Nursing Direct Ltd - DCA Office

Updated 7 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2008.

Inspection team

This inspection was carried out by 1 inspector 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since registration. We used this information to plan our inspection.

During the inspection

We visited the offices of this service. We spoke with 7 staff, the nominated individual, the registered manager, the head of compliance and a care coordinator or home care manager. We inspected 5 people’s care files and 5 staff files. We also reviewed a variety of records relating to the management of the service. After the inspection we spoke with 15 people who used the service and their relatives on the telephone about their experience of the care provided. We continued to seek clarification from the provider to validate evidence found.

Updated 7 September 2023

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and autistic people and providers must have regard to it.

About the service:

Nursing Direct Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. People had a wide range of complex nursing needs including people living with moderate to complex learning disability needs. At the time of the inspection it provided a service for 76 people. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People's experience of using this service and what we found:

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Some people using the service and their relatives said communications from the office when staff were late for their calls, could be improved. Other people said communications were good and they said they were informed if staff were going to be late.

Relatives told us they felt they and their family members were safe and were protected from the risk of abuse. The service had appropriate safeguarding procedures. Staff told us they received regular training and they knew how to safeguard people from abuse and the processes that should be followed where concerns arose.

Assessments of people’s needs and any risks were carried out and formed part of the care plan. Relatives told us these care plans were reviewed appropriately and drawn up together with themselves. Risk management strategies were in place as part of the assessment and support planning process. This meant risks to people and to staff were minimised and people’s care was appropriately delivered to meet their needs.

There were robust recruitment practices in place that meant new staff were safely recruited. There were sufficient staff levels to meet people's needs.

Appropriate policies and procedures were in place to ensure people received their medicines safely. Comprehensive training was available for staff on the safe administration of medicines. This together with appropriate supervision and monitoring meant when required people received their medicines, it was administered safely and staff had clear guidance to follow.

Right care

The provider had ensured that appropriate training and supervision was available for staff. This included understanding and how to manage best practice for infection control and the use of PPE.

There were systems in place to ensure that accidents, incidents and risks were appropriately recorded. Analysis of the information meant any trends could be identified and actions put in place to reduce the likelihood of events re-occurring in the future.

People and their relatives told us they were supported by a regular team of staff who knew them well and were able to identify their likes and dislikes. They were supported to eat and drink according to their dietary requirements taking into consideration their preferences.

Right culture

People told us they received good quality care from kind and caring staff. They said in most cases their care was delivered by regular staff and this provided the consistency and continuity they needed. They told us they were treated with dignity and respect. They told us staff had the right skills to deliver appropriate care and support.

People were confident that any concerns would be addressed appropriately and resolved by the registered manager. They told us the registered manager welcomed feedback.

People told us they thought the service was well led and that they were very happy with the support they received.

There were effective systems in place to monitor the quality of the service provided to people which ensured good governance. The service had systems in place to notify the appropriate authorities where concerns were identified. The culture of the service was positive, open and person centred.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was good (published July 2018).

Why we inspected:

We undertook this inspection to assess that the service is applying the principles of right support, right care and right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for this service has remained good based on the findings of this inspection.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.