This inspection took place on 19 and 27 September, and 4 and 5 October 2018 and was announced. This was to ensure someone would be available to speak with and show us records.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults of all ages. Some of the people who used the service had mental health needs or were living with a dementia type illness.

On the days of our inspection there were 1490 people using the service. Not everyone using Comfort Call Gateshead receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We last inspected the service in March 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Risk assessments were in place for people who used the service and staff. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place to support people with the administration of medicines.

Although there had been some missed and late calls, appropriate action had been taken in response and most of the feedback from people was positive.

The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People were supported with their health care needs and to attend appointments where necessary.

People who used the service and family members were complimentary about the standard of care at Comfort Call Gateshead. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation and the service had links with the local community.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People, family members and staff were regularly consulted about the quality of the service.

The last inspection of Comfort Call Gateshead was carried out in March 2016. At that inspection we found the provider had breached regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s quality assurance processes had not always been effective in addressing identified shortfalls. Also, some notifications required by the Care Quality Commission (CQC) had not always been sent to us in a timely way.

We carried out this focused inspection on 7 and 21 December 2016 to check whether the provider’s quality assurance and management systems led to improvements in the running of the service.

Comfort Call Gateshead is a domiciliary care agency which is registered with the Care Quality Commission to provide personal care for people in their own homes. The agency operates in the Sunderland, South Tyneside and Gateshead areas. The agency also provides a domiciliary care service to people who live in extra care housing schemes. There were approximately 1,500 people using the personal care service provided by this agency.

There were registered managers in place at the service. 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.

Since the last inspection the registered manager had been promoted to regional manager. Two branch managers, who were responsible for the management the care service provided in two local authority areas, had registered as managers with the Commission. A third branch manager, who was new in post, was also planning to apply for registration. This meant there was shared responsibility and greater management oversight of this very large domiciliary care agency.

We found the provider had made its quality assurance processes more robust and this was leading to improvements in the service. The managers were using the organisation's business management systems more effectively so that trends and areas for remedial action were identified and addressed.

Most of the people and relatives we spoke with felt the service was “well managed” and all felt able to contact the office.

While improvements had been made we could not improve the rating for Well-Led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

At the last inspection of Comfort Call Gateshead in March 2015, we asked the provider to take action to make improvements. This was because medicines were not being managed in a safe way for the people who used the service. Also people and their relatives did not feel their complaints were listened to or acted upon.

After the inspection the provider wrote to us to say what they would do to meet legal requirements.

On 10 and 11 February, and 4 March 2016 we carried out this comprehensive inspection to check whether the provider had addressed these breaches. We found there had been improvements in these areas.

Comfort Call Gateshead is a domiciliary care agency which is registered with the Care Quality Commission to provide personal care for people in their own homes. The agency operates in the Sunderland, South Tyneside and Gateshead areas. The agency also provides a domiciliary care service to people who live in an extra care housing scheme. At the time of this inspection there were approximately 1,500 people using the personal care service provided by this agency.

The agency had 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.

During this visit we found the provider had recently begun to carry out more in-depth quality assurance audits of the service. However, these showed that some previously identified areas for improvement had not been actioned. In this way, although the provider had quality assurance processes in place, these had not always been effective. Also, some notifications required by the Care Quality Commission (CQC) had not always been sent to us in a timely way. You can see what action we asked the provider to take at the back of this report.

People told us they felt “safe” and “well treated” by the care workers who visited them. For example, one person told us, “I feel safe. I like the carers they are all good. They are kind.” Staff had training in safeguarding adults and they knew how to report any concerns.

There were enough staff employed to carry out all the visits that were required, and the agency constantly recruited new members of staff. The agency made sure that staff were fully checked before starting to work with people.

Some people had regular teams of care staff and this made them feel confident in the staff who supported them. Other people said they did not always know which care staff would visit them and were not always told if they were going to be late. Staff told us they were not allocated travelling time between calls, which meant they sometimes arrived late.

People and relatives we spoke with felt the care workers were “well trained” and provided the right support. Staff felt they received good training and were supported in their roles. One staff member told us, “The training is phenomenal.”

People who needed support with meals told us they were in control of what they had and how it was prepared. Staff liaised with other care or health services if there were changes in people’s needs.

