Archived: Niche Care Cheshire East

Niche Care Cheshire East is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Cheshire East area. 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. At the time of this inspection 23 people were receiving support with personal care.

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

Following the last inspection the new provider had not effectively embedded monitoring and auditing systems. Issues in relation to staff recruitment checks, staff competency checks and supervisions, information within care plans, as well as effective quality assurance systems were identified at this inspection.

The provider had identified areas for improvement and had started to work on these. There were some governance systems in place, however these had not effectively identified or addressed issues in timely way.

There was a relatively new management team in place, who had undertaken significant work over the past few weeks to make improvements. New systems and procedures to monitor the quality of the service needed to be fully embedded and the provider needed to demonstrate improvements would be sustained.

Improvements were required in relation to staff support and supervision. The provider was unable to clearly demonstrate all staff had received the required supervisions, appraisals and competency checks. The new management team had recently started to take action to address this.

The provider had experienced significant staffing pressures due to staff leaving and sickness, at times impacting on the timing and length of planned calls. The local authority were temporarily supporting the provider and the number of people being supported had been reduced, until they were able to recruit more staff. The provider was actively recruiting for new staff.

We received some positive feedback about the care and support people received. However, there remained mixed views about the timings of care calls and consistency of staff. Some people felt unsettled by recent staff changes.

Following audits, gaps had been found in records relating to robust recruitment procedures being followed. the provider was acting on this. A process was being implemented to ensure systems were more robust in future.

Since the last inspection improvements had been made in relation to the safe management of medicines, The management team were still in the process of undertaking staff competency checks for administering medication.

Staff understood their responsibility to identify and report any safeguarding concerns. People were protected from the risk of infection.

Care plans included risk assessments and guidance about measures to minimise the risk. The manager was in the process of undertaking reviews with each person who used the service, including care plans and risk assessments.

People told us staff sought their consent before providing care. Staff had some understanding of the MCA and confirmed they were required to record when consent was obtained. Clearer information was required within a person’s care plan to demonstrate that relevant decisions had been made in line with the person’s consent or the Mental Capacity Act (MCA) if required.

The provider was working in partnership with others such as the local authority to improve the service.

The provider and the new management team demonstrated their commitment to making the necessary improvements to achieve good outcomes for people.

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 2 March 2021). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

We met with the new provider and they completed an action plan to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the new provider was in breach of two regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the safe management of the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions of safe, effective and well-led.

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 remained the same and is rated as requires improvement. 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, Cheshire East 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. We have identified breaches in relation to staff supervision and competency checks and quality assurance processes at 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 updated 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.

Niche Care Cheshire East is a domiciliary care agency providing personal care to people in their own home. At the time of the inspection the service was supporting 69 people.

Not everyone who used the service received personal care. The Care Quality Commission (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 found shortfalls in relation to the safe administration of medicines. Staff had not always followed procedures to ensure medicines were administered as prescribed.

The provider was unable to evidence all staff had adequately demonstrated the required levels of competency to carry out their roles. There were gaps and inconsistencies in records relating to staff checks, such as medicine administration or moving and handling.

People gave mixed feedback about the timings of care calls and consistency of staff. Some were positive however, others felt call timings varied and they did not always see familiar staff. The provider was recruiting new staff and had recruited several new supervisory staff. They had undertaken a review of the rotas and were continuing to monitor and make further adjustments.

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 fully support this practice. There were gaps in some staff knowledge around capacity assessments.

We have made a recommendation about following MCA guidance.

Whilst formal complaints were deal with in line with their policy. other concerns had been received, which were not fully recorded and available for review.

We have made a recommendation about the complaints process.

Accidents and incidents had not been recorded as per the provider's policy, staff needed further guidance on the full use of the electronic recording system. The management team had acted in response to feedback provided to make some improvements to people's care.

A risk assessment had been undertaken in relation to the impact of COVID -19. Regular staff testing was being undertaken. Staff had access to personal protective equipment (PPE) when visiting people.

Overall people received care which considered their individual needs. Staff identified changes to health needs or concerns, contacting health professionals when needed.

People who used the service generally felt safe with the care and support staff provided. People and their relatives told us staff were kind and caring, promoted their dignity and encouraged them to be as independent as possible.

The provider’s quality assurance systems had not effectively identified all of the issues identified during this inspection. The management team were responsive to the inspection findings and were keen to take action to make the necessary improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 10/07/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the safe recruitment of staff, staff training and competency and staffing levels. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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 have identified breaches in relation to the safe administration of medicines, staff training and competency and the governance of the service at 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.