About the service:

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.

The inspection took place on 13 July 2018, and was unannounced The service was last inspected in January 2018 , and was rated Good. We carried out this inspection as we had received concerning information about the service, and found that the service had deteriorated to Requires Improvement.

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.

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 service was supporting 216 people. Care and support is co-ordinated from the agency’s office, which is based on the outskirts of Rotherham.

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 deve

The inspection took place on 21 April 2017, with the provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The service was last inspected in November 2015, and was given an overall rating of “good.” No breaches of regulations were identified at that inspection.

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.

The inspection took place on 16 and 19 November 2015 with the provider being given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. This was the first time this service has been inspected by the Care Quality Commission. The service was registered with the Commission on 9 July 2014.

Niche Care limited is a domiciliary care service. They are registered to provide personal care to people in their own homes. At the time of our inspection the service was supporting people with a variety of care needs including older people, people living with dementia and younger people with a disability. Care and support was co-ordinated from the services office which is based on the outskirts of Rotherham.

There is a registered manager which manages the day to day operations of the service. 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 our inspection there were approximately 50 people who used the service. We spoke on the telephone with eight people who used the service and their relatives. We also visited four people in their home. We were introduced to the people by the registered manager. We asked people about their experiences of using the agency. People we spoke with told us they were entirely happy with the service provided.

People told us they felt safe in their own homes and staff were available to offer support when needed to help them maintain their independence. One person told us, “The staff are very good. They are wonderful so much more reliable than the last agency I had.” A relative we spoke with said, “My relative gets on well with most of the carers but some more than others. I have asked them not to send a particular one as they are too loud. The agency has sorted this. Staff know to contact me at any time if there is a problem.”

People’s needs had been assessed before their care package commenced and they told us they had been involved in formulating and updating their care plans. We found the information contained in the care records we sampled was individualised and clearly identified people’s needs and preferences, as well as any risks associated with their care and the environment they lived in.

We found people received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care package amended to meet their changing circumstances. Where people needed assistance taking their medication this was administered in a timely way by staff that had been trained to carry out this role. We saw on rotas that people who needed their medication were prioritised regarding calls.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. We found most staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills.

People were able to raise any concerns they may have had. We saw the service user guide included ‘how to make a complaint.’ This was written in a suitable format for people who used the service. One person said, “No complaints, the carers always see if there is anything I need doing and I would recommend them to anyone.”

People were encouraged to give their views about the quality of the care provided to help drive up standards. Quality monitoring systems were in place and the registered manager had overall responsibility to ensure lessons were learned and action was taken to continuously improve the service.