Background to this inspection
Updated
26 May 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The was a focussed inspection. The information received by the CQC indicated concerns about the management and safety of the service. This inspection examined those concerns.
Inspection team
The inspection was carried out by two inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was announced. We gave a short period notice of the inspection because the location provides a domiciliary care service and we needed to be sure that someone would be available to support us with our inspection.
Inspection activity started on the 7 April 2021 and ended on 23 April 2021. We visited the office location on the 20 April 2021.
What we did before the inspection
We reviewed the information we held about the service, which included correspondence we had received, and any notifications submitted to us by the service. Statutory notifications are information the registered provider is legally required to send us about significant events that happen within the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We contacted social care commissioners who help arrange and monitor the care of people using the Niche Care Sheffield. We also contacted Healthwatch Sheffield. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all, of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and 13 relatives about their experience of the care provided. At our visit to the office we spoke with the registered manager, the regional operations manager and the director of operations. We contacted 21 care staff and eight staff provided feedback about their experience of working for the service.
The registered manager sent us a range of records prior to our visit to their office location. This included records relating to the management of the service, including policies and procedures. This enabled us to review these records and reduce our time at the office location.
We reviewed a range of records. This included reviewing seven people's care records. We also reviewed the systems in place to manage people’s medicines safely. We looked at two staff files in relation to recruitment and support provided.
After the inspection
We obtained clarification from the provider to validate evidence found.
Updated
26 May 2021
About the service
Niche Sheffield is a domiciliary care service which provides personal care to adults with a range of support needs in their own homes. At the time of this inspection the service was supporting approximately 240 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
We received mixed views from people and relatives about the quality of care. Some were satisfied with the quality of care and made positive comments about the staff. Comments included, “I have nothing, but praise for the carers” and “Yes, they [staff] are looking after me okay. They are all very pleasant.” Some told us the lack of regular care workers and inconsistent calls times impacted on the quality of their care. Comments included, “There is no consistency of care” and “A few weeks ago, two carers came in who just didn’t know what to do.”
We checked to see if enough improvement had been made so people experienced continuity of care and experienced consistent call times. At this inspection we found further improvement was required.
Systems in place to ensure people were protected from abuse and improper treatment required improvement. Care staff were aware of their responsibility to report concerns or changes in people’s needs. However, some staff were not confident these were recorded or/and actioned by office staff. Care staff told us the registered manager responded to concerns promptly and took appropriate action.
The provider had not ensured each person using the service has an accurate, complete and contemporaneous care plan in place. We found the management of medicines required improvement. Most people and relatives told us staff used gloves, masks and aprons appropriately whilst supporting them or their family member.
The providers recruitment processes required improvement. Some staff felt supported, whilst others felt unsupported and not valued. The registered manager told us it had been challenging to deliver regular supervisions during the pandemic. Staff, people and relatives shared concerns about the training of new inexperienced staff. The registered manager told us all staff would complete the new content training by the end of May 2021.
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.
The provider had systems in place to engage and involve people using the service and their representatives. However, relatives and people shared concerns about the poor response to their calls to the office. Staff did not always ring back as promised. There were missed opportunities to continue to learn and improve service delivery.
The systems in place to assess, monitor and mitigate the risks relating to the health and safety of people were not effective in practice.
For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk
Rating at last inspection
The last rating for this was requires improvement 18 February 2020.
Why we inspected
The focussed inspection was prompted in part due to concerns received about the safety, quality of care and management of the service. The information CQC received indicated concerns about the safe care and treatment of people. This inspection examined those risks. We undertook a focussed inspection to review the key questions, safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The last rating for this service was requires improvement (published 18 February 2020). The service remains rated requires improvement. The service has been rated requires improvement for the last two consecutive inspections.
We found evidence the provider needs to make improvement. Please see the safe, effective and well-led sections of the full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Niche Care Sheffield on our website at www.cqc.org.uk.
Enforcement
We identified breaches in relation to the management of people's risks, records and quality assurance.
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.
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 for 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.