5 February 2021
During an inspection looking at part of the service
Niche Care is a domiciliary care agency providing personal care to adults living in their own homes. Not everyone who used the service received personal care. 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 the inspection, the service was supporting around 300 people.
People’s experience of using this service and what we found
We found concerns relating to governance within the service. Although there were comprehensive systems in place to enable managers to monitor the service, we saw many examples of poor quality and at times unsafe care. Management records showed there was an awareness of late calls, short calls and missed calls, but people told us these were still happening; care records reflected this.
Managers had failed to take appropriate action when concerns were identified. They had not reported certain key incidents to the Care Quality Commission, which is a legal requirement. They had also failed to report a breach of confidential personal information to the Information Commissioner’s Office. The registered manager addressed this after we brought it to their attention.
We have made a recommendation that the registered person has robust oversight of complaints and concerns, so that any allegations of abuse are identified and reported in accordance with the law.
We were not assured people were being cared for safely. Care visits did not always take place at the agreed time or for the agreed duration. This meant people were at risk of harm where, for example, their medication was not administered at the correct time, or they had to wait a long time before being taken to the toilet or given a drink.
People using the service and their relatives gave us a mixed picture about their experience of Niche Care. Some praised the service, with one person telling us: “The care package is reviewed regularly and there is an annual review where [we] have the opportunity to discuss. The mobile app is really effective where we can monitor regularly. Everything is listed including medicines, visits done, timings etc.” Another person said: “[my relative] gets on well with her regular carers. They are brilliant.” However, some people commented far more negatively, raising concerns about late and missed calls and staff not having the knowledge they required. We reported one matter to the local authority safeguarding team.
Staff also gave us a mixed picture of Niche Care. Some were very positive about their employer, saying they felt well supported and would recommend them to anyone seeking care, but others were not of this view, and described the company as disorganised, citing examples of late rotas and last minute changes, alongside poor levels of support.
Recruitment was undertaken safely, with appropriate background checks before staff started work, and staff received training in relevant areas relating to care and safety.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published March 2019)
Why we inspected
The inspection was prompted due to concerns received about how the provider was ensuring care was delivered safely in a way that met people’s needs, and about the provider’s governance arrangements. A decision was made for us to inspect and examine those risks. As this was a focussed inspection, we reviewed the key questions of safe and well led only. Ratings from previous comprehensive inspections for other key questions were used in calculating the overall rating at this inspection. The overall rating for the service is now requires improvement.
We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Follow up
We will request an action plan for 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.