Niche Care Rotherham

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.

Niche Care Ltd is a domiciliary care agency providing personal care to people in their own homes. At the time of this inspection it was providing services to over 150 people.

People’s experience of using this service:

We found that people received a good service. The provider ensured care was delivered in a safe way, and had introduced a range of systems since the last inspection to ensure care was monitored effectively.

People told us they felt the staff were caring, and said they received care in a way which suited them. One person said: “They’re all smashing, nothing to grumble about at all.”

Staff received training which they told us equipped them for their roles, and also told us the induction they received was effective. Most staff held a nationally recognised qualification in care.

People were supported in maintaining good health, and staff liaised with external healthcare providers where appropriate to ensure that care was provided in a way that met people’s needs.

Staff told us the management team were supportive and understanding of their own personal circumstances.

We found the provider was complying with the principles of the Mental Capacity Act, and people had given consent to their care and support.

More information is in the full report

Rating at last inspection:

Requires Improvement. The report was published on 16 August 2018.

Why we inspected:

We had received concerning information about the service from staff and a relative of a person using the service, although at the inspection we found the provider had addressed these concerns.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults in the Rotherham and Sheffield areas. At the time of the inspection they were providing support to over 300 people.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People told us that they experienced a good standard of care and that they found staff to be pleasant and caring.

There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. Risk assessments were predominantly up to date and detailed.

We found recruitment processes were mostly thorough, which helped the employer make safer recruitment decisions when employing new staff. Staff had completed a comprehensive induction and training programme before commencing work. This helped them meet the needs of the people they supported.

The way that medicines were managed by the service was not safe and did not ensure that people received their medication in accordance with the prescriber’s instructions.

Records did not demonstrate people’s capacity to make decisions had been considered as part of their care assessment, and on occasion relatives had been required to make decisions on other people’s behalf, which does not reflect lawful decision making.

People’s care files showed that their care needs had been thoroughly assessed, and they mostly received care in accordance with their assessed needs. However, care visits did not always last the planned duration.

There was a system in place to tell people how to make a complaint and how it would be managed, and this was explained to people when they first started using the service.

The registered manager had a clear oversight of the service, and of the people who had used or were using it. However, the formal audit system had failed to recognise or address shortfalls within service provision.

Staff received regular supervision and appraisal, and the standard and quality of care visits was regularly monitored.

The inspection took place on 4 January 2018 with the registered provider being given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies. At our previous inspection in April 2017 the service was given an overall rating of ‘Requires Improvement’. We found improvements were required with regards to the provider’s recruitment process and notifying CQC about safeguarding concerns reported to the local authority. We asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Niche Care Ltd’ on our website at www.cqc.org.uk’

We carried out the inspection a little earlier than planned due to concerns raised with us about the way the service was operating. However, we found improvements had been made since the concerns were raised and the majority of people were happy with the service provided. We also found the areas we identified for improvement at our last inspection had been addressed. At this inspection we rated the service as Good.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People told us staff were caring and efficient in their job. They said they treated them with respect and dignity, and cared for them in a way which met their needs.

There were systems in place to reduce the risk of abuse. Staff had received appropriate training in relation to protecting people from the risk of abuse. We found the registered provider ensured they followed the correct process in reporting safeguarding concerns to all appropriate agencies and worked with the local authorities to address any concerns.

Recruitment processes had been made more robust, which helped the employer make safer recruitment decisions when employing new staff. Staff had undertaken a structured induction, essential training and regular support, which aimed to develop staffs’ knowledge and skills so they could effectively meet people’s needs.

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. Records showed where possible people’s consent had been obtained and staff understood the importance of listening to people and acting in their best interest.

People were encouraged to manage their own medication if they were able to, with some being supported by relatives. However, when assistance was required appropriate support was provided by staff who had been trained to carry out this role.

People’s needs and any potential risks had been assessed before their care package started, and where possible they or their relatives had been involved in formulating care plans. Care plans provided information and guidance to staff, which assisted them to deliver the care people needed, in the way they preferred.

The complaints policy was provided to people using the service. The people we spoke with told us they would feel comfortable raising concerns, if they had any. When concerns had been raised we saw the correct procedure had been used to record, investigate and resolve issues.

Since the last inspection the registered provider had developed the way they assessed the quality of care provided. Systems were in place to check staff were following company policies and people had been consulted about their satisfaction in the service they received. All the people we spoke with told us that overall they were happy with the way the service was run. People spoke positively about the management team and how staff delivered care.

Further information is in the detailed findings below.

Niche Care Ltd provides personal care to people living in their own homes in the Rotherham and Sheffield areas. At the time of the inspection the provider had been through a rapid growth period and they were providing support to around 200 people.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run. The registered manager told us that the provider was in the process of restructuring, and another manager within the organisation was in the process of applying to register with CQC. They told us that this manager had day to day oversight of the service.

People gave positive feedback about their experience of receivng care from Niche Care Ltd, and praised the staff. Staff we spoke with told us that dignity and a caring approach underpinned all their work.

Staff received a broad range of training which assisted them with their roles, and the provider worked closely with an external trainer to ensure training was tailored to people’s needs.

In most cases people had given consent to their care and support, although we discussed with the provider some areas where this could be strengthened.

People’s care and progress was monitored so that the provider could respond to any changes, altering care packages as required to ensure people’s needs were met.

We found that recruitment procedures were not always sufficiently robust and did not always comply with legislation.

The provider did not follow all required procedures in relation to safeguarding, although staff had a good knowledge of their safeguarding responsibilities. The provider had failed to make a number of legally required notifications to CQC, and managers stated they had not been aware of the requirement to do so.

Although individual aspects of service delivery were monitored, there was no overarching assessment of quality in place which meant that some shortfalls were not always identified.