The inspection of Comfort Call – Kirklees took place between 4 January and 21 January 2019. We previously inspected the service in November 2017, we rated the service Requires Improvement. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

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 150 people were receiving care and support from Comfort Call – Kirklees.

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.

At the time of the inspection Comfort Call – Kirklees were in the process of reviewing call times and staff rotas. People told us they did not always feel safe. They did not always know when staff would arrive or which care worker would be delivering their care and support.

We found the recruitment of staff was safe. Neither people or staff felt the service was understaffed.

Staff received training and an assessment of their competency to ensure they had the knowledge and skills to administer people’s medicines.

The prevention and control of infection protected people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

New staff completed a programme of induction to ensure they had the knowledge and skills to deliver effective care and support. There was an on-going programme of training and support for all staff.

People received appropriate support to enable them to eat and drink.

Staff supported peoples to access other healthcare professionals if they were unwell.

People told us staff were predominantly kind and caring although staff were limited by constraints on their time. Staff we spoke with talked about the people they supported with empathy and professionalism.

People’s privacy, dignity and confidentiality was respected.

People had a care plan in place which was person centred and reflective if their care and support needs. Care records were reviewed at regular intervals.

There was a system in place to manage complaints. We saw evidence complaints were handled appropriately. We have made a recommendation about the method used to gain feedback from people who use the service.

An annual survey conducted in May 2018, evidenced some key areas of concern. Despite an action plan being implemented the feedback we received as part of this inspection evidenced the issues had not been fully addressed.

The registered provider had a number of audits in place to monitor the service and to ensure staff were meeting the requirements of their role. An operations manager visited the service on a regular basis to provide support to the registered manager and office based staff.

People received a regular newsletter providing them with information and regular meetings were held with staff.

This is the second consecutive time the service has been rated Requires Improvement.

The inspection of Comfort Call – Kirklees took place on 8 November2017, this was the services first inspection since their registration with the Care Quality Commission in November 2016. This service is a domiciliary care agency providing personal care to people living in their own homes in the community within Kirklees. At the time of our inspection the service was providing care and support to 107 people.

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.

Staff were aware of the safeguarding procedures and felt confident appropriate action would be taken in the event of a concern being raised. Risk assessments were in place and action was being taken by the registered manager to improve the level of detail in these documents where staff needed to use a hoist to transfer people.

There were systems in pace to reduce the risk of employing staff who may not be suitable to work with vulnerable people. A number of people we spoke with told us staff arrived late and they did not have a consist team of staff visiting them. The registered manager had taken action where shortfalls were due to staff error an electronic call monitoring system was to be introduced.

Staff received training in medicine management but we were unable to evidence an assessment of staffs competency to administer medicines had been recently completed in two of the four staff files we reviewed.

People felt staff had the skills to do their job. New employees received an induction which included face to face training and shadowing a more experienced staff member. There was a rolling programme of refresher training, management supervision and observational assessments to ensure staff had the knowledge and ability to fulfil their role.

People received support to eat and drink where this was an identified need. Peoples care plans recorded the support they needed from staff.

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. However, the service needs to ensure, where people lack capacity to make specific decisions, this is clearly evidenced including the process of making decisions in their best interests.

Everyone we spoke with told us staff were caring and kind. Staff treated them with respect and took steps to maintain their privacy. Staff were able to tell us about the actions they took to maintain people’s dignity and ensure people’s private information was kept confidential.

People had a care plan in place which was person centred and provided sufficient detail to enable staff to provide the care and support required by each individual. Staff made a record of the care they provided and these records were returned to the office in a timely manner.

There was a system in place to manage complaints.

There were systems in place to continually monitor the service, for example, the registered provider had an online management reporting system and audits were completed on people’s daily logs and medicines records. Staff felt supported and regular meetings were held to seek feedback and share information. Feedback regarding the service was also gained at regular intervals from people who used the service. However, these systems had not identified or actioned the shortfalls identified within this report.