Community Careline Services

Community Careline Services is a domiciliary care service, providing personal care to people in their own homes. At the time of our inspection there were 22 people using the service.

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

The service supported people with taking their medicines however the medicines were not always managed safely. Risk assessments were in place however, these were brief and lacked personalisation. Where risks required addressing, there was no record to confirm they had been undertaken. Staff were safely recruited. However, where gaps in the records were noted with long term staff, the manager told us they would develop a system to confirm these staff were suitable to work with vulnerable people . The provider was planning to introduce a new electronic system to monitor visits. We received some feedback that visits were occasionally missed or late and people felt the service would benefit from more staff. People told us they felt safe, a system had been developed for incident and accident recording, there was some evidence of lessons learned.

Training was being undertaken by staff. Staff told us there was sufficient training for them to undertake their role. People who used the service were confident in the skills of the staff team. Some staff fed back the training would be better spread over some time. 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. Consent had been recorded in staff files and consent was sought by staff. People told us they had been involved in the development of the care plans but not always in reviews. Records contained information about their GP to enable staff to seek support and review if required.

People received good care and they were treated with dignity and respect. People provided positive feedback. Policies, guidance and training was available to support good care delivery to people. Care records had been developed however, they were brief and required details about individual needs. Records included information about supporting people with their communication, the service was in the process of introducing a new electronic system for care records. There was some evidence people were supported in activities of their choosing. A system had been developed to record complaints. The records would benefit from more detail in relation to the concerns and the actions taken as a result.

Where audits forms had been developed these had not always been commenced. These would have identified the shortfalls found at this inspection. Regional audits and monitoring had been undertaken however these did not identify the findings we found at the inspection. The call logging system was not being used to monitor the calls. Some people told us they knew who the manager was and was positive about the management of the service. However, others told us about difficulties communicating with the office and one said the service lacked consistency of management. The manager told us about the changes they had made and the improvements planned going forward. Questionnaires had been sent to people and the initial feedback from the manager was positive. There was good information on display in the office along with certificate of registration and employer liability insurance.

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 inadequate (published 9 November 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 9 November 2021. During this inspection, the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this 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 Community Careline Services on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to the safe management of risks, medicines management, and good governance at this inspection. We have made recommendations in relation to, staff deployment and ensuring care records are detailed and individualised.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Careline Services (CCS) is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection they were supporting 41 people across the borough of Rochdale.

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

Most people we spoke with told us that their experience of the service was poor. People had not always received their care and some care visits had been excessively delayed. Family members told us that they had been asked to step in to look after their relatives. We had received concerns prior to the inspection and several packages of care were returned back to the local authority as people could not be cared for safely.

Staffing levels were low and existing staff felt undervalued and pressured to work long hours. People were concerned about the stress the carers were under and did not feel they were at fault in any way. We were made aware that the previous registered manager and several staff had left the service in April. The service had deteriorated since then and recruitment had been limited. Staff that had been recruited, had been recruited in a safe manner.

Communication was poor at the service and both service users and staff told us how difficult it was to contact the office and on call system. Rotas were chaotic and there was no designated person responsible for ensuring the visits were covered. Missed visits and duplications in the rotas were not picked up by the current system. Following on from inspection the provider ensured that a care coordinator had overall responsibility for the management of rotas.

Medication was not being managed safely. People were not receiving their medication at the specific times that they needed them and there were concerns around administration.

The service was moving to new electronic care plan system, but this had not yet been fully implemented. Some care plans we saw did not always reflect people’s needs fully and there were discrepancies around what hours were actually being provided.

We identified a lack of oversight of the service and there was no monitoring of the quality of care people were receiving. There were no audits or spot checks taking place at the service and people were not being consulted about their views on the service.

Infection control was being managed safely. Staff wore appropriate PPE and followed government guidelines around infection control and testing.

The service had a new manager in post, who was not available at the time of the inspection.

Feedback we received about the new manager was positive and we saw evidence that some concerns had been addressed. Following on from inspection, the manager and the area manager sent us an immediate action plan addressing the issues we found on inspection and this was also shared with the local authority. We had a meeting with the provider following on from the inspection who informed us that the area manager had left their post and they had recruited a new area manager, as part of a restructure of the company.

