Care Link Northern Limited

Care Link Northern Limited is a service registered to provide personal care to people living in their own homes in the Hartlepool area. At the time of our inspection there were 24 people using the service.

Not everyone using Care Link Northern Limited received a regulated activity; CQC only inspects the service being received by people provided with '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

The oversight of the operation of the service needed improvement. Due to unrelenting pressures caused by the pandemic and staffing shortages the management team had needed to concentrate on delivering hands on care. They had prioritised this and hoped once the current staffing issues were resolved they could turn their attention to fully completing the records associated with the governance of the service.

People reported they were extremely satisfied with the service. People and relatives said staff always went above and beyond in delivering the care. They described the little extras staff just did as a part of their job. Staff were passionate about providing good care outcomes and took ownership for their practice.

There were enough staff on duty to cover the care packages. Staff reported the rotas were very well organised and enabled them to easily travel to deliver each care package and have enough time to properly support people. An effective recruitment programme was in place.

Medicines management was effective and closely monitored. Staff who administered medicines had the appropriate training.

Staff adhered to COVID-19 regulations and procedures. The registered manager ensured staff had access to ample supplies of PPE and they completed regular spot checks to make sure staff complied with the guidance and best practice.

Staff had received training around the Mental Capacity Act 2005 and associated code of practice and felt confident applying this in their practice. 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 took steps to safeguard people and promote their human rights.

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 24 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care Link Northern Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Care Link Northern Limited provides domiciliary services and support to people living in their own homes. The service also provides care under supported living arrangements for adults with a learning disability, so they can continue living in their own homes and communities. At the time of our inspection visit the service provided care and support to 35 people.

The service had a registered manager who was also the provider. We met with the registered manager and the office manager during the course of our visit. 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.

On our last visit to Care Link Northern Limited in August 2016 we rated the service as Requires Improvement. At that visit we found breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014 in relation to the recruitment of staff and quality assurance and records. At this visit we found improvements had been made and we rated the service as Good.

People were protected by the service’s approach to safeguarding and whistleblowing. People and their relatives told us they could raise concerns if they needed to and were listened to by staff. We saw that concerns were listened to and acted on straight away by the management team and outcomes were recorded in safeguarding records we saw. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management listened and acted upon staff feedback.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs. People who used the service told us that they had a team of staff, who were reliable and arrived when expected. Staff confirmed that they were not rushed and had time to provide the care people needed and expected.

Our conversations with people who used the service and their relatives during the inspection showed us that people who used the service were supported in their own homes by sufficient numbers of staff to meet their individual needs and wishes.

We looked at the recruitment process and found that relevant checks on staff took place before they started work and this process was safe. The office manager had implemented a checklist to ensure the appropriate recruitment checks were in place for prospective employees.

We saw that people’s prescribed medicines and topical medicines were recorded when administered. We looked at how medicines records were kept and spoke with the registered manager and office manager about how staff were trained to administer medicines and we found that the medicines administering, recording and auditing process was safe.

The service had introduced systems to ensure staff were appropriately trained and supported. Staff had received supervision, had observations carried out on their practice and we saw appraisals were all scheduled to take place in December 2017.

The care records we looked at included risk assessments, which had been completed to identify any risks associated with the person’s environment and delivering the person’s care.

From looking at people’s support plans we saw they were person-centred. ‘Person-centred’ care is about ensuring the person is at the centre of everything and their individual wishes and needs and choices are taken into account. The support plans made good use of personal history and described individuals care, treatment, wellbeing and support needs. These were in the process of being reviewed by the care co-ordinator and the office manager.

People and staff told us when they raised any issues they were dealt with promptly and professionally and everyone we spoke with knew how to speak to the management team at the office if they had any concerns.

There were now systems in place to gains the views of people using the service and the staff team, and an action plan was in place to ensure any comments or suggestions were acted upon. Whilst improvements were clearly evident, the provider had yet to demonstrate that sustained quality assurance and auditing systems were embedded at the service.

The service was an active part of the local community. People were encouraged to plan and participate in activities that were personalised and meaningful to them. We saw that the manager and staff were committed to supporting people to remain in their own homes with support and worked with district nurses, G.P’s, occupational therapy, physiotherapists and other specialist services as and when needed.

This inspection took place on 17 August 2016 and was unannounced. We last inspected this service in February 2014, at which time we found them to be compliant against all the regulations that we inspected.

The service had a registered manager in post who was also the registered provider. 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 found the safety of staff recruitment was not robust. Personnel records were missing essential evidence which would verify a person was suitable to work with vulnerable adults. We discussed this with the office manager who told us she would arrange for the collection of the necessary documentation.

