Archived: Comfort Call - Beechfield

Comfort Call Beechfield provides care for people living in flats and bungalows at Beechfield Court in Middlesbrough and Orchid Close in Thirsk.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, people who have physical and mental health conditions and those who have a dementia type illness. Not everyone using Comfort Call Beechfield receives a regulated activity. CQC only inspects the service being received by people provided with personal care. At the time of our inspection 72 people using the service received personal care.

The communal areas of Beechfield Court include a café and hairdressing salon which are also open to the public. People have emergency buzzers in their homes which they can use to alert staff if they require emergency assistance outside of their regular care calls. Staff are based on-site at all times. The building is managed by Group Thirteen which is also based at the service.

There was a registered manager in place. 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.

At the last comprehensive inspection of the service in January 2017 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to Dignity and respect, Staffing, Safe care and treatment and Good governance. We issued two warning notices in relation to Safe care and treatment and Good governance and asked the registered provider to take immediate action to make improvements. A subsequent inspection took place in August 2017 which focused on the areas where we had issued warning notices. At the focused inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to Safe care and treatment and Good governance. Following the focused inspection, the provider sent us an action plan which detailed actions already taken and those yet to be completed. All actions had dates in place by which the registered provided expected them to be completed.

At this inspection we reviewed the action the provider had taken to address the issues we found at the last two inspections. We noted that improvements had been made however we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Safe Care and treatment and Good governance.

You can see what action we told the provider to take at the back of the full version of this report.

This is the fourth time the service has been rated Requires Improvement.

We identified that medicines were not always managed safely. We found that some risks to individuals were documented but information was missing around other risks. Regular quality assurance checks took place; however, these were not robust.

People and relatives gave mixed reviews about staffing levels. Staffing levels were monitored by the registered manager.

People were safeguarded from abuse and avoidable harm. The provider followed safe recruitment procedures to minimise the risk of unsuitable staff being employed.

Infection control policies and procedures were followed to support the control of infection.

We identified some gaps in care plans relating to people’s health conditions. The care that was planned was personalised.

Staff were supported with their inductions and had regular supervision meetings and an annual appraisal. Staff received training, the provider deemed key to help them keep people safe.

Staff sought consent from people before carrying out tasks with them. People were always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to access external professionals to monitor and promote their health. People told us that staff helped them with shopping and the preparation of food when needed. The registered manager told us that procedures were in place should anyone require additional support with their nutrition and hydration.

Most of the people and relatives we spoke with said that the staff team were kind and caring. We were told by both people and their relatives that staff treated people with respect and promoted independence.

Outside of people's planned care visits, regular activities took place at the service which relatives and friends could attend. Group Thirteen, Comfort Call Beechfield and people using the service worked together to plan these activities. People told us they were happy with the activities at the service.

People and their relatives told us they knew how to complain. A complaints policy and procedure was in place. Feedback from people, relatives and staff about the service was sought.

Staff understood and followed people's care and support plans. The provider had policies in place to support people with end of life care if needed.

The inspection was announced. This meant the provider; staff and people using the service knew that we would be carrying out an inspection of the service. The provider was given 48 hours’ notice prior to inspection because the service provided domiciliary care services. This meant we could be sure that the registered manager and people’s care records would be available for inspection. This also gave the provider time to gain consent from people who used the service for us to speak to them by telephone. Due to some concerns found during the inspection around staff using hoists they were not trained for, a near miss fall from a hoist and not enough stock of medicines, we sent an urgent action letter to the provider requesting further information

Comfort Call Beechfield provides domiciliary care services for people living in Beechfield Court in Middlesbrough. Beechfield Court is made up of flats and bungalows. The communal areas of Beechfield Court include a café and hairdressing salon which are also open to the public The service caters for people who have physical and mental health conditions and those living with dementia. The building is managed by Group Thirteen (Landlord) and care was provided by Comfort Call Beechfield, both based at the service. At the time of our inspection there were 70 people using the service.

There was a registered manager at the service who had been registered since May 2015. However, a new manager had been employed to look after the day to day running of the service. 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. We were told on the second day of inspection that the new manager was planning on becoming registered. Once this happened the existing manager would de register.

At this inspection we reviewed the action the registered provider had taken to address the issues we found at the previous inspection..

We found work was still needed to improved the safety of medicine administration. There were gaps in medicine records. Management had identified some issues in records relating to medicines during audit and had taken action, but not all issues were identified. Risk assessments were not in place for one person who administered their own medicines. Where care staff had, responsibility for obtaining medicines for people this was not clearly documented and there was no procedures documenting how this would be undertaken. Some people were not administered medicines because they were not available.

We found audits were now taking place with an action plan to highlight concerns found and dates they would be rectified. However staff were still not following correct processes set out. For example, staff had not contacted the on call team during night duty when they were unable to attend planned calls because of a medical emergency. This meant people received calls much later than planned and had caused people to delay their medicines and go to bed much later than they normally would.

