The inspection of Northern Community Careline Services took place between 11 October and 7 November 2018. We previously inspected the service in January 2018, at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, complaints, staffing and good governance. The registered provider had also failed to display their previous Care Quality Commission inspection rating, clearly and conspicuously on their website.

We rated them as inadequate and placed the service in special measures. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. On the day of our inspection 45 people were receiving care and support from Northern Community Careline Services.

The service had a registered manager in place. 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.

People told us they felt safe. Risk assessments were now in place and there was a system in place to ensure equipment was routinely checked for safety.

There was a system in place to reduce the risk of people receiving late or missed calls. Improvements had been made to recruitment procedures to make it safe.

Risks associated with the management of people’s medicines were not always identified which meant appropriate measures were not always in place to ensure safety. Records relating to the management of people’s prescribed topical creams needed to be improved.

New staff received an induction. Since the last inspection staff had received supervisions and checks on their performance. A significant amount of training had been undertaken by staff although some staff had not received training in all the topics recorded on the training matrix.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had signed their consent to the care and support they received although where people lacked capacity to manage their own medicines, a formal assessment of capacity had not been completed.

People told us staff were caring and kind. Staff respected people’s privacy, confidentiality and maintained their dignity.

Since the last inspection people’s records had been reviewed and updated. Records were person centred and provided sufficient information for staff to ensure people’s needs were met. Although further work was needed to ensure all aspects of people’s care and support included enough detail.

Staff spoke positively about the management of the service. Changes to the systems of governance had been made including the implementation of audits. However, they were not yet sufficiently robust to ensure they would drive the improvements required for all people to receive a consistently high level of service.

At this inspection we found sufficient improvement had been made to meet the regulation relating to complaints and staffing. The service is no longer in Special Measures. This is the first time the service has been rated Requires Improvement. Further improvements were needed to safe care and treatment and good governance to ensure the regulations were fully met.

We found 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.

The inspection took place between 3 and 19 January 2018. The inspection was announced. At the previous inspection on 27 September and 4 October 2016, we found a breach of legal requirements in relation to staff supervision and training. We checked for improvements to demonstrate the registered provider was meeting the relevant requirement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question to at least good. At this inspection we found sufficient improvements had not been made.

Northern Community Careline Services provides personal care and support to adults and children living in the North Kirklees area of West Yorkshire. It is registered to provide a service to children 4-12 years, people with dementia, older people, and people detained under the Mental Health Act, people who misuse drugs and alcohol, people with a physical disability and younger disabled adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of the inspection they were supporting approximately 80 people.

There was a registered manager who had been registered since 15 March 2012. 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.

Although people told us they felt safe, we found aspects of the service that were not safe. Risk assessments were not accurate or up to date and did not contain all the information required to reduce the risks to people using the service.

We found concerns about the way staff recorded the administration of medicines. Medicines policies and procedures to guide staff were not up to date to evidence the registered provider was following best practice. There was evidence not all staff had their training to administer medicines refreshed or their competency checked by a person with the necessary skills.

Staff recruitment was not robust. The reason for a gap in a candidate’s employment history had not been recorded, there was only one reference in one candidate’s file and another candidate’s second reference did not match the referee on their application form, with no reason recorded for this. There was no evidence recent recruits had undergone an interview prior to taking up their post to ensure people with the right values and behaviours were employed to work with vulnerable people.

The registered manager told us no one at the service lacked capacity to consent to their care. Staff had not been trained in the Mental Capacity Act 2005 and were not aware of the principles of the act. Policies and systems did not provide guidance to staff to ensure people were supported to have maximum choice and control of their lives. Staff had very limited knowledge about mental capacity when questioned. There was no written consent form in place to evidence people had agreed with and consented to care outlined in their care plans.

Not all staff had received the required training; supervision and appraisal records were of poor quality and did not follow nationally recognised best practice. Informal supervision was not recorded as had been agreed by the registered manager in their action plan following the last inspection.

Some people and their relatives told us care workers were kind and caring although we were told that this had not always been the case. People said care workers were respectful and mindful of their privacy and dignity at all times.