Some people said they had had the same care staff for years. This allowed them to develop good relationships. One person said it was just like having their family come in to help because they knew them so well. All the people we spoke with said care workers were “caring” and “kind”. care and kindness of care staff. Their comments included, “The girls are polite and kind”, “they are very courteous” and “they are very nice”.

Care workers were positive about their work and spoke warmly of the people they cared for. They said they stayed longer if a person was upset or ill and in need of a bit of comfort.

The care records about people were detailed, personalised and written in a sensiti

People we spoke with told us they were visited by someone from the office to assess their needs before they started to receive the service. One person told us, “The senior person came here to ask me questions and how I wanted things done for me”. People told us the care staff treated them with dignity and respect.

We received information through the Care Quality Commission (CQC) website that suggested there was inadequate training of staff in catheter care. We found care plans were in place and these provided detailed guidance to staff on managing the support people needed with their catheters. The daily report sheets showed the care that people had received in relation to catheter care, and these were dated and signed by the carers who provided the support.

We looked at staff training and the records showed that all staff except two had received appropriate training in catheter care. On the day of our visit to the offices of agency, we noticed some staff were receiving update training in catheter care.

Some of the comments we received from the people we spoke with included:

“I have nearly the same carers all the time which makes me happy”;

”They let me know if my regular carer was not available and someone else was coming in their place”;

“My carers are a great comfort to me and I have a lot of confidence in them”.

“I have concerns at about the care I get. I have been using this company for years and I have no complaints”.

Comfort Call Gateshead is a domiciliary care agency which is registered with the Care Quality Commission to provide personal care for people in their own homes. The agency operates in the Sunderland, South Tyneside, Gateshead and Chester-le-Street areas. The agency also provides a domiciliary care service to people who live in an extra care housing scheme. At the time of this inspection there were approximately 1,300 people using the personal care service provided by this agency.

The last inspection of Comfort Call Gateshead was carried out on 2 May 2014. The service met the regulations we inspected against at that time.

This inspection was carried out on 5 February, and 13 and 31 March 2015.

The agency had a registered manager who had worked for the provider for several years. 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 provider had breached Regulations 13 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found improvements were required to the management of medicines. People were not always supported with their medicines in a safe way. People did not always receive the right support and medicines records were not always completed.

Also, the agency did not always manage complaints in the right way. Some people felt their complaints were not listened to, some people felt their concerns continued to reoccur even after their complaint had been investigated, and the records of how some complaints were managed were not always completed. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe with the staff who supported them. Staff completed training in safeguarding adults before they started to work with people and had annual refresher training. This meant they knew how to deal with any concerns about people’s safety.

There were enough staff employed to carry out all the visits that were required, and the agency constantly recruited new staff. The agency made sure that staff were fully vetted before starting to work with people.

Some people had regular teams of care staff and this made them feel confident in the staff who supported them. Other people said they did not know which care staff would visit them and were not always told if they were going to be late. People and staff told us care staff were not allocated travelling time between calls, which meant they did not always get their full visit.

People felt the staff were suitably skilled to provide their care. Staff had relevant training and supervision to assist people in the right way. New members of staff received thorough induction training so they were prepared for their role.

People were involved in making decisions about their own care arrangements. Their care was planned and regularly reviewed. People who had a regular team of care workers felt staff were knowledgeable about their individual needs and preferences. People were supported with their meals if they needed support with their nutrition.

People were very positive about the caring nature of the agency staff. People and their relatives described care staff as caring, kind and helpful. People said their dignity and privacy were respected and maintained by the care workers. They told us staff supported them with closing curtains if they were getting washed.

A health care professional told us the care staff they had observed showed “compassion and kindness in their interaction with clients”.

People felt they were fully involved in making decisions about their care package. All the people we spoke with said they (and sometimes a relative) had been present when their care plan was drawn up. People kept a copy of their care plans in their own homes so they and their care workers could refer to them at any time. The care plans were personalised and written in a sensitive way.

People, relatives and health care professionals who knew the registered manager made many positive comments about her professionalism and helpfulness. Staff said they felt valued and supported by the registered manager and by the organisation.

However some people did not know any of the management staff and had no information about this. Some people felt there were not enough office staff to support the running of the agency, because they did not always receive a response when they requested return phone calls.

The provider had systems to check the quality of the service such as questionnaires, spot checks and audits. Although the system identified gaps these were not always addressed so the system was not always effective.