Risks to people arising from their health and support needs were not always assessed, and plans were not in place to minimise them. A serious incident took place in May 2017 which was reported to the management team however the incident was not recorded or investigated. We informed the management team at inspection on 30 August 2017, yet no action had been taken to address this when we returned on 12 September 2017.

There were enough staff to meet people’s planned calls, however this became problematic when there were unplanned calls or when staff were off sick. The volume of unplanned calls was problematic for staff because people used the emergency buzzer when there was no emergency. No robust monitoring was in place to manage unplanned calls.

Limited feedback was sought from people, relatives, external professionals and staff to assist with the quality of the service.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Comfort Call Beechfield provides domiciliary care services for people living in their own flats and bungalows at Beechfield Court in Middlesbrough. The communal areas of Beechfield Court include a café and hairdressing salon which are also open to the public. People have emergency buzzers in their homes which they can use to alert staff if they require emergency assistance outside of their care packages. Staff are based on-site at all times.

The service caters for people who have physical and mental health conditions and those who have a dementia type illness. The building is managed by Group Thirteen and care provided by Comfort Call Beechfield, both based at the service. At the time of our inspection there were 56 people using the service and 35 staff employed.

The registered manager was responsible for ensuring people received their care packages at Beechfield Court in Middlesbrough and another service in Hartlepool. A manager was based on site to oversee the domiciliary care provided to people. 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.

At the last inspection of the service, carried out 22, 25, 26 January and 1 February 2016, we found that the service was not meeting all of the regulations which we inspected to meet the needs of people safely. Missed and delayed calls had impacted . We found that there were insufficient staff upon the dignity of people. People who needed support with their medicines had not been given it and some people did not have the medicines they needed. Safeguarding alerts had not always been made; a lack of communication meant that there was a delay in making some safeguarding alerts. We identified gaps in all records reviewed during inspection.

After the inspection, the registered provider submitted an action plan which identified the action they were going to take to make improvements.

At this inspection, although we noted that improvements had been made to procedures in place to manage safeguarding concerns and safeguarding alerts had been made. We found the service was not meeting all of the regulations which we inspected to meet the needs of people safely. This meant people's dignity continued to be compromised; medicines were not managed safely and there were not enough staff to deal with people's planned calls and emergency call bells effectively. Staff had not received regular supervision and people's care records did not always contain the information needed or had inaccurate information contained within them. We wrote to the registered provider about our concerns about the continued breaches. They responded to our concerns and provided a detail action plan which included the action they had already taken and included dates by which any outstanding actions would be addressed.

At this inspection, people and relatives gave mixed reviews about the care and support which they received.

Some people spoke highly of staff, gave many positive examples and told us staff provided them with time, the support they needed and meaningful conversation. However, some people told us they felt rushed and felt they knew too much information about other people and staff because confidentiality was not respected or maintained. People told us that staff talked to them about the care they had carried out or were going to carry out with other people. People also told us about specific incidents where their dignity had been compromised.

People told us they were involved in their care and there was evidence of this in people’s care records. However, people gave mixed reviews about feeling listened to. Some people told us they felt their concerns were not taken seriously or had not been given information when they requested changes to their care package.

Some people had excessive quantities of prescribed medicines. Some people we spoke with told us they didn’t know what their prescribed medicines were for and during our observations staff did not provide information about this when they were dispensing medicines to people. Some people had not been given their medicines, eye drops and topical creams as prescribed. There were gaps in medicine records and in audits. Risk assessments were not in place for people who administered their own medicines.

We were concerned that one person had been not been given their medication appropriately and this may had adversely affected their health. We advised the person and their relative to contact their GP for advice. They GP recommended that the person visit accident and emergency which they did and were discharged the same day. We asked the registered manager to make a safeguarding alert which they did.

Care records did not reflect all of people’s actual needs and some information looked at was inaccurate. We also found care records contained limited information about the support people needed, what they could do for themselves and their personal preferences. This meant that staff did not have the information they needed to provide the care people wanted.

Quality assurance measures in place had not highlighted the levels of concerns which we had received from people and their relatives during inspection. Staff kept records which showed people were dissatisfied with the service, however, there was no evidence of staff taking action to make improvements. Although there was evidence of regular audit taking place, they were not identifying all of the concerns which we found at this inspection.

Staff had not received supervision and appraisal in line with the registered provider’s policy. Staff training was up to date, however we received mixed reviews about the knowledge, skills and experience of staff from people and their relatives.

Staff told us there were enough staff on duty during the day when the shift was fully staffed. They told us staff were not always replaced when they were off sick.

People told us they continued to experience a delay when they pressed their emergency buzzer and told us staff were regularly late for planned calls within their care packages. Nearly all of people and their relatives spoken to during inspection told us more staff were needed.

