Archived: Nurseplus UK - Ashford

Updated 5 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 24 hours’ notice of the inspection visit because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

Inspection site visit activity started on 20 November 2018 and ended on 21 November 2018. We visited the office location on both days to see the management team and office staff; and to review care records and policies and procedures. On the 21 November 2018 we shadowed a member of staff undertaking lunch time calls and spoke with people who received a service by telephone.

The inspection team consisted of two inspectors and two experts by experience who undertook telephone calls to people who used the service and their relatives. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We sought feedback from relevant health and social care professionals and staff from the local authority on their experience of the service. We contacted Healthwatch, who are an independent organisation who work to make local services better by listening to people’s views and sharing them with people who can influence change.

During the inspection, we visited five people in their own homes and spoke with sixteen people and thirteen relatives on the telephone to gain their views and experiences. We looked at fourteen people's care plans and the recruitment records of six staff employed at the service.

We spoke with one of the providers, the acting manager, and five members of staff. We viewed a range of policies, medicines management, complaints and compliments, meetings minutes, health and safety assessments, accidents and incidents logs. We looked at what actions the provider had taken to improve the quality of the service. We also used information from a recent survey of people undertaken by the provider.

Updated 5 February 2019

This inspection took place on the 20 and 21 of November 2018 and was announced.

Nurseplus UK – Ashford is a domiciliary care agency. It provides personal care to adults who want to remain independent in their own home in the community. At the time of the inspection not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 130 people were receiving the regulated activity personal care. The service is also registered to provide treatment for disease, disorder or injury. However, no one was in receipt of nursing care when we inspected.

At the last inspection on 6 and 7 November 2017 the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that the rating remained requires improvement. This is the third consecutive time the service has been rated Requires Improvement.

There was a registered manager at 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 the inspection the registered manager was on planned leave and the deputy manager was the acting manager.

At the previous inspection we found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not always administered safely and the provider had failed to ensure care was provided in a safe way. At this inspection some improvements had been made to medicines management but there continued to be concerns relating to the recording of medicines and dating when bottles and creams were opened. We made a recommendation relating to the administration of medicines.

At the last inspection the service we found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014, in that systems and processes had been not been consistently effective in identifying shortfalls and driving improvements in a timely way to ensure compliance and make sure people received a quality service. At this inspection, audits undertaken by the service had identified that there continued to be concerns relating to the recording of medicines and actions taken had not resolved all of the concerns. Further improvements were needed to be made and the service remained in breach There continued to be concerns about communication between the people who used the service and office staff.

Risks to people and from the environment were assessed and there was information for staff on how to lessen these risks. People were protected from the risk of infection and personal protection equipment such as aprons and gloves were available for staff and were used.

People were protected from abuse. Staff had a good understanding on what abuse was and reported concerns when they had them. Concerns were reported to the local authority and CQC and dealt with appropriately. Staff understood the principles of the Mental Capacity Act 2005 and supported people to make choices for themselves.

There were sufficient numbers of staff to cover care calls. Staff were recruited safety and the appropriate pre-employment checks had been carried out. Where things went wrong the service took action where this was needed. Staff had the skills, training and knowledge they needed to support people effectively. Staff received appropriate levels of supervision, underwent competency checks and had an annual appraisal. New staff undertook appropriate training and a period of shadowing.

Where people needed support to eat and drink this was provided. People also had the support they needed to access healthcare services. Staff had the information they needed to share with healthcare services if someone was taken ill.

People were treated with kindness, compassion and respect. Staff communicated well with people and asked their permission before providing care. People’s dignity and privacy were respected and promoted. People were supported to maintain their independence and continue to do things for themselves where possible.

People’s needs were assessed before they started to receive a service and this assessment was used to plan people’s care. People and their relatives were involved in reviews of their care and people were supported to express their views. Care plans were personalised and contained information about people’s preferences and cultural and religious needs where people had these.

There was a complaints policy in place which was shared with people who used the service. People knew how to complain, and complaints were recorded and investigated appropriately.

The service was not currently supporting people at the end of their life. The acting manager was aware that they needed to discuss people’s end of life preferences if they supported people in the future. Where people had “do not resuscitate” forms in place these were in people’s care files. There was also information about any advance decisions people had made about care and treatment.

The acting manager was committed and passionate about the service and had the skills and experience they needed to undertake this position. The acting manager was supported by the area manager and was aware of their responsibilities.

The staff we spoke to told us that they enjoyed their role and were listened to. There were regular staff meetings. Attendance at these meetings had not been high, however, there were plans in place to address this. There were annual staff surveys and surveys for people and their relatives. Where issues were identified these were added to an action plan for completion.

The acting manager planned to access local forums to meet with other managers and share best practice. The service had access to best practice information and guidance which was sent out by the provider.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.