The service had risk assessed aspects of people’s daily living to ensure their safety, but some wider aspects, such as behaviours which may challenge the staff and people accessing the community, had not been considered. We have made a recommendation about this. The company policies and procedures had been recently reviewed and updated. We discussed the implementation of additional policies with the office manager to ensure the service was more robust in areas such as recruitment, social media and use of mobile phones.

Medicines were administered safely and in line with safe working practices. People and relatives told us they had no issues with medicine support and care workers told us they felt competent with this task, we found that formal medicine competency checks were not being carried out with care workers. The office manager told us she would ensure these checks took place in future.

Staff received an induction and had been trained upon commencement of employment; we found that refresher training was not up to date. For example, two of the four staff files we examined belonged to staff who had been employed for a long time. There was no evidence of refresher training for these two care workers.

The service had supervision and appraisal policies in place but staff told us and records confirmed that formal supervision sessions had not taken place for over 12 months. The office manager told us staff often visited the office to discuss and resolve any issues they may have although these had not been formally recorded as supervision sessions. There was also no appraisal documentation in two files of long standing employees. The registered manager told us she monitored staff competence daily by working with the care workers and had no concerns about them. We have made a recommendation about this.

The office manager maintained a diary to record actions to take, however formal audits of the quality and safety of the service were not being undertaken. Formal observational quality checks of staff practice had not been completed since March 2015.

The registered manager told us that she regularly worked shifts as a care worker which enabled her to have oversight of the service. People and staff told us they had a good relationship with the registered manager and were able to approach her with any feedback.

People told us they felt safe living at home with support from their care workers. Staff understood their responsibilities to report any safeguarding concerns to the office manager or registered manager. People and staff told us they felt there were enough staff employed to provide a reliable and consistent service. We confirmed this through records.

There had been a low number of accidents and incidents; these were recorded as appropriate. There was evidence to demonstrate that regular reviews of people needs were carried out and information was passed onto the care workers and other health and social care professionals as necessary.

Evidence showed the registered manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. The service used the local authority’s mental capacity assessments within their records. Care records showed that wherever possible people had been involved in making some decisions, but significant decisions regarding people’s care were made in people’s best interests and had been taken appropriately with other professionals and relatives involved.

People told us they were respected and their dignity and privacy were maintained. All of the staff displayed kind and caring attitudes and through discussion, care workers demonstrated to us how they respected privacy and dignity. People’s care needs were recorded in detail and reviewed by the management with input from people, their families and healthcare professionals. The office manager told us people’s care records had been updated with new personalised documentation which had been recently introduced.

People told us they were offered a choice in all aspects of the support they received and care workers told us they gained verbal consent before providing any support. The service encouraged and promoted social inclusion and supported people to maintain links with family and friends. People and their relatives told us they had nothing to complain about but they knew how to complain and would feel confident to do so if necessary.

All of the staff told us they worked very well as a team. Care workers felt supported by the registered manager, office manager and supervisors who they said were approachable, caring and made them feel like a valued member of the team. People, relatives and staff all described the service as “a family run business” with “family values”.

The last annual customer survey had been carried out in 2014. People told the service they had found these surveys difficult to complete so no further surveys had been issued. The service had also tried to gather feedback by telephone courtesy calls in 2014 but this had also been a failed attempt. We discussed the need to formally gather opinion of the service from customers with the office manager who told us they would try courtesy calls again. The feedback we gathered as part of the inspection was excellent from each person and relative we contacted.

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.

Arrangements were in place to help people take their medication safely. Staff had received medication training, including more specialist training where this was appropriate.

People who used the service and their relatives told us that the service's staff were professional and competent. Comments made to us included 'They are very good actually' and 'Very professional.' Arrangements were in place to provide staff with training and support, to help them do their jobs.

Arrangements were in place to provide appropriate training and support to staff. People were asked if they were satisfied with their care during satisfaction surveys, reviews and visits by senior staff. People told us that they had regular contact with the manager and senior staff, and would feel able to raise any concerns that arose.

Improvements had been made to people's care records since our last visit, although the provider needs to ensure that all care plans are regularly kepy under review.

The people we spoke with said they thought they received the care they needed and that the provider was able to respond as their needs changed. For example one person told us, "I wouldn't go anywhere else. They do all the right things. All the things that I like. If anyone is going to be late, I always get a call to let me know."

From what we witnessed and were told we found that people who used the service were protected from the risk of abuse.

The provider had carried out appropriate pre-employment checks to ensure the suitability of staff.

Although the people we spoke with were happy with the service, we found that records about the care planning and assessment of people's needs lacked detail. There was a risk that important information contained in people's care records could not be retrieved promptly when required.