Comfort Call - Liverpool

This service provides care to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

Comfort Call Liverpool provide care and support at four separate extra care sites across Liverpool. They are Milachip Court, Meadow Court, Latham Court and Linksview, which is also the registered location were the care is managed from. We conducted our site visit at Linksview, and we visited three of the four schemes during our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Most people had up to date risk assessments in place. However, not all risk assessments contained relevant and up to date information, and risks were not always being monitored. This placed people at risk of unsafe care. We received mixed feedback regarding the staffing levels across the schemes, however most people said staff were quick to respond and visited them in time. We have made a recommendation regarding staffing levels. Incidents and accidents were recorded, and the provider ensured lessons were learnt where incidents occurred to prevent them occurring in the future. People were supported to take their prescribed medication. Staff had access to appropriate personal protective equipment (PPE) and had received training in relation to infection prevention and control and COVID-19. Staff were recruited safely.

People were supported to access healthcare services. However, people’s health and well-being were not always monitored appropriately due to relevant records, daily logs and communication between staff not being completed correctly.

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. Staff were trained in a range of subjects relevant to their role and underwent regular supervision and appraisal

Governance and quality checks were in place, however they were not robust enough and did not highlight the concerns we found with regards to some inaccurate risk assessments and incomplete records. This meant the service was not always well-led. The regional manager was open and transparent with us during the inspection and has since started to make improvements in this area.

The organisation worked in partnership with the housing provider and local authority safeguarding teams. Most staff said they liked the regional manager; however, some staff felt the turnover of scheme managers was too high. Feedback was gathered from people using the service and their families which was positive.

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 14 December 2017)

Why we inspected

The inspection was prompted in part due to concerns received about records, communication and staffing. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective 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 Requires Improvement. This is based on the findings at this inspection

You can see what action we have asked the provider to take at the end of this full report.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and governance.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Comfort Call Linksview on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was announced. We gave the provider 24 hours’ notice that we would be coming as the service delivers domiciliary care to people in an extra care setting, and we wanted to be sure people would be available to talk to us.

This was the service’s first inspection at their new location.

The inspection was carried out by a three adult social care inspectors.

There was 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.

This service provides care [and support] to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

Comfort Call Liverpool provide care and support at three separate extra care sites across Liverpool. They are Milachip Court, Meadow Court, Latham Court, and Linksview, which is also the registered location were the care is managed from. We conducted our site visit at Linksview, however, we visited the other four schemes during our inspection.

Everyone across of the four schemes told us that they felt safe being supported by Comfort Call.

Staff we spoke with were able to describe the course of action they would take if they felt someone was being harmed or abused, this included reporting the abuse to their manger, the Local Authority or CQC.

Risks to people’s health, safety, and welfare were assessed and clearly explained to enable staff to support people to stay safe.

There were enough staff deployed throughout all of the four schemes to support people safely. Staff told us they felt that they had enough time to spend with people and did not feel rushed or pressured.

We spoke to the registered manager about any learning they had implemented across the service as a result of feedback from safeguarding’s or complaints, and saw evidence that ‘lessons learned’ was regularly discussed as part of the culture of the service.

There was personal protective equipment (PPE) available for staff to use such as gloves and aprons. Additionally, there were hand washing facilities at each scheme.

Staff recruitment procedures were robust and we saw that staff were only offered positions within the company once all satisfactory checks had been completed on their character and suitability for the role.

Medication was managed safely. People were supported to store their medication in a safe place within their home. People who required support from staff to take their medication were supported only by staff who had been trained to do so. These staff also underwent regular competency checks to ensure they were still able to complete this task safely.

People had undergone a pre-assessment before offered a care package from comfort call. This was to ensure the service was able to meet people’s individual needs.

All staff were trained in a variety of subjects which were classed as mandatory in the provider’s training policy. Staff were also trained in specialist subjects to help their understanding when supporting people with complex medical needs. All staff were regularly supervised, and had undergone an annual appraisal.

People had their own kitchen in their own property, however staff would support them to make meals and snacks if this was part of their care plan. People told us staff made sure they ate well, and staff were knowledgeable regarding any specialist diets people were required to follow.

The staff across the four schemes worked well together to ensure shifts were covered. The provider worked alongside the different housing providers and the local authority to ensure people were offered the best possible support package. Additionally, in situations where anti-social behaviour was reported, we saw the provider had contacted and appropriately reported these events to the police.

People were supported to access the GP when needed, staff would accompany people to appointments if this was required.

The Mental Capacity Act and associated principles had been considered for some people who were found to lack capacity. Decisions were made in people’s best interests, and the registered manager was able to demonstrate a good understanding of when people required assessment due to a change in their capacity.

People lived in their own apartments, and had access to communal areas of the scheme for socialising. Each person had a call bell in their apartment they could use if they required support or assistance.

We observed staff treating people with kindness and respect and people were complimentary regarding the staff’s professionalism.

Staff we spoke with were able to describe how they protected people’s dignity and right to choose how they wanted their care delivered.

People told us they were able to get involved in how their care was coordinated and overall felt satisfied with the provision of care in the scheme, and their own individual care packages.

There was a high level of personalised information in each person’s care plans. Each care plan went into detail regarding what the right care and support should look like for the person, including any medical needs they had, emotional needs or hobbies and interests. There was information about people’s backgrounds and past histories which had been collated with people’s permission, to enable staff to get to know them.

There was a complaints procedure in place. The service had logged and responded to all complaints in accordance with their own policy and procedures. There was one complain on-going which we did not see an outcome for because it was still being looked into.

Staff had received training in end of life care and were able to support people and their families. As people lived in their own homes, we saw that where possible, people had chosen to remain at home until their final days.

There was a strong emphasis on team work and the culture of the service was to support people to do as much for themselves as possible. This was evidenced during our conversation with staff and when we visited people in their own homes within each of the four schemes.

People spoke positively about the scheme managers and most people knew who the registered manager was.

People who lived at the schemes and their families were involved in any decisions regarding their care and support, and feedback was requested to judge how the service was performing as whole across the four schemes.

The registered manager frequently had to engage with other professionals such as the housing provider, police and local safeguarding teams to ensure transparency and people were protected from harm.

The service had recently won third prize at the older people’s awards, which was an external award ceremony and regularly looks for ways they can improve their services.