Archived: Prestige Nursing Liverpool

Updated 13 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

This was the first inspection since the provider changed address. Reports relating to previous inspections can be found by following the link on the CQC website.

The inspection took place on 6 November 2017 and was announced. We gave the service three days’ notice of the inspection site visit because some of the people using it could not consent to a home visit from an inspector and we needed to ensure that people were consulted prior to the inspection. Each of the four people receiving a regulated activity or their representative chose not to receive a home visit and were contacted by telephone.

The inspection was conducted by an adult social care inspector.

The registered provider had completed and returned a Provider Information Return (PIR) in June 2017. This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make.

We checked the information that we held about the service and the registered provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We used all of this information to plan how the inspection should be conducted.

We spoke with people using the service, their relatives, staff and managers. We also spent time looking at records, including four care records, four staff files, staff training plans, complaints and other records relating to the management of the service. We contacted social care professionals who have involvement with the service to ask for their views.

During our inspection we spoke with three people using the service and one relative. We also spoke with the registered manager and three other staff.

Updated 13 December 2017

This announced inspection took place on 6 November 2017 and was conducted by an adult social care inspector.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults, younger disabled adults and children. The service is also registered to provide nursing care, but was not actively doing so at the time of the inspection.

Not everyone using Prestige Nursing Liverpool receives 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.

A registered manager was in post.

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.

People told us that they felt safe when receiving a service from Prestige Nursing Liverpool. The service had a robust approach to safeguarding people from abuse and discrimination. Staff were trained in safeguarding practice and were able to refer to an extensive policy which clearly defined how to respond when concerns were identified.

Senior staff were trained in the completion of risk assessments and we saw from care records that they were regularly reviewed and updated when needs changed. This was done in conjunction with health and social care specialists where appropriate.

Staff were recruited safely and in sufficient numbers to allow for consistency of care. Staff were appointed following the completion of essential checks and in accordance with best-practice.

Medicines were stored and administered in people’s own homes in accordance with best-practice. We saw from care records that people’s needs and wishes regarding medicines were clearly documented and regularly reviewed in conjunction with the person, their representative and healthcare professionals where appropriate.

People told us that the service and staff ensured that their care needs were met and that staff were suitably skilled. People also told us, and we saw in care records that their needs in relation to a range of health and social requirements were assessed and regularly reviewed.

New staff were inducted in accordance with the principles of the Care Certificate. However, because of the complexity of people’s health and social care needs, the service chose to recruit staff with experience. We saw evidence of this in staff records.

Staff told us that they were well trained and supported by the provider and received regular supervision. We saw evidence of this in paper and electronic records. Training records indicated that all staff training was up to date or had been booked.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff demonstrated that they understood the key principles of the MCA and delivered care and support in accordance with the act.

Each of the people that we spoke with was extremely positive about the attitude and approach of care staff and the quality of relationships.

We did not have the opportunity to observe the delivery of care because people declined the offer to visit them in their own homes. However, the quality of care records and the feedback from people and their staff gave a clear indication that people were consistently treated with kindness, compassion and respect.

It was clear from discussions with staff that they knew people very well and enjoyed working with them. The care records that we saw contained information which was extremely detailed and respectfully worded.

It was clear from the rotas that we saw and feedback from people using the service and their staff that sufficient time was built into visits to ensure that people’s needs were fully met. We saw examples where the service had deployed staff flexibly to meet people’s needs.

People using the service and their relatives spoke positively about their involvement in care assessment, planning and review, and how the process had influenced their care. We saw from care records that people’s care needs and wishes were considered as part of the assessment and planning process. It was clear that the promotion of people’s independence was a priority.

Care records were sufficiently detailed to allow staff to understand their needs, but they also contained a high-level of personal detail which helped staff get to know people. It was clear from care records and through speaking with people that they were supported in an individualised way to pursue hobbies and interests.

People told us how effective Prestige Nursing Liverpool was in communicating with them. We saw evidence of written communications, but were also told how some people preferred information to be given in face to face meetings to aid their understanding and retention.

The service was part of a larger provider organisation that had a clear and consistent vision for the development of its services. We saw that the service promoted its vision and values through its web site and written materials.

Staff were encouraged to give feedback on their experiences and make suggestions for development. This was done during supervisions and though the distribution of an annual survey.

The registered manager and supervisors were clearly aware of the day to day culture and issues within the service. We saw that they knew the people using the service and their staff well. It was also clear that they understood their responsibilities in relation to the Commission and the local authority.

The organisation had a robust approach to the monitoring of quality at a local and national level. Systems included; spot checks, care file audits, telephone calls to people using the service, [staff] member surveys and general audits.

The service worked effectively with other partners to ensure positive outcomes for people. We saw evidence of partnership working with healthcare professionals, local authorities and appointed case managers. Communication between partners was well detailed and demonstrated maturity and trust in professional relationships.