [my relative] was in safe hands.”

However, at the last inspection we identified a number of concerns about how safe, effective and well-led the service was. At this inspection the majority concerns had not been addressed and a number of improvements were still needed.

Quality assurance systems were not robust enough to drive forward improvement. Audits of records and people’s care had not always identified the concerns we found at the inspection. Where issues had been identified these had not always been addressed. The registered manager and provider continued to have regular meetings. However, these meetings had not sufficiently focused on improving quality and actions had not been taken in a timely way.

Staff did not to always have the information they needed to reduce risks to people’s health and wellbeing. Risk assessments were not to always be in place. Some risk assessments continued to be missing important information. The management of people’s medicines continued to need improvement to ensure they were always administered as prescribed. Improvements were needed to infection prevention and control policies and practices. Essential recruitment checks had not always been carried out.

People’s needs were assessed. However, there continued to be limited information for staff in relation to people’s health needs. Staff had not undertaken training in some areas such as epilepsy and diabetes but supported people with these needs. Staff were also not up to date with their refresher training.

People were supported to eat and drink safely. Where people needed support to access health care this was in place. 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. However, the policies and systems in the service did not always support this practice as the registered manager had not checked to ensure relatives had power of attorney in place.

Staff knew how to identify and report abuse. Staff were confident the registered manager would report on concerns raised. Incidents were recorded and actions were taken to reduce re-occurrence. However, there continued to be no systems in place to monitor trends and patterns. There were enough staff to support people.

Staff were positive about the support they received and were regularly supervised and felt listened to. There had been surveys for people and their relatives and staff to seek their opinion on the service. The service continued to work in partnership with healthcare professionals.

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 Requires Improvement (Published on 11 September 2019) and there were breaches in three regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement.

The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 01 August 2019 to the 12 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and checks to ensure that fit and proper persons were employed.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 not changed. 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 Community Careline 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 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 safe care and treatment, staff recruitment, staff training and the management of the service at this inspection. We took enforcement action against the provider in respect to safe care and treatment and the management of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Community Careline is a domiciliary care agency providing personal care to people living in their own homes. 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. The service was providing personal care to approximately 26 people at the time of the inspection.

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

The service people received was not always safe. The recording and administration of people’s medicines were still not carried out in a safe way for those who needed the assistance of staff to help them to take their medicines. Some improvements had been made to the identification and assessment of individual risks, to prevent harm, however, further improvement was needed in this area. The recruitment of new staff was not managed in a safe way to make sure only suitable staff were employed to provide care and support to people. Accidents and incidents were not monitored to learn lessons and make improvements.

People told us they felt safe with staff and were confident in their care. People said they felt there were enough staff as their care was rarely cancelled, staff were usually not late, and stayed the full length of time when visiting.

The service was not always effective. People now had a thorough assessment of their needs, with information gathered to provide a more person centred service. However, information about people’s health or diagnosed medical conditions gained in the assessment had not informed the care plan to make sure staff had the guidance they needed to recognise signs or symptoms or concerns.

Improvements had been made to the training and supervision of staff since the last inspection. However, further work needed to be made to the training provided to meet people’s specific and specialist needs. People were supported to access healthcare advice and given assistance with their nutrition and hydration when this was needed. People and their relatives told us they were involved in and directed their care, making their own choices and decisions.

The service was not always well led as systems to monitor the quality and safety of the service had failed to pick up the areas of concern we found around, people’s medicines and how these were managed and recorded; the measures in place to keep people safe from risk; guidance within care plans to support their medical and health conditions and safe recruitment.

People were very positive about the service they received and how it was managed. Staff felt listened to and supported and were very complimentary about the manager and the management team.

People and their relatives were very happy with the staff supporting them, saying staff respected them and described them as caring and kind.

Care plans had improved and provided individual information that helped to provide a more person centred service. People said they knew how to complain if they needed to and complaints that had been raised had been dealt with appropriately.

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.

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 requires improvement (published 8 August 2018) and there were four breaches 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, enough improvement had not been made and the provider was still in breach of three regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to, the assessment of individual risk, the recording and management of medicines, safe recruitment, accurate record keeping and the monitoring of quality and safety.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an 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.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Community Careline Service receives regulated activity; 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. At the time of inspection, approximately 30 people were receiving personal care in their own homes.

This was the first comprehensive inspection following a change of legal entity and new registration on 20 December 2017.

The provider employed a registered manager at the service who had been the registered manager of the service for many years with the previous provider. 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.

Risks to individual people were not always identified to ensure measures were in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people, staff and others safe from hazards.

Accidents and incidents were recorded by staff but not always followed up by the registered manager to ensure appropriate action had been taken and identify themes to learn lessons and prevent future occurrences.

Some areas of the management of people’s prescribed medicines needed improvement to ensure people received their medicines in a safe way at all times. Care plans, medicines administration records (MAR) and daily records showed conflicting information about people’s medicines. Information for staff about people’s medicines, why they were taking them and the side effects to watch out for was not available.

A safeguarding procedure with the information staff would need to follow if they had concerns about people was available. People told us they felt safe and knew who they would talk to if they did not.

The provider and registered manager followed safe recruitment practices to make sure only suitable staff were employed. Enough staff were available to be able to run an effective service and be responsive to people’s needs. The people we spoke with told us they had regular staff to support them who were on time when visiting and always stayed to support them for the whole time they were allocated. Staff had a suitable induction period when they were new where they were introduced to people before they started to support them.

Many staff had not had suitable training to make sure their skills and knowledge were up to date. Although most staff had a one to one supervision meeting, most staff had not been regularly observed while carrying out their duties to ensure they continued to provide safe care and follow good practice.

People had an initial assessment before they received a service and the assessment was used to inform their care plan. Documentation in the care plan was not always fully completed. We have made a recommendation about this.

Although people gave positive accounts of the care that staff provided, a person centred approach had not been taken in the care planning process to ensure the personal and individual information about people was documented.

People were supported to make their own decisions about their care or had a family member who helped them. The registered manager was aware of their responsibilities within the principles of the Mental Capacity Act 2005 if people required a mental capacity assessment to test their capacity.

People were supported with their nutrition and hydration needs where necessary, although many people did not require this assistance. People and their relatives told us they were happy with the support given by staff.

Many people did not require the assistance of staff to manage their health care needs as they either took care of this themselves or had a relative or friend to help. Where assistance was required, staff knew who to contact to get people the help they needed.

The caring approach of staff was clearly evidenced by people and their relatives making positive comments about the staff who supported them. People told us they had regular staff providing their care and support who had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.

The provider had an up to date complaints procedure and people and their relatives told us they would know how to make a complaint if they needed to. Complaints made had been followed up by the registered manager, in line with their complaints procedure.

Although the provider and registered manager had some auditing systems in place to monitor the quality and safety of the service, these were not always used effectively to identify where improvements were needed and to take action.

Few staff meetings were held to provide support and keep staff updated with organisational information and new guidance.

People thought the service was well run and were positive about their experiences.

The provider sought people’s views of the service on an annual basis. People told us they were regularly asked their views to check if they were satisfied with the service.

During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report. This is the first time the service has been rated requires improvement.