Care records in the office were kept in a locked drawer to ensure these remained secure and confidentiality had been discussed at induction. However, the registered provider used members of staff own personal mob

The inspection of Northern Community Care Line took place on 27 September and 4 October 2016, and was announced. The service had previously been inspected in October 2013 and found to be compliant with all regulations at the time.

Northern Community Care Line provides personal care support to people living in the North Kirklees area of West Yorkshire. At the time of the inspection they were supporting 77 people.

There was a registered manager in post and we spent time with them. 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.

People and relatives said they felt safe when with staff from Northern Community Careline as they knew what they were doing and saw regular staff. Rotas were planned around continuity of care provision which meant people were able to build relationships with staff.

Medicines were administered safely and staff knew how to respond to any concerns.

Staff had regular contact with the office and informal discussions took place around workloads and practice issues but there was little formal supervision. All staff had received training in the main skill areas and some of these were due for a refresher. This is a breach of Regulation 18 Health and Social Act 2008 (Regulated Activities) Regulations 2014 as staff did not receive regular supervision and some training had expired.

People had support with nutrition and hydration where this was part of their care plan and staff knew when to request additional external support from other health and social care providers.

The registered manager understood the principles of the Mental Capacity Act 2005 and staff were aware of the importance of seeking a person’s consent before undertaking any tasks.

People spoke positively of the staff saying they were caring and kind. Reviews took place but these needed to be more detailed and to show who had been involved.

The service had a reputation for supportive end of life care and was spoken highly of by other agencies in this regard.

Care records were person-centred and showed how people’s needs were to be safely met and in their preferred way. The service was flexible and accommodated additional requests as much as possible as long as they had the capacity to do so.

The registered manager was spoken highly of and staff felt supported. People told us they had seen the registered manager delivering care themselves and felt able to approach them. The quality assurance systems were in existence but needed further development to ensure that changes and improvements to the service were evident.

You can see what action we told the provider to take at the back of the full version of the report.

We visited three people in their own homes and observed some of the care provided. We spoke with three people in person and a further three on the telephone after our visit. We spoke with three relatives on the telephone and one in their own home. We spoke with three staff and the manager.

People we spoke with made comments such as: “Staff know my needs, they never rush me and I’m happy with the service” and “I feel respected”.

We saw staff respected and involved people in their care. Staff were seen to be kind and friendly. They cared for people in a sensitive and personalised way.

We looked at seven care records and saw people’s needs were clearly outlined. People knew they had care records and had signed them.

People told us they felt safe and staff we spoke with said they knew how to safeguard people from abuse.

We found staff were recruited and vetted effectively to make sure they were suitable to care for people.

People and their relatives mostly knew how to complain if they were not happy with the service but we found there had been no complaints since the last inspection.

We looked at the care records of four people using the service. We saw their care needs were clearly documented and appropriate risk assessments were in place. We spoke with one person who received care from this agency and two relatives. They told us they were happy with the care provided and knew how to complain or make changes.

We spoke with three care staff who were complimentary about the manager and the support they received. They told us they had competed training for their role which included a National Vocational Qualification (NVQ) in care at level 2. This meant they have been assessed as competent in their caring role. However, we found that not all staff had received fist aid training which meant they may not have the knowledge and skills to deal with unforeseeable first aid situations.

The purpose of this inspection was to follow up on compliance actions made at a previous inspection. Consultation with people who use the service was not required to assess compliance on this occasion.

A number of people who use the service were contacted by telephone to seek their views. They were positive about the agency and the support they receive.

‘They are all very nice I do get the same carer mostly’

People told us that the carers were good and carried out the care that had been agreed and recorded in their care plan. They also said that staff mostly arrived on time and stayed for the time agreed.

‘They are alright they don’t rush’

People were asked about their care and completed questionnaires that gave them the opportunity to express their views and opinions about the service. They said that carers wear uniforms and have an identity badge. The following are some of the other comments made.

People told us that they did not have any concerns but if they did they knew who to contact.

‘I would give them 10 out of 10!’