Archived: Comfort Call (Salford)

Comfort Call Salford is a domiciliary care agency, which provides personal care to people in their own homes who require support in order to remain independent. The office is located in Eccles near Manchester. The agency predominantly covers the areas of Swinton and Eccles.

At time of inspection there was a registered manager at the service. The registered manager had been in post since July 2016. 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.

At the last comprehensive inspection on 11 January 2017 we found the service to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were relating to staffing, monitoring and audit systems, medicines practice and the service had failed to ensure that suitable arrangements were in place for planning and reviewing people’s care and support in a way that met their individual needs and preferences. Following the inspection we held a joint meeting with the local authority and the provider to highlight the areas of concern and determine what immediate action would be taken. In addition to this we monitored the on-going compliance of the service through regular action plans submitted by the provider.

As part of this inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements. We found improvements had been made in each area of concern from the previous inspection; however the service remained in breach of regulation 17 good governance.

We found on-going improvements in the recording of medicine administration. However, we saw medicine support plans were not updated and often contained incomplete or out of date information. Missing signatures were also evident on Medicine Administration Record (MAR) charts.

Improvements had been noted with the services auditing and governance systems, however these were still not robust h and had not identified the issues highlighted in the management of medicines.

Feedback we gained from people throughout the inspection was positive overall. People spoke about feeling happy and having their care needs met in a person centred, respectful manner. When questioned, staff gave relevant examples of how to care for a person in line with their individual needs and wishes, whilst ensuring the person’s dignity and privacy was respected.

Safeguarding procedures were in place and staff were able to confidently inform us about the types of abuse people could be subject to and how to raise concerns should they suspect or witness any abuse or abusive practice. All staff had received training in safeguarding and we were able to confirm this was in date.

People spoke about feeling safe in their homes and confirmed staff left them secure following a care visit. The provider ensured processes were in place to ensure a safe environment was maintained for people using the service and its staff. Environmental risk assessments were established to identify any risks associated with lone working, water temperature, sharps and the control of substances hazardous to health (COSHH).

Staff rotas and time sheets indicated that staffing levels had improved. The registered manager told us the rate of pay for care staff had recently been increased and further staff were being interviewed for jobs. People also commented that they did not feel rushed in their daily routine and did not experience any missed visits.

Recruitment procedures were thorough and robust. Staff told us their induction process contained enough information to ensure they had the knowledge to carry out their care role effectively. People spoken with confirmed staff were competent. Staff files we looked at contained all necessary information along with appropriate checks of staff’s character, to ensure the provider was following a detailed and safe recruitment selection of all staff.

Staff were provided with a suitable amount of training which enabled them to confidently and competently carry out their roles and provide people with care and support based on their individual needs.

Staff meetings and supervisions were offered and staff felt fully supported by the management structure and told us they were able to approach management whenever they had an issue.

People were provided with personalised care and support based on their individual needs and requirements, detailed care plans and risk assessments were in place in which gave clear information about people's needs, wishes, feelings and health conditions. Changes to people's needs and requirements were also captured giving staff up to date and relevant information.

Staff we spoke with were aware of the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). These provide legal safeguards for people who may be unable to make their own decisions. Staff were also able to give relevant examples of how to ensure people were offered choices and supported to make decisions.

This inspection of Comfort Call (Salford) was carried out on the 9, 10 and 11 January 2017 and the first day was unannounced.

Comfort Call (Salford) is a domiciliary care agency which provides personal care services to people living in their own homes in the Salford area of Manchester other services are offered such as domestic and shopping visits. Comfort Call also manage five extra care housing schemes based in the Salford area. The service is registered with the Commission to provide personal care. The main office is located on the high street in the centre of Eccles.

At the last comprehensive inspection on the 16 December 2015 breaches of legal requirements were found. These were relating to medicines management. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We then carried out an unannounced focused inspection on the 11 April 2016. As part of this inspection we checked to see that improvements had been implemented by the service in order to meet legal requirements.

During this focused inspection we found that the service was now in breach of three Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to staffing, good governance and a continued breach of safe management of medicines. The overall rating at this time was changed to inadequate and the service was placed into special measures.

At this inspection we found the service to be in breach of four regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three of these were continued breaches in areas around staffing, safe management of medicines and good governance. An additional breach was found around person centred care. You can see what action we told the registered provider to take at the back of the full version of the report.

At the time of inspection the service had a registered manager who had been registered with the Commission since, 25 July 2016. 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 as set out by the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found minimal improvements had been made in the safe handling of medicines. At the previous inspection we had found that there were a high percentage of signature omissions on the Medication Administration Records (MARs).

At this inspection we saw that the number of omissions had reduced but there were still numerous times when carers had failed to make a record of medication administration either on the MARs or in the daily notes. We also found that unexplained codes and symbols were still being used on the MARs.

Medicines which must be given at specific times of day or with specific reference to food were not given at the correct times. We also saw that some people had medication to be taken once a week but this was not always consistently administered. The service did not have protocols to guide carers how to give /apply these medicines safely and consistently.

Staff had all been retrained in medicines handling, but policies and procedures had not been updated to include the new training and staff would have to remember what they had learnt during training sessions.

Staff monitoring systems showed differences on people’s allocated call times and the actual time of visit. Staff reported they at times felt rushed, however, overall people using the service were happy with the call times. New staff were being employed to alleviate this issue. However this was a slow process due to the amount of care staff applying.

People told us they felt safe and that staff ensured their needs were met before securing their properties when leaving.

People told us they were provided with personalised care and support based on their individual needs and requirements. However, care files lacked detail for staff around people’s assessed needs and preferences.

Care plans also lacked detail and appropriate documentation around people’s dietary requirements and risks associated with pressure areas. This meant, staff both established and newly recruited were reliant on each other and the person to ensure the person’s needs were met safely and in line with the person’s preferences.

People’s opinions were routinely sought and acted upon by means of questionnaires, Action plans were created however we found certain negative responses had not been added.

Clear safeguarding policies and procedures were in place. These provided staff with guidance and training in recognising the signs of abuse and helped to ensure the staff team were fully aware of action they needed to take should they be concerned about a person’s welfare.

Staff displayed appropriate knowledge about how to respond to and ensure any safeguarding issues had been notified to the relevant authorities and the Care Quality Commission (CQC).

Detailed environmental risk assessments were in place in people’s files. Lone worker policies were also in place. The service had contingency plans in place in the event of failure to utility services or equipment.

The provider had ensured a robust recruitment system had been implemented. Appropriate steps were taken to verify new employee's character and fitness to work. Following successful appointment to the role the provider ensured a thorough induction plan was carried out which ensured staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner.

The service also offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting the people using the service.

Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. However not all staff had an understanding around Deprivation of Liberty Safeguards.

People spoken with did not know who the registered manager was but were able to inform us what they would do should they have a complaint. Staff reported that the registered manager was approachable and that the service had improved since she had been appointed.

We found audits had not been effective as they had not identified the issues raised in this inspection around areas such as care plan content, reviews and medicines compliance.

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