Prior to our inspection we received information from the local authority safeguarding team, who are responsible for investigating safeguarding concerns. This information told us that there were concerns regarding the recruitment and training of staff, and the planning and delivery of care. We brought forward our planned inspection of this service to check how these identified shortfalls were being managed. We undertook the inspection of Comfortcare on 30 May 2014 and 3 June 2014. During our inspection we spoke with the registered manager who is also one of the providers and two members of staff based in the office. We carried out telephone interviews with four members of staff who provided care to people who used the service on 5 June 2014 and 10 June 2014.
At the time of our inspection the service provided personal care for 20 people within their own homes. We carried out telephone interviews with people who used the service and/or their relatives/representatives on 5 June 2014 and 10 June 2014. We spoke with five of the 20 people who used the service and four relatives of people who had communication difficulties and were unable to verbally communicate with us about the care that was being delivered.
We inspected a sample of records at the service's office during our inspection. This included five people's care records and risk assessments. Other records seen included: five staff personnel files, staff establishment list, staff training plan, staff rota, provider's safeguarding vulnerable adults from abuse policy and procedures, service user guide, office diary, staff handbook and satisfaction surveys from people who used the service
We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, Is the service effective, Is the service caring? Is the service responsive? Is the service well-led?
This is a summary of what we found;
Is the service safe?
People told us they felt safe.
Our discussions with staff showed that they were knowledgeable about people's individual needs and how they were met
Safeguarding procedures were not robust. Not all staff understood their role in safeguarding the people they supported. Some staff did not understand the safeguarding procedures completely, for example who to contact if they suspected abuse which meant that some people were put at risk.
There was no formal documentation on people's care records to show their ability to consent to care and that their general mental capacity to make every day decisions had been assessed.
There were no systems in place to make sure that the registered manager and staff learned from events such as accidents and incidents, complaints, whistleblowing and investigations. This meant that people were not benefitting from a service that was taking on board lessons learnt.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, care planning, risk management, recruitment, supporting staff, quality assurance and records.
Is the service effective?
The registered manager set the staff rotas. Records showed that the registered manager had not taken into account when making decisions about the number of staff the service required, the travelling times and size of the geographical area they covered. This meant inconsistent and late visit times for people.
The provider did not have effective recruitment and selection processes in place. There were shortfalls found in the staff personnel files concerning relevant checks and no evidence of an induction when staff first started working at the service.
There were no formal systems in place or records of staff supervision, team meetings and / or support arrangements to provide staff with on-going learning and development opportunities.
People's care records did not show that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were no individual risk assessments for people despite there being risks identified at assessment stage. We could therefore not be assured that staff received the information required to meet people's needs.
It was not clear when people's care records were due to be reviewed and if their care records reflected their current situation and the actual care being delivered. We were unable to look at the care records for two people as they were not available in the service for staff to access or for us to review. This meant that we could not be assured that people were not at risk of receiving unsafe or inappropriate care.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, care planning, risk management, recruitment, supporting staff, quality assurance and records.
Is the service caring?
Overall people told us they were happy with the care they received and their needs were met. One person told us, 'When they (care staff) are here they are great and do everything I need them to do. They do what needs to be done and are good.'
However one person told us they were not so happy with the care arrangements in place and told us about their experience. They said, 'It really depends who comes to you and you don't know who that is until they turn up. Some (staff) are better than others and you can talk to them and have a good chat and we understand one another. But some people (staff) come and it's really hard to understand what they are saying and they ignore me. They don't listen and don't do what I want and talk over me or in another language. This makes me uncomfortable.'
Is the service responsive?
Records showed that the registered manager was no longer providing staff with their mandatory training and had outsourced the training to an external company. This was in response to concerns raised by the local authority about staff training.
We requested information to show how training was planned and delivered to staff. The provider submitted to us a staff training plan following our inspection.
Is the service well-led?
People told us that they knew how to make a complaint if they were unhappy about the care they received. However two people were not sure of the contact details for the service and said they would tell their relative or representative if they had any concerns.
Staff had not been provided with the supervision and appraisal that was identified in the service's own staff employee handbook. There was no evidence of staff meetings having taken place. This meant that staff were not provided with the opportunity to discuss the way that they worked and to receive feedback on their work practice.
Records seen were kept securely. However during our inspection the registered manager had difficulty accessing certain records we requested and these could not be located promptly when needed.
The provider did not have systems and procedures in place to monitor and assess the quality of the service provided. There were no records to identify best practice or shortfalls in the service and how they had been addressed. We could not see how feedback from people who used the service about their views and experiences was valued, taken into account and influenced the running of the service.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, care planning, risk management, recruitment, supporting staff, quality assurance and records.
We found that the service was failing in several areas. This meant we could not be assured that the service was well led.