Age UK Northumberland was rated Requires Improvement overall, with a continued breach of Regulation 17 due to persistent gaps in staff recruitment records and insufficient audit effectiveness, despite improvements in MCA compliance, training, complaints management and care planning since the previous inspection. The service was noted to have managed significant additional pressure from an emergency takeover of a closing provider in December 2017, with caring, effective and responsive domains all rated Good.
Concerns (5)
criticalRecord keeping — “gaps in staff recruitment records including missing references, gaps in employment history, and a lack of evidence of Disclosure and Barring [DBS] checks”
criticalGovernance — “continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 17. Good governance.”
moderateStaffing levels — “Recruitment was ongoing at the time of the inspection as it was recognised there was a shortfall in numbers required to ensure staff were not working excessively long hours”
moderateMissed or late visits — “told us there had been initial difficulties with missed and late calls, but this had since settled down”
moderateCommunication with families — “communication could be very poor between them and the manager or office based staff. Staff told us a minority of office staff could be rude”
Strengths
· Medicines were managed safely and staff competency to administer medicines was assessed on a regular basis
· People and relatives spoke very highly of staff, describing them as kind, caring and respectful
· Improvements had been made to staff training, supervision and appraisals since the last inspection
· MCA compliance had improved; people supported to have maximum choice and control with least restrictive practices
· Person-centred care plans ('My support plan') were clear, written in the first person, personalised and easy to follow
Quality-Statement breakdown (18)
safe: Recruitment recordsRequires improvement
safe: Medicines managementGood
safe: Staffing levels and consistencyRequires improvement
safe: SafeguardingGood
safe: Risk assessmentGood
effective: Mental Capacity Act complianceGood
effective: Staff training and developmentGood
effective: Nutrition and health supportGood
caring: Dignity and respectGood
caring: Equality and diversityGood
caring: Independence and choiceGood
responsive: Care planning (person-centred)Good
responsive: Complaints handlingGood
responsive: Reliability of visitsRequires improvement
well-led: Governance and record-keepingRequires improvement
well-led: Communication with people, relatives and staffRequires improvement
well-led: Audits and quality monitoringRequires improvement
Age UK Northumberland was rated Requires Improvement overall following an announced inspection in November–December 2016, with two breaches of Regulation 17 (good governance) and one breach of Regulation 18 (staffing) identified. While staff were praised for their caring approach and medicines were managed safely, significant failures were found in record-keeping, Mental Capacity Act compliance, staff training for complex needs, and complaints management.
Concerns (7)
criticalGovernance — “Records were not satisfactorily maintained in relation to recruitment, training, MCA and complaints. Systems to monitor the quality and safety of the service had not picked up all the shortfalls we identified.”
criticalStaff training — “30 out of 61 care workers had requested training in how to care for people living with dementia, and 37 had requested training in supporting people with mental health issues.”
criticalConsent / capacity — “restrictions had been placed on them in their best interests and that covert medicine was in fact being administered...best interests' decisions had not been documented.”
moderateRecord keeping — “Recruitment records did not always demonstrate best practice had been followed in the recruitment of staff.”
moderateComplaints handling — “Complaints records and responses varied in quality and detail. There was no standard recording format and the outcome of complaints...was not always recorded.”
minorCare planning — “care workers had adapted the care they provided to suit a person's changing needs, but this was not reflected in care records or reported back to office staff.”
minorStaff competency — “Competency checks were not always documented but staff told us they had been assessed and that they had received appropriate training in this area.”
Strengths
· Staff were consistently described as kind, caring, attentive and respectful by people and their relatives.
· Medicines were managed safely with a medicine profile in place and regular competency checks carried out.
· Risk assessments were up to date and covered both environmental and individual risks.
· Specialist bespoke training was provided by visiting professionals for complex medical needs such as PEG feeding and catheter care.
· Regular supervision and appraisals were carried out and staff felt well supported.
Age UK Northumberland, a large domiciliary care provider serving 739 people, was rated Good across all five key questions at its July 2015 inspection. The service demonstrated strong safeguarding practice, safe medicine management, and a caring workforce, with only minor shortfalls noted in supervision frequency, appraisal completion, and the personalisation of some care planning documentation.
Concerns (4)
minorSupervision / appraisal — “Supervisions and appraisals took place although in some team areas these were outstanding... not all appraisals had been completed for the previous year.”
minorCare planning — “Some care records were in need of further detail to make them more person-centred... environmental risk assessment carried out by the organisation was generic and would benefit from some personalisation.”
minorRecord keeping — “Some further detail around people's abilities to assist with the administration of their own medicines, and less restriction around the structure of generic risk assessments, would assist staff further.”
minorCommunication with families — “Some care workers told us that they did not always get the messages they thought they should from management and at times they struggled to contact team leaders.”
Strengths
· People felt safe and spoke highly of caring, consistent staff who went above and beyond agreed duties
· Robust safeguarding policies with prompt reporting to local authority and knowledgeable staff
· Thorough recruitment processes including DBS checks, references, health declarations and occupational health referrals
· Medicines managed safely with competency checks on staff administration practice
· Strong continuity of care with people supported by the same small group of care workers over time
Age UK Northumberland improved from Requires Improvement to Good across all five key questions, having resolved a prior breach of Regulation 17 relating to recruitment records and governance. The service demonstrated strong person-centred care, robust quality systems, and effective partnership working, with no new breaches identified at this inspection.
Strengths
· Safe recruitment procedures followed with robust records, resolving prior breach of Regulation 17.
· Staff received training specific to people's health-related needs, including specialist areas such as PEG feeding and end of life care.
· People and relatives spoke very highly of staff friendliness, kindness and professionalism.
· Significant improvements to care plan quality since last inspection — detailed, personalised and consistently formatted.
· New registered manager appointed with clear vision; quality monitoring systems strengthened with plans for real-time data.
Quality-Statement breakdown (25)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood