Archived: GreenSquareAccord Nottingham City

Direct Health (Nottingham City) is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham City. It provides a service to older and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (Nottingham City) 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. At the time of our inspection, 303 people were receiving personal care as part of their care package.

People’s experience of using this service and what we found

Whilst improvements had been made since our last inspection in how people received their care, people were not consistently receiving care that was responsive to their individual needs. People had experienced late calls and missed calls and whilst no person’s safety had been put at risk, improvements were required. Action was being taken provide people with regular staff and for calls to be made within the allocated timeframe.

Staff had received training in safeguarding adults. Allegations or suspicion of abuse were reported and acted upon, where action was required to protect people this was completed. Improvements had been made to the completion of assessments and guidance provided to staff of how to safely provide care. Information was detailed and up to date.

Staff recruitment was ongoing and in areas where recruitment and retention of staff was problematic, no new care packages were being accepted until staffing levels had increased. Robust checks were completed on staff’s suitability to provide care before they commenced their employment.

Where people required support with the administration of medicines, improvements had been made to the guidance provided for staff. Additional checks and monitoring had also been introduced. People were protected from the risk of cross contamination because best practice guidance in infection control practice was followed.

Incidents and accidents were reviewed and analysed for lessons learnt and action was taken and shared with staff to reduce further reoccurrence. People were supported to have maximum choice and control of 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 support this practice.

Staff received an induction and ongoing training and support. This included opportunities to discuss their work and development needs. Staff practice was monitored. Staff shared information with healthcare professionals to support people with their ongoing care needs. People’s health was monitored, and staff took action if people required urgent assistance. Where people required assistance with nutrition and hydration needs, staff had detailed guidance.

People were complimentary about staff and considered them to be kind and caring. End of life care considered people’s wishes and preferences. Staff provided care that was respectful about people’s privacy and dignity. People’s communication and sensory needs had been met and were understood by staff.

The provider’s complaints procedure had been shared with people and when concerns and complaints had been received these had been responded to. People had opportunities to share their experience about the service. The provider had systems and processes to monitor the service and since the last inspection, improvements had been made to increase oversight and accountability. The provider had an ongoing action plan and the management team showed a commitment to continually improve the service.

Rating at last inspection

The last rating for this service was Requires Improvement (published 29 June 2018). The service has improved to an overall rating of Good. Responsive remains Requires Improvement, further action was required to ensure people received a service that was consistently responsive.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Direct Health (Nottingham City) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham City. It provides a service to older adults and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (Nottingham City) 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.

At the time of our inspection, 325 people were receiving personal care as part of their care package.

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.

Risks associated with people’s needs had not been consistently assessed and planned for. Some risk assessments used to instruct staff of action required to manage risks, were insufficiently detailed or not completed.

Shortfalls were identified in the management of medicines; best practice guidance was not always followed.

Accidents and incidents were recorded but there was an inconsistency in how one incident had been responded to. Incidents were reviewed to consider if there were any lessons that could be learnt.

There were sufficient staff to meet people’s needs. New staff were constantly being recruited due to the size of the service. Staff’s availability to pick up new care packages was considered. Safe staff recruitment checks were in place and followed.

Staff had received training in infection control and food hygiene. Staff followed best practice guidance in the management of risks associated with infection and cross contamination.

Staff received an induction and ongoing training, but shortfalls were identified in the ongoing support provided to staff.

People’s nutritional needs had been assessed, but these needs were not always sufficiently supported and effectively managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, staff had limited knowledge of how to respond if people no longer had capacity to make some specific decisions. Some mental capacity assessments and best interest decisions had been made, but these had not always been consistently completed.

People’s healthcare needs were monitored and action was taken when changes occurred such as informing the person’s relatives and representatives or health and social care professionals.

Staff treated people with respect and kindness, they were caring and compassionate in their care and approach. Independence was promoted and privacy and dignity respected. People had access to information about independent advocacy services.

There were plans in place, which detailed people’s care and support needs but these lacked detail in places and had not always been updated when required.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

People received opportunities to share their feedback about the service. The provider and registered manager had met their registration regulatory requirements.

The provider had systems and processes in place to regularly review the quality and safety but these had not always been effectively managed. The provider’s internal auditor found shortfalls in April 2018 as identified in this inspection. At the time of the inspection, an action plan was already in place to address these issues and progress was being made.