Comfort Call Nottingham, is a domiciliary service providing personal care to vulnerable older people and younger adults in their own home. The service is run from an office located at Southglade Business Park, on the north-western outskirts from Nottingham.

Not everyone using the service received a regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; such as help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection there were 216 people using the service.

The service 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

At our last inspection in June 2016, the service was rated as Good. At this inspection, we found the service rating as Requires Improvement. This is the first time the service has been rated Requires Improvement. This was because the provider had not operated effective governance and quality monitoring arrangements to ensure people were consistently protected from risks associated with unsafe or ineffective care. People had not always received safe or timely care and their medicines had not always been safely given when required.

Risks to people’s safety had not always been identified or managed in a timely way to keep people safe. The provider had also not told us about safeguarding concerns relating to some people’s care when required, to help us ensure people’s safety when they received care from the service. Following local authority safeguarding investigations, care improvements were now being made at the service, with revised management monitoring and provider oversight arrangements established, to fully ensure this. However, the provider had not yet demonstrated their ability to fully ensure and sustain the service improvements required for people’s care.

Staffing and deployment arrangements for care calls had not been effectively managed, monitored or acted on, which had resulted in late or missed care calls. This placed people at risk of unsafe or ineffective care. Management safety checks, including for people’s medicines, were also revised to help ensure people’s safety at the service.

Risks to people’s safety from their health condition, environment or any care equipment they needed to use, were assessed before people received care, but not always consistently reviewed to help inform any care changes needed when required. Remedial action was in progress to address this in consultation with local care commissioners. Staff knew how to keep people and themselves safe and to report any related safety concerns or health incidents. Relevant systems, procedures, training and equipment were in place to enable this. This helped to protect people from the risk of harm or abuse.

People’s care plans had not always been maintained or reviewed with them in a timely manner, to help accurately inform people’s care. The provider’s remedial actions in progress helped to fully ensure this. Recent introduction of an electronic care planning system was imminently due to go live, to enable staff to ensure the timeliness and effectiveness of people’s care.

People often spoke positively about their care experience and felt most staff understood and followed their care needs and knew what they were doing. Staff supported people to help ensure their healthy nutrition and hydration and followed any instructions from relevant community health professionals concerned with people’s care when needed.

Staff understood and followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent or ensure people received care that was rightly agreed, in their best interes

This inspection took place on 23 March 2016 and was announced.

Comfort Call Nottingham is a domiciliary care service which provides personal care and support to people in their own home in the city of Nottingham. On the day of our inspection around 200 people were using the service each week.

The service 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

Staff took the necessary steps to keep people safe and understood their responsibilities to protect people from the risk of abuse. Potential hazards were identified and detailed plans were in place to enable staff to support people safely.

There were enough staff to ensure that people received their calls at the planned time and meet their care needs. Where required, people received the support they needed to safely manage their medicines.

Where people required support to eat and drink enough, this support was provided. However, the records were not always kept updated so people could not be sure if they had been given enough to eat and drink to maintain their good health.

People’s consent was sought before care was provided. The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) The provider was aware of the principles of the MCA and how this might affect the care they provided to people.

Staff were provided with the knowledge and skills to care for people effectively and received supervision of their work. Staff made sure that people had access to their GP and other health care professionals when needed.

Positive and caring relationships had been developed between staff and people who used the service. People were involved in the planning and reviewing of their care and making decisions about what care they wanted. People were treated with dignity and respect by staff who understood the importance of this.

People’s care plans provided comprehensive information about their basic care needs and were regularly reviewed and updated. However, care plans did not always contain such detailed information about any specific medical conditions people may have and the implications of this for the support being provided. People felt able to make a complaint and knew how to do so.

The culture of the service was open. People were supported by staff who were clear about what was expected of them and staff had confidence that they would get the support they needed from the registered manager, both during and outside of office hours. The registered manager undertook audits and observed practice to ensure that the care provided met people’s needs.

Prior to our visit we reviewed all the information we had received from the provider. We carried out telephone interviews with 11 people who used the service and eight relatives and asked them for their views. We also spoke with six care workers, the training officer, a care coordinator and some other managers within the provider’s organisation. We looked at some of the records held in the service including the care files for 10 people.

The most recent registered manager left the service on 11 July 2014 and has not yet completed the process to be deregistered. This means the previous manager’s name shows on this report. A new manager has been appointed and takes up their position on 21 July 2014. The regional support manager said the new manager would be applying for registration with us during their first week of employment.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The local authority had investigated a number of concerns about people’s care where they had been placed at risk of poor or inadequate care, such as visits being missed. Although not all the investigations had been completed the regional support manager said the majority of these concerns had occurred and the safeguarding investigations would be substantiated.

Some people said care workers had responded promptly when they had an accident. One person said, “They called for the medics when I passed out.”

Medicine administration records had not been checked by another worker to ensure they had been written out correctly. Records about people’s medication administration were not fully completed or accurate. One person said they had run out of tablets. They said, “Nobody said the tablets had run out.”

Is the service effective?

We found staff were effective at respecting and involving people who used the service. A relative said, “One lady carer had a really good way with him, she got him to have a routine.”

We found staff were not always effective at meeting the care and welfare needs of all the people who used the service. Rotas had mistakes such as calls missing, different calls planned for the same time and calls from another round included on the wrong rota. A person who used the service said, “They don’t know what they are doing half the time my carer was sent to the wrong place yesterday, it was on her rota.”

A recently appointed care worker told us they had a week long induction when they started which they had found to be “Very good.” Care workers told us they felt the training was good and helped them with their work. People told us generally they felt care workers were suitably trained. One person said, “Obviously some are better than others.”

Is the service caring?

Some people told us they felt the care workers understood their needs and met these in a sensitive and caring manner, but some people did not. A relative said, “Some of the carers are good, others go through the motions.”

Some people who used the service told us care workers used their mobile phones during their visit.

Is the service responsive?

The majority of people who used the service and their relatives told us they felt respected by care workers, however there were some occasions when people did not. One person said, “Generally yes, but it is person dependent. I am very happy with the good ones.”

People who used the service told us care workers encouraged them to do as much as they could for themselves and their privacy and dignity was respected. One person said, “We work together.”

Care workers told us they did not always have enough time allowed to travel between calls which meant they arrived late. A relative said, “The timekeeping is pretty erratic they come early or late.”

Is the service well-led?

We found people’s care and support was not always planned and delivered in a way that ensured their safety and welfare. Some people told us their care plans had not been updated when their circumstances had changed. A person who used the service said, “I am having more calls. The new care plan is not written yet.” There was no evidence to show completed care records were checked as part of the management of people’s care and support.

People received calls over a wide time period of their planned call time and calls did not always take place for the length of time they were planned to. Half of the people we spoke with said on one or more occasions a care worker had not turned up for a planned call.

The regional support manager said they were currently based at the service to provide the support and leadership to rectify a number of problems that had been identified.

Care workers said they often had problems reaching the staff member on call as the phone was busy or the staff member was unable to answer because they were driving or carrying out a visit to people who used the service.