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

Rating at last inspection.

The last rating for this service was good (published 21 June 2018)

Why we inspected

We received concerns in relation to concerns around the management of the service and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe 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 overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this 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 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 have identified breaches in relation to medication, staffing, safe care and treatment and good governance at this inspection.

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

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.

Community Careline Services (CCS) is a domiciliary care agency providing personal care to people in their own homes. It provides a service to adults and older people. When we inspected the service the service were supporting approximately 50 people across the borough of Rochdale.

The service had a registered manager who was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the last inspection of Community Careline Services in January 2016 we found there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the Medicine Administration Records (MAR) did not contain all the prescribing directions to help ensure people received their medicines as prescribed, guidance was not in place to guide staff where variable dose or ‘as required’ medicines had been prescribed, and the medicines policy was out of date. Following that inspection the provider sent us an action plan informing us that they had taken action to ensure the Regulations had been met. During this inspection we found the provider had complied with the previously breached Regulations. Systems had been put into place to ensure all pain relief medicines were documented with dosage and prescribing times; the medicine policy had been updated and all staff were made aware of the level of support and documentation required when offering pain relief. The service was no longer in breach of this regulation and we found that all other regulations were being met.

People supported by Community Careline Services told us that they felt safe with the service. They said that staff understood and respected their need for security, and ensured that the items they would need when staff left their property were easily accessible. Staff demonstrated a good understanding of the risk of abuse, and took steps to ensure people felt safe in their own homes. Risks were evaluated and assessed in line with the people they supported taking their abilities, preferences and capacity into consideration.

There were enough staff. Safe recruitment procedures ensured that people were protected from unsuitable staff, and we saw that staff were employed in small teams which ensured that people supported by Community Careline services had consistent help and support from people they knew. The staff showed us that they knew the people they supported well and were knowledgeable about their needs. There was a low rate of staff turnover, and we saw that training opportunities helped people who worked for Community Careline Services to develop their skills and improve their knowledge.

We saw that staff had access to supervision and yearly appraisal but the service would benefit from more regular spot checks to ensure that staff worked in accordance with current best practice.

Care was delivered in a person centred way by caring and patient staff; people told us that they were made to feel like they mattered. Staff understood issues around capacity and consent, and people told us that their consent was always sought. Care and support was planned around people’s needs and there was a degree of flexibility in how visits were planned to allow for people’s changing circumstances and social activity.

Care records were comprehensive and gave a good indication of people’s needs and how they liked them to be met. People were involved in reviews of their support and they influenced how their care was delivered. Dietary needs and health concerns were considered and taken into account when planning and delivering services. There was evidence of co-operation with health professionals to ensure that health needs were monitored and met.

People who used the service knew how to make a complaint if they were unhappy with their support. There were relatively few complaints, but any received were appropriately dealt with. Where errors or mistakes were made appropriate action was taken to minimise the risk of repetition.

Effective systems for monitoring the quality of the service were in place. Records showed that audits were undertaken on all aspects of the running of the service. There were also opportunities for people who used the service to comment on the care and support provided, and their feedback was used to make improvements in the way services were delivered.

Staff worked closely with other agencies so that people's health and physical needs were effectively met.

Adequate numbers of staff were available to meet the needs of people. Arrangements for staff training and development were in place so that staff were adequately supported and had the knowledge and skills needed to support people safely.

Systems were in place to monitor and review the service provided so that people received a safe and efficient service which met their individual needs.

We also looked at the individual care records for people. Information provided guidance for staff about how people were to be supported so that they received safe and effective care and support.

Two people told us that the office staff kept them fully informed in there were any changes in the staff visiting them.

All of the people we spoke with had access to the office contact details and said that if they had any issues or concerns they would have no hesitation in contacting the office staff.

People told us that they were very happy with the standard of care they received. Their comments included; "I'm perfectly happy', 'Thrilled to bits, they are better than my previous carers' and 'Wonderful staff, they couldn't do anything better'.

The relative we spoke said 'I have confidence in the agency' and 'the main thing is I know she is safe with them [the staff]'.