This was an announced inspection which took place over two days 21 and 22 November 2016. The last inspection took place in July 2016. The service was not meeting the regulations at the last inspection and submitted an action plan to us describing the measures they planned to take to become compliant. The service had failed to ensure that staff were supervised and that effective leadership of the service was in place, two warning notices were issued. The service had also failed to ensure that care was delivered safely; that peoples consent was sought; that complaints were managed; that confidentiality was protected and that risks and medicines were managed safely. Requirement notices were issued against the provider. The provider also agreed to a voluntary suspension of new work with the CQC.

Pinpoint Health and Homecare is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes in the North East. The care offered varied from short support visits to 24 hour care. There were 28 people using the service at time of inspection.

The service did not have a registered manager in post. They had recently appointed a new manager who intended to apply to register with us. 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.

The service had recently recruited to a number of key posts and most senior staff had been in post for around two months. This meant that most of the new procedures and checks the provider had implemented had either just started, or were about to start.

We found that people’s medicines were still not being managed as required. We found that staff had undergone recent training and a new policy had been implemented, but that action was not taken where recording errors were found. This meant people may not have received medicines as prescribed.

People still told us that support calls were late or missed and that they were not told if there was to be any delay in support arriving. Staff and people told us that consistency and timeliness of staff support remained an issue.

Staff were now receiving regular supervision, but annual appraisal of staffs training and development needs had still not taken place for staff employed more than a year. We have made a recommendation about this.

People or their representative’s consent was still not being consistently sought or recorded in peoples care plans. Where people lacked the mental capacity to make decisions it was not always clear that staff followed the correct processes when making decisions on their behalf.

A new complaints process had been implemented and more recent complaints were being managed effectively. However some complaints made since our last inspection had not been completed and staff were not managing all complaints in line with the new process. We have made a recommendation about this.

A number of issues we found at previous inspections had not been acted upon, or completed in a reasonable timeframe; the leadership and governance of the service had changed a number of times in the last year resulting in intermittent progress. Information submitted to the CQC by the provider before inspection was inaccurate. A voluntary agreement with the CQC to suspend new work had been missed by staff and new people had been assessed and provided with a service. However the service had made improvements in a number of areas in a short time period following the appointment of new senior staff and care staff recruitment.

Risk assessment and contingency plans for the delivery of the service were now in place. Staff felt able to raise any concerns they may have about the safety of the service

This was an announced inspection which took place over three days, 29 June, 6 July and 8 August 2016. The last inspection took place in November 2015. The service was not meeting the regulations at the last inspection and submitted an action plan to us describing the measures they planned to take to become compliant. The service had failed to ensure that peoples care plans were effective, that medicines were managed safely and that staff were supported.

Pinpoint Health and Homecare is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes in the North East. The care offered varied from short support visits to 24 hour care. The service did not have a registered manager. They had recently appointed a new manager in April 2016 who intended to apply to register with us. 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 that the provider’s medicines policy and procedures were not implemented effectively to ensure that people’s medicines were handled safely. We found that staff competency in this area had been checked but that audits of records were not occurring.

Not all risks to people were assessed and managed by the service effectively. Some advice from external professionals on how to manage or reduce these risks was not being followed consistently.

Records did not show that the service safely recruited new staff to work with vulnerable people or that effective disciplinary action was always taken. There were known gaps in employment records and action was taken by the provider to address these after our inspection.

Some people, staff and commissioners felt the service did not always respond robustly to concerns they raised. They told us that in the past they had raised issues such as late calls, but that effective action had not always been taken. They told us this had improved under the new manager.

Staff had not received training support to ensure they were able to carry out their role effectively. Regular formal induction and supervision processes were not in place so staff did not receive feedback on their performance and help in identifying future training needs.

People’s consent, or their representatives, was not always obtained before care commenced. Staff lacked awareness and knowledge of the Mental Capacity Act 2005, which meant they could not support people to make choices and decisions where they did not have capacity, or had fluctuating capacity.

Arrangements were in place to request support from health and social care services to help keep people well. External professionals’ advice was sought when needed, however this was not always reflected in updated care plans or records.

People’s confidential information was not always protected as the service had sent out people’s names by error to other people using the service. People told us most staff were respectful and treated them with dignity and some told us they felt empathy and care from the staff who supported them although this wasn't always consistent across all staff. There were some concerns raised about changing staff teams meaning that staff did not always know people well.

People had their initial needs assessed but these lacked details of how to provide personalised care. Information as people’s needs changed over time were not always reflected in updated care plans. People were given information about the service and initial assessment and could contact the manager for support.

People could raise any concerns with staff, but the provider lacked a consistent process for investigating and responding to complaints. We saw that the new manager had respo

We carried out an announced comprehensive inspection of this service in February 2015. After that inspection we received concerns in relation to possible breaches of the regulations regarding staff recruitment, supervision, training and care planning. As a result, we carried out this announced focused inspection on the 5, 13 and 17 November 2015. This report only covers our findings in relation to these regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pinpoint Health & Homecare on our website at www.cqc.org.uk.

Pinpoint Health and Homecare is a domiciliary service based in Gateshead covering the North East. A registered manager has been in post since May 2014. 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 were recruited by a process that ensured that staff were safe to work with vulnerable people. The process of checking previous training and qualifications needed to be more robust.

People’s medicines were not always managed well. Some medicines care plans and risk assessments had not been completed when required. Records of administration were not completed correctly and the care plans did not always contain details of how to use as and when required medicines.

Staff told us they had regular support from seniors, but senior staff did not keep written records of supervisions and appraisals of staff when these occurred.

Care plans did not contain details of how best to support people, or reflect their preferences. There was no evidence to show how people had been involved in the creation of their care plans. Some risk assessments had been completed incorrectly and had not been identified in a recent review of plans.

Formal complaints were investigated and responded to by the registered manager. However, not all senior staff were aware of when to initiate the formal complaints process, so complaints may have been under reported.

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