Archived: Niche Care North Tyneside

Niche Care North Tyneside is a domiciliary care agency providing personal care to adults living in their own homes. At the start of the inspection 76 people were receiving personal care support. However, the number of people receiving a regulated activity reduced during the inspection period. The registered provider had applied to CQC to remove the location of Niche Care North Tyneside from their registration. This application was being progressed by CQC during the inspection period.

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

The service was not well led. Effective governance systems were still not in place to monitor quality and deliver improvements across the service. Systems were in place to gather feedback from people, their relatives and staff. However, there were missed opportunities to respond to feedback to improve outcomes for people. The provider had not followed their own action plan developed following the last inspection to improve standards at the service.

A robust system to ensure people were protected from the risk of abuse was still not in place. We identified several safeguarding concerns which had not been reported to the local authority in line with safeguarding thresholds which exposed people to a risk of harm. Medicines were not managed safely. In addition, medicine administration records did not always demonstrate medicines had been administered to people as prescribed.

Safe infection control systems and procedures were still not in place to ensure people were protected from the risk of infection. The provider had not taken sufficient action following our last inspection to ensure staff were aware of and followed safe infection control procedures. An effective system to ensure all the risks people were exposed to, was still not in place. There were not enough staff to safely meet people’s needs and safe recruitment procedures had not been followed.

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.

The majority of staff we spoke with did not feel supported at work. In addition, not all training deemed mandatory by the provider had been delivered to staff. The nutritional needs of people were not always met, and action had not always been taken to report concerns to the appropriate health or social care professional for people with specific needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement following an inspection in February 2021 (report published 28 July 2021) and there were multiple breaches of regulations. We issued the provider with a Warning Notice related to infection prevention and control. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, the provider has not complied with the Warning Notice and enough improvement had not been made overall, meaning the provider was still in breach of multiple regulations.

Why we inspected

The inspection was prompted in part due to serious concerns received about people’s care and treatment, staffing, missed calls and the management oversight at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

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 the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care, safe care and treatment, safeguarding people from the risk of harm, staffing, fit and proper persons employed and the overall governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Niche Care North Tyneside provides personal care to adults living in their own homes. At the time of the inspection 63 people were receiving support.

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

The service was not always well led. Effective systems were not fully in place to monitor quality and deliver service improvements. In addition, an effective system to ensure all notifications were submitted to the CQC in a timely manner was not in place. The failure to notify the CQC of incidents in line with legal requirements meant there had been no overview by CQC to check whether the appropriate actions had always been taken.

A robust system to ensure people were protected from the risk of abuse was not in place. Concerns and allegations had not been reported to the local authority in line with safeguarding thresholds which exposed people to a risk of harm. Medicine administration records did not always demonstrate medicines had been administered to people as prescribed.

Safe infection control systems and procedures were not in place to ensure people were protected from the risk of infection. Government guidance in relation to safe working practices for the wearing and removal of PPE was not always followed by staff.

Risk assessments and care plans varied in the amount of detail they contained, and some sections of records were blank. Some care plans did not provide enough information to guide staff in the actions to take to deliver support. Action had not always been taken by staff to report concerns to the appropriate healthcare professional for people with specific health conditions. Environmental risk assessments were in place to assess any risks in the home environment.

Recruitment was generally safe. However, some recruitment checks had not always been thoroughly completed. We have made a recommendation about this.

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. We received mixed feedback from staff regarding feeling supported at work. Training the provider had deemed mandatory was delivered to staff. Most training completed by staff were e-learning courses. Some staff said they would prefer to receive face to face training as they felt this was more beneficial for learning.

The registered manager told us systems were in place to obtain feedback from people and their relatives. We saw documentation which evidenced investigations had been undertaken in response to complaints. However, no records of the complaints received were available.

People and their relatives were complimentary about staff. However, we received mixed feedback from staff about the caring attitudes of the whole staff team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 11/10/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people receiving safe care and treatment and the management oversight at the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive, effective and well led sections of this full report.

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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding people from the risk of harm, receiving and acting on complaints and the overall governance of the service. In addition, we also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 namely, Notification of other incidents. We have dealt with this matter outside of the inspection process.

Follow up

We will request an action plan for 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.