Background to this inspection
Updated
17 December 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. There was an acting manager in place as the registered manager was currently on an extended period of leave.
Notice of inspection
We gave the service over 48 hours' notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 12 November 2021 and ended on 23 November 2021. We visited the office location on 15 November 2021.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We also sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection-
We spoke with five people who used the service and one relative about their experience of the care provided. We spoke with eight members of staff including the regional manager, branch manager, director of compliance and five care staff.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
17 December 2021
About the service
Niche Care Cheshire East is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Cheshire East area. 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. At the time of this inspection 23 people were receiving support with personal care.
People's experience of using this service and what we found
Following the last inspection the new provider had not effectively embedded monitoring and auditing systems. Issues in relation to staff recruitment checks, staff competency checks and supervisions, information within care plans, as well as effective quality assurance systems were identified at this inspection.
The provider had identified areas for improvement and had started to work on these. There were some governance systems in place, however these had not effectively identified or addressed issues in timely way.
There was a relatively new management team in place, who had undertaken significant work over the past few weeks to make improvements. New systems and procedures to monitor the quality of the service needed to be fully embedded and the provider needed to demonstrate improvements would be sustained.
Improvements were required in relation to staff support and supervision. The provider was unable to clearly demonstrate all staff had received the required supervisions, appraisals and competency checks. The new management team had recently started to take action to address this.
The provider had experienced significant staffing pressures due to staff leaving and sickness, at times impacting on the timing and length of planned calls. The local authority were temporarily supporting the provider and the number of people being supported had been reduced, until they were able to recruit more staff. The provider was actively recruiting for new staff.
We received some positive feedback about the care and support people received. However, there remained mixed views about the timings of care calls and consistency of staff. Some people felt unsettled by recent staff changes.
Following audits, gaps had been found in records relating to robust recruitment procedures being followed. the provider was acting on this. A process was being implemented to ensure systems were more robust in future.
Since the last inspection improvements had been made in relation to the safe management of medicines, The management team were still in the process of undertaking staff competency checks for administering medication.
Staff understood their responsibility to identify and report any safeguarding concerns. People were protected from the risk of infection.
Care plans included risk assessments and guidance about measures to minimise the risk. The manager was in the process of undertaking reviews with each person who used the service, including care plans and risk assessments.
People told us staff sought their consent before providing care. Staff had some understanding of the MCA and confirmed they were required to record when consent was obtained. Clearer information was required within a person’s care plan to demonstrate that relevant decisions had been made in line with the person’s consent or the Mental Capacity Act (MCA) if required.
The provider was working in partnership with others such as the local authority to improve the service.
The provider and the new management team demonstrated their commitment to making the necessary improvements to achieve good outcomes for people.
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 (published 2 March 2021). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.
We met with the new provider and they completed an action plan to show what they would do and by when to improve.
At this inspection not enough improvement had been made and the new provider was in breach of two regulations.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels and the safe management of the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions of safe, effective and well-led.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same and is rated as requires improvement. 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, Cheshire East 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. We have identified breaches in relation to staff supervision and competency checks and quality assurance processes at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an updated 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.