Background to this inspection
Updated
12 November 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.
Inspection team
This inspection was carried out by two inspectors, a medicines inspector and an Expert 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 homes. The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Inspection activity started on 23 August 2021 and ended on 16 September 2021. We visited the office location on 23, 27 and 31 August 2021.
What we did before the inspection
We reviewed information we held about the service, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We contacted the local authority commissioning and safeguarding teams and Healthwatch to request feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
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 used all of this information to plan our inspection.
During the inspection
We spoke with 11 people who used the service and four relatives about their experience of the care provided. We spoke with 10 members of staff including the manager. We reviewed a range of records. This included care records for eight people and multiple medicines records. We looked at recruitment records and a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We communicated with the nominated individual of the service by email. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with six professionals who were involved with the service. We shared details of our inspection findings with the local authority safeguarding and commissioning teams.
We liaised with the local authority and CQC registration colleagues as the provider had applied to remove this location from their registration.
Updated
12 November 2021
About the service
Niche Care North Tyneside is a domiciliary care agency providing personal care to adults living in their own homes. At the start of the inspection 76 people were receiving personal care support. However, the number of people receiving a regulated activity reduced during the inspection period. The registered provider had applied to CQC to remove the location of Niche Care North Tyneside from their registration. This application was being progressed by CQC during the inspection period.
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
The service was not well led. Effective governance systems were still not in place to monitor quality and deliver improvements across the service. Systems were in place to gather feedback from people, their relatives and staff. However, there were missed opportunities to respond to feedback to improve outcomes for people. The provider had not followed their own action plan developed following the last inspection to improve standards at the service.
A robust system to ensure people were protected from the risk of abuse was still not in place. We identified several safeguarding concerns which had not been reported to the local authority in line with safeguarding thresholds which exposed people to a risk of harm. Medicines were not managed safely. In addition, medicine administration records did not always demonstrate medicines had been administered to people as prescribed.
Safe infection control systems and procedures were still not in place to ensure people were protected from the risk of infection. The provider had not taken sufficient action following our last inspection to ensure staff were aware of and followed safe infection control procedures. An effective system to ensure all the risks people were exposed to, was still not in place. There were not enough staff to safely meet people’s needs and safe recruitment procedures had not been followed.
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 majority of staff we spoke with did not feel supported at work. In addition, not all training deemed mandatory by the provider had been delivered to staff. The nutritional needs of people were not always met, and action had not always been taken to report concerns to the appropriate health or social care professional for people with specific needs.
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 following an inspection in February 2021 (report published 28 July 2021) and there were multiple breaches of regulations. We issued the provider with a Warning Notice related to infection prevention and control. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, the provider has not complied with the Warning Notice and enough improvement had not been made overall, meaning the provider was still in breach of multiple regulations.
Why we inspected
The inspection was prompted in part due to serious concerns received about people’s care and treatment, staffing, missed calls and the management oversight at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.
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 the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. 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 Niche Care North Tyneside 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, safe care and treatment, safeguarding people from the risk of harm, staffing, fit and proper persons employed and the overall governance of the service.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.