Staff told us that two members of staff on site during the night was sufficient to meet people’s needs. However, staff told us that when emergency incidents occurred, they needed a third member of staff to be available to respond to emergency buzzers whilst they dealt with the emergency incident. Staff told us they had previously tried to contact on-call managers during the night without success. This is something the management team disputed during inspection.

Procedures to safeguarding had improved since the last inspection, however staff had not always raised concerns when people had missed their prescribed medicines. We found this to be a training issue.

The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff to make sure they were suitable to work with vulnerable people.

Staff were aware of the emergency evacuation procedures they would need to follow if they were in people's property at the time of an incident. People had risk assessments in place and these had been regularly reviewed.

Staff participated in an induction programme when they started working at the service. This included shadowing more experienced staff, attending training and participating in reviews.

People told us staff assisted them with shopping and the preparation and cooking of food. Staff understood the procedures which they needed to follow if people experienced any deterioration in their health because of inadequate nutrition and hydration.

People told us they had regular involvement with the health and social care professionals involved in their care. People told us staff arranged transport and attended appointments for them.

The registered manager responded when people’s needs changed by putting extra calls in place for people when they became unwell or during the Christmas holiday period.

Outside of people's care packages, regular activities took place at the service which relatives and friends could attend. Group Thirteen, Comfort call and people using the service worked together to plan these activities. People told us they were happy with the activities at the service.

Everyone we spoke with told us they knew how to make a complaint. Records in place showed that complaints procedure had been followed and the service had acted appropriately.

People and relatives gave mixed reviews about the management team. Many told us that the management team needed to be stronger.

The registered manager and manager understood the responsibilities of their role. They had submitted notifications to the Commission when required to do so. During inspection, they investigated all concerns which we asked them to when people had raised their concerns with us. They responded quickly when one person’s GP recommended that they visit accident and emergency following our findings and they put new procedures in place to minimise the risk of reoccurrence.

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The registered provider was given 48 hours’ notice prior to inspection because the service provided domiciliary care services. This meant we could be sure that the registered manager and people’s care records would be available for inspection. This also gave the registered provider time to gain consent from people who used the service for us to speak to them by telephone.

Comfort call Beechfield provided domiciliary care services for people living in Beechfield Court in Middlesbrough. The building was managed by Group Thirteen and care provided by Comfort call Beechfield, both based at the service. At the time of our inspection there were 70 people using the service and 35 staff.

Comfort call Beechfield was a new development which had been running for less than one year. This meant all of the staff and the management team were fairly new in post. Staff were recruited when care needs increased or when new people were moving into the service. The registered manager was responsible for two services, one in Middlesbrough and one in Hartlepool. 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. At the time of our inspection, the registered manager was in the process of recruiting for a manager for Beechfield Court. They told us they would remain responsible for the two services but each would have a manager who would be responsible for the day to day running and as the registered manager they would oversee this.

There were insufficient staff to deal with the demands of the service. Staff were appropriately recruited.

People used call bells to alert staff when they needed assistance. The service said people abused this because call bells were for emergencies only. The volume of calls put increased pressures on staff.

People did not always have the medicines they needed. Some people who needed support with their medicines were not always given it.

People who used the service and staff had concerns about the security of the building at night.

Some safeguarding alerts had been made. Staff had not always informed the management team of potential safeguarding alerts which meant they had not been made.

Staff understood procedures to follow when they suspected abuse and told us they would whistle blow [tell someone] if they needed to.

People had detailed risk assessments in place which included information about how to reduce risk and where appropriate equipment needed to reduce risk.

Each person had a personal emergency evacuation plan in place. Staff told us they felt confident to deal with an emergency.

Safety certificates were up to date. Maintenance repairs were carried out quickly.

Training, supervision and appraisals were up to date.

People who needed support with nutrition and hydration were given it.

Staff followed the guidance given by health professionals and supported people to attend healthcare appointments if they needed it.

Each person lived in their own accommodation at Beechfield Court and had access to communal areas and outside space.

People spoke positively about the care and support they received from staff. People told us they felt rushed at times because of staff workloads.

People told us they were involved in all aspects of their care and made their own decisions.

People told us staff respected their privacy and dignity when care and support was provided to them.

People were able to negotiate their calls and were involved in assessments of their care.

People were able to make complaints. We could see that complaints were investigated; however outcomes were not always clear.

Staff told us they were happy working at the service.

We heard mixed reviews about the management team from staff and people who used the service.

The registered manager was responsible for two services; this meant their time was shared. However recruitment for a manager who would be based at the service everyday was taking place.

The registered manager was aware of their roles and responsibilities and had submitted notifications to CQC when needed.

The registered manager openly discussed their achievements and challenges about the service and was motivated to continue in their role.

Quality assurance processes were in place. Feedback from people, their relatives and staff was regularly sought. However feedback from this, such as the recent survey had not been given.

We found four breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.