Archived: Community Care North East

Updated 7 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22, 23, 29, 30 June 2017, 3, 4, 7, 10 July 2017 and 28 July 2017. The first and last days of our inspection were unannounced.

The inspection team consisted of two adult social care inspectors. A third adult social care inspector joined the inspection team for the feedback meeting with the provider and the manager.

Before we visited the home we checked the information we held about this location and the service provider, for example we looked at the inspection history, safeguarding notifications and complaints. A notification is information about important events which the service is required to send to the Commission by law. We also contacted professionals involved in caring for people who used the service; including local authority commissioners. Local authority commissioners told us they had concerns about the service and were carrying out monitoring visits.

We did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used the opportunity of the inspection to explore the plans for the service with the manager and the provider.

During the inspection we spoke with seven people who used the service and six of their relatives. We reviewed 11 people’s care files and visited six people with their permission at their homes. We looked at 13 staff files and checked other records held by the service in the management of the regulated activity. We spoke with 11 staff including the owner director, the manager, two senior carers and seven care staff members

Updated 7 October 2017

This inspection took place on 22, 23, 29, 30 June 2017, 3, 4, 7, 10 and 28 July 2017. The first and last days of inspection were unannounced. Community Care North East is registered with the Commission to provide personal care in people’s own homes. The service is provided in County Durham and Gateshead. At the time of inspection the provider was no longer providing the service from their registered address. They had move to a new location and had applied to CQC to change their location address. Their new address was Suite 10, Enterprise House, Spennymoor, County Durham, DL16 6JF.

At the last inspection between November 2016 and January 2017 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.The breaches were:-

Regulation 9 Person-centred care

Regulation 10 Dignity and respect

Regulation 11 Need for consent

Regulation 12 Safe care and treatment

Regulation 15 Safeguarding service users from abuse and improper treatment

Regulation 17 Good governance

Regulation 19 Fit and proper persons employed

We also found at the last inspection the provider was in breach of Care Quality Commission (Registration) Regulations 2009. The breaches were:-

Schedule 1 Registered Manager Condition

Schedule 3 Statement of Purpose

Regulation 18 – Notification of other incidents

We asked the provider to take action to make improvements. During this inspection we found continued breaches of the regulations listed above with the exception of Regulations 10 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 18 and Schedule 3 of Care Quality Commission (Registration) Regulations 2009.

There was not a registered manager in post. 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.

People and their relatives we spoke with during the inspection held mixed views on whether or not the service was caring. One person liked the staff who visited them and we observed one person engaged in a conversation with humour with two staff members. Another person described the staff as arriving and doing what they had to do, and then leaving without caring. Three relatives were frustrated with the service provided and felt they had received all possible excuses for lateness.

The service had identified risks to people but had failed to put in place risks assessments which detail to staff actions they needed to take to mitigate the risks. We found documents used in the service were not always accurate and up to date.

We found the service did not administer people’s medicines in a safe manner. There were not appropriate arrangements in place with relatives to ensure people received their medicine. Medicines which were required by people on an ‘as and when’ basis were not always documented with suitable guidance given to staff.

People and their relatives told us staff do not always arrived on time to deliver care. We found staff did not having travelling time between calls. One staff member told us they had been short staff and covered hours. We found the newly appointed manager was attending a recruitment event at a local college to recruit more staff.

People and their relatives had mixed views about whether or not the service could be described as ‘Caring’. However due to the deficits we found in the service the ability of staff to care for people was constrained by a number of factors including the lack of risk assessments, supervision and the need to get from one person’s home to another without having in place travel time.

Staff completed online training in their own homes and in their own time. There were no checks in place to confirm that the actual staff member completed the training or had absorbed the re required learning. Staff did not receive regular support through supervision.

The provider had in place an electronic monitoring system. This was a system used to monitor when staff arrived and departed from people’s homes. We found this was not being monitored effectively and missed visits had not been identified. The system was not monitored to check if staff spent the required amount of time providing people’s care. Calls to people who chose not to have staff use their personal landline were not monitored. This meant there were risks of people’s visits being missed and systems to reduce this risk were ineffective.

We found staff references did not include sufficient information to ensure people employed in the service were suitable for their role. Brief comments were written down after a telephone call to the referee which did not fully explore the prospective staff member’s fitness to work in the service. Following the inspection the provider told us this was a historical issue and did not reflect current practice.

The provider had introduced a four weekly cycle of spot checks on staff whilst they undertook their duties. Staff were not able to tell us which week they were working to. We found these had not been carried out in line with the provider’s plan.

Surveys had been carried out by the provider of people who used the service. In two people’s surveys they had said they were satisfied with the outcome of their complaints. The provider was unable to demonstrate what these complaints were and what actions they had taken.

We found new audit systems had recently been introduced into the service by the newly appointed manager. These had been used to monitor the daily care records. However we found staff had written about a person experiencing pain when they had applied a person’s topical medicine (a cream applied to the skin). We found the audit tool did not address the specific details of care given to each person.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. These are listed throughout the report. You can see what action we told the registered provider to take at the back of the full version of the report. Details of any enforcement action taken by CQC will be only be detailed once appeals and representation processes have been completed.

Following our inspection we wrote to the provider with our concerns and asked them to provide us with a remedial action plan. They provided us with explanations and actions with deadlines they intended to take. We visited the service on 28 July 2017 to verify if the actions had been taken. We found some actions had not been completed within the timescales and other actions were in progress.