Archived: Nurse Plus and Carer Plus (UK) Limited

Updated 29 July 2015

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.

The inspection took place on 30 June, 1 and 3 July 2015 and was announced. The provider was given 48 hours notice of the inspection to ensure that the people we needed to speak with were available. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had personal experience of community services.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed the provider’s website.

Prior to the inspection we spoke with two commissioners of the service. During the inspection we spoke with the manager, the Director of Compliance and Training, the Compliance and Clinical Manager, the training coordinator, two care coordinators, a field care supervisor and four care staff. We also spoke with a visiting Qualifications and Credit Framework (QCF) assessor.

We reviewed 16 people’s care plans and nine care staff recruitment and supervision records. We also looked at information relating to the management of the service, which included audits of the service and the provider’s policies and procedures.

We visited 12 people and three relatives at their homes. We spoke with them about their care and looked at their care records. We observed some aspects of care, such as care staff preparing people’s meals and supporting them to move. During the home visits we spoke with eight further care staff.

Our expert by experience spoke with a further 11 people on the telephone to find out about their experience of the quality of care provided by the service. Following the home visits we spoke on the telephone with six further members of staff and two health and social care professionals.

Updated 29 July 2015

This inspection took place on 30 June, 1 July and 3 July 2015 and was announced.

Nurse Plus and Carer Plus provides a domiciliary care service to enable people living in the Basingstoke and the surrounding areas to maintain their independence at home. There were 97 people using the service at the time of the inspection, who had a range of physical and health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes and sensory impairments. At the time of the inspection the provider deployed 37 care staff to care for people and meet their individual needs.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The previous registered manager had resigned in April 2015 and a new manager was appointed on 8 June 2015. In the interim period an experienced manager from within the provider’s care group had managed the service. Records confirmed that this manager had started the process to become the registered manager of the service.

At our previous inspection on 12 and 16 September 2014 the provider was not meeting the requirements of the law in relation to people’s care and welfare and safeguarding people from abuse.

Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 14 October 2014. During this inspection we found improvements had been made to meet these requirements.

People using the service were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Care staff engaged with people to identify their individual needs and what they wanted to do in the future. Care staff were committed to promoting people’s independence and supporting them within the community.

Comprehensive risk assessments had been completed with people and where appropriate their relatives. Where risks to people had been identified there were plans in place to manage them effectively. Care staff understood the risks to people and followed guidance to safely manage these.

The care staff responded flexibly to people’s individual wishes and changing needs and sought support from health and wellbeing specialists when necessary. People’s dignity and privacy were respected and supported by care staff. Care staff were skilled in using individual’s specific communication methods and were aware of changes in people’s needs, which were reported to relevant healthcare services promptly when required. People were encouraged to be as independent as they were able to be, as safely as possible.

People told us they trusted the care staff who made them feel safe. Care staff had completed safeguarding training and had access to local authority guidance and contact numbers. They were able to recognise if people were at risk and knew what action they should take to protect people from harm. The manager had taken action when people had been identified to be at risk and learning for staff had taken place. People were kept safe as safeguarding incidents were reported and acted upon.

The manager and provider completed a weekly staffing needs analysis to ensure there were always sufficient staff with the necessary experience and skills to support people safely. Wherever possible the manager and care staff worked together with people to identify in advance when their needs and dependency were likely to increase.

People were cared for by care staff who had undergone the required pre-employment checks to ensure their suitability and had received an induction based on the social care industry requirements. The induction also took into account the specific needs of the people cared for by the service, including diabetes and dementia. Care staff had the required training updated in accordance with the provider’s policy. The provider supported staff to meet people’s needs with an effective programme of induction, supervision and appraisal. Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s care effectively and were supported with their career development.

Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed annually by the training coordinator and senior staff.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

People’s needs in relation to nutrition and hydration were documented in their support plans. We observed people supported appropriately to ensure they received sufficient to eat and drink. Meals reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice.

The suitability of staff to form caring relationships with people was assessed as part of their recruitment process. People were supported to maintain relationships with people who were important to them.

Where complaints were made they were investigated and actions taken by the provider in response. Complaints were analysed for themes and where these had been identified action had been taken.

The provider’s values focussed on treating people with dignity and respect whilst providing high quality care. People were cared for by care staff who understood and practised the values of the service in the provision of their care.

The manager and provider carried out a comprehensive programme of regular audits to monitor the quality of the service and plan improvements. The manager monitored people's support and took action to ensure they were safe and well. People’s welfare, safety and quality of life were looked at through regular checks of how people’s support was provided, recorded and updated. We found that accidents and incidents had been recorded appropriately. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented to improve the service.

People’s needs were accurately reflected in detailed plans of care and risk assessments, which were up to date. These plans contained appropriate levels of information. For example, if a new member of care staff arrived to provide support in response to staff absence after reading these plans they would be able to support people safely. Throughout the inspection the manager and office staff were able to find any information we asked to look at promptly.

Records were stored securely, protecting people and care staff confidential information from unauthorised persons, whilst remaining accessible to authorised staff. Processes were in place to protect care staff and people’s confidential information.