Archived: Comfort Call Northampton

This unannounced inspection took place on the 8, 10, 15, 16 and 21 December 2015. Comfort Call Northampton provides personal care to people in their own homes, there were 132 people receiving care during this inspection.

Following our inspection in April 2015 the service was rated as ‘Requires improvement’ due to concerns about the safety and well-being of the people receiving care. We placed conditions on their registration that prevented the service from taking on any new packages of care, and a condition that they provide all the care that had been agreed with the individual.

The service is required to have a registered manager; 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 previous registered manager left the service in August 2014 and their registration has now been cancelled. Since our last inspection the provider has employed a manager; they had begun the process of submitting an application to be registered with the Commission.

At the time of this inspection we found that although there were areas where improvement had been made, there were still significant concerns in the way that the service operated and in relation to the way in which care was being provided.

People were at risk of serious harm as there were inadequate systems and processes to manage their medicines appropriately. People did not always receive their medicines safely. Where the service had been commissioned to provide people with their medicines, there was no system in place to ensure that staff were aware of all of people’s prescribed medicines. Staff had received training in managing medicines; however, the training had not provided staff with the required competency to manage the medicines effectively. This had led to people not always receiving their prescribed medicines, or receiving too much medicine, resulting in potential harm. Although there were systems in place to audit the medicines charts, these audits had failed to identify that people had not received their prescribed medicines.

People were at risk of harm as staff did not report their concerns to the manager. Although staff had received recent training in safeguarding of vulnerable adults, they failed to recognise the significance of what they were finding at people’s homes. People relied on staff to notice when they required referral to health professionals or required equipment. Staff did not report any concerns routinely back to the manager, which had left people not receiving their medicines or not being referred to the commissioners or GP for review.

People did not always receive their planned care because staff did not always turn up at the time planned or spend enough time with them to provide the care. Staff had been allocated to more than one person at a time and travel time had not been accounted for when planning calls. The manager was unaware of the number of calls that were not carried out as planned as there were no effective systems in place to identify this. There was a failure to allocate time to provide people’s planned care.

Processes designed to monitor the quality of the service were not always effective. Although systems to monitor the quality of the service had improved, the systems themselves failed to identify significant concerns. Where audits and checks were carried out, they did not identify issues which could affect people’s safety and well-being.

People did not always receive adequate food to maintain their well-being. Some people required assistance with preparing their food and drink, staff received training in food hygiene but not in the preparation of food. Some people did not receive regular meals.

People’s risks were identified and assessed, at the time of their review by the commissioners. However, not all people’s risk assessments had been updated when their care needs changed. Household and environmental risk assessments were completed and the outcomes were taken into account in helping to make the environment as safe as possible.

People’s experiences were dependent upon having regular care staff. Where people had regular care staff they spoke highly of them and valued their therapeutic relationship. However, the system for allocating care staff did not always ensure that people received the same care staff at the same time every day. Where people did not receive care from the same staff every day, they expressed their dissatisfaction.

Verbal complaints had not always been responded to and there was no record of these verbal complaints. Where people had made a formal written complaint there was a system in place to deal with the these; complaints had been responded to in a timely way and actions had been taken in response to people’s concerns. However, lessons learnt from each complaint were not always shared with all staff and they were not applied to all care packages.

People’s preferences and choices were not always listened to and there was no provision in the system to allow people to choose when they wanted care.

People received care from staff that had undergone the appropriate employment checks. New staff underwent an induction period where they received training and shadowed experienced staff during their first calls.

We identified that the provider was in breach of six of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.