This was an announced inspection which took place over two days 21 and 22 November 2016. The last inspection took place in July 2016. The service was not meeting the regulations at the last inspection and submitted an action plan to us describing the measures they planned to take to become compliant. The service had failed to ensure that staff were supervised and that effective leadership of the service was in place, two warning notices were issued. The service had also failed to ensure that care was delivered safely; that peoples consent was sought; that complaints were managed; that confidentiality was protected and that risks and medicines were managed safely. Requirement notices were issued against the provider. The provider also agreed to a voluntary suspension of new work with the CQC.Pinpoint Health and Homecare is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes in the North East. The care offered varied from short support visits to 24 hour care. There were 28 people using the service at time of inspection.
The service did not have a registered manager in post. They had recently appointed a new manager who intended to apply to register with us. A registered manager is a person who has registered with the Care Quality Commission 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.
The service had recently recruited to a number of key posts and most senior staff had been in post for around two months. This meant that most of the new procedures and checks the provider had implemented had either just started, or were about to start.
We found that people’s medicines were still not being managed as required. We found that staff had undergone recent training and a new policy had been implemented, but that action was not taken where recording errors were found. This meant people may not have received medicines as prescribed.
People still told us that support calls were late or missed and that they were not told if there was to be any delay in support arriving. Staff and people told us that consistency and timeliness of staff support remained an issue.
Staff were now receiving regular supervision, but annual appraisal of staffs training and development needs had still not taken place for staff employed more than a year. We have made a recommendation about this.
People or their representative’s consent was still not being consistently sought or recorded in peoples care plans. Where people lacked the mental capacity to make decisions it was not always clear that staff followed the correct processes when making decisions on their behalf.
A new complaints process had been implemented and more recent complaints were being managed effectively. However some complaints made since our last inspection had not been completed and staff were not managing all complaints in line with the new process. We have made a recommendation about this.
A number of issues we found at previous inspections had not been acted upon, or completed in a reasonable timeframe; the leadership and governance of the service had changed a number of times in the last year resulting in intermittent progress. Information submitted to the CQC by the provider before inspection was inaccurate. A voluntary agreement with the CQC to suspend new work had been missed by staff and new people had been assessed and provided with a service. However the service had made improvements in a number of areas in a short time period following the appointment of new senior staff and care staff recruitment.
Risk assessment and contingency plans for the delivery of the service were now in place. Staff felt able to raise any concerns they may have about the safety of the service and felt these would be acted upon.
New staff had been recruited safely and staff had been subject to thorough checks and a revised induction programme. New staff felt supported and adequately trained before they started work with people. Supervision had started for all staff and they told us they felt supported by senior staff to do their jobs well. Staff told us they could seek support from office staff and felt this was responded to quickly.
Arrangements were in place to request support from health and social care services to help keep people well. External professionals’ advice was sought when needed.
People and relatives told us the staff were caring towards them and treated them with dignity and respect at all times. Staff gave us examples of how they helped people maintain their independence and choice through supporting them as they wished and working in collaboration with family carers.
Care plans were more person centred and detailed how best to support people in a manner of their choosing. Reviews of care had been conducted and people’s feedback sought as part of the review process.
People, relatives and long standing staff told us the service leadership had improved recently. They felt the service had ‘turned a corner’ following changes in senior management and other changes to how the service was delivered and managed.
Newly appointed senior staff were open and transparent with us about the issues affecting the service. Where action was needed they took this quickly and supplied us with information requested. The provider was willing to work with the CQC to help improve the service further.
We found breaches in relation to safe care and treatment, consent and good governance. You can see full details of the actions we have asked the provider to take in the full report.