Archived: Nationwide Care Services Limited- Coventry

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We saw people's care had been arranged according to their personal needs. People we spoke with told us they had reviews to make sure care plans were accurate and up to date.

We found there was a process in place for managing risks associated with people's care. Some people who used the service were unable to move around without assistance. There was detailed information in care plans for staff about how to move people safely. People told us care workers were competent in using equipment, including a hoist.

All the people we spoke with said they felt safe with their care workers and were confident any concerns or complaints would be investigated by the service.

We asked people if they thought staff were properly trained to provide the support they needed. We were told; 'Yes, they know what to do' and 'Yes and if it's a new person they always have someone with them'.

Is the service effective?

People told us they had been involved in planning their care and the care they received met their needs. We saw care plans were reviewed and updated regularly so care staff could continue to provide the correct level of support.

Staff we spoke with said they were allocated regular clients and were allocated sufficient time to carry out all the tasks required. People said care workers arrived around the time expected and stayed long enough to do everything they needed. People said staff 'logged in' by telephone when they arrived and left. One person told us, 'They do this to let the office know they have arrived and the office can tell if they are running late.' Some people told us they had experienced late calls. They said this was due to care staff leaving and being replaced with another carer.

We found staff had regular supervision and their practice was observed to make sure they provided care and support in line with the provider's policies and procedures.

Is the service caring?

Care plans contained information about people's likes and preferences. This made sure people received care in a way they preferred.

We asked people if care workers treated them in the way they liked. Everyone indicated that people were treated as individuals. Comments from people included, 'They treat me as I would expect them to.' We asked people if care workers were polite and respected their privacy. One person said care workers were, 'Always respectful and very polite.' People indicated the carers were kind and understanding. Comments included, 'Yes, very kind and friendly. They try to make time for a chat and cup of tea.'

Is the service responsive?

People told us they were asked for their views and opinions during reviews and any changes were recorded and acted on. People told us that concerns were listened to and acted on.

People told us care staff noticed when their needs changed and took action. For example when asked if staff monitored people's skin to make sure it remained intact and healthy, a relative told us, 'They check when they provide personal care. They apply the cream and let me know if there is any redness'

Staff we spoke with said there was an 'on call' system. We were told, 'If you leave a message the on call person always gets back to you.'

Is the service well led?

The service had a clear management structure in place and senior staff spoken with understood their role and associated responsibilities.

We found the service had a quality assurance system in place. This included regular reviews with people who used the service, telephone conversations and staff spot checks. The service had auditing procedures in place to make sure staff provided care to people as recorded in their care plans and worked in line with the provider's procedures. Staff received regular supervisions that included work based observations to make sure they worked in line with policies and procedures.

People who used the service told us they were satisfied with the service they received. Comments from people included, 'I am happy with my carers.' 'Yes I am quite satisfied with the service I get.' 'When it is working properly it is great.'

We visited the service on 12 February 2014 to check the actions taken by the provider and to make sure improvements had been made. We did not speak to people who used the service during this follow up visit.

We found the provider had made the improvements we required. People who used the service could be confident the provider was meeting the standards for managing people's medication, assessing and monitoring the quality of the service and for managing complaints.

At the time of our visit the agency was providing support to approximately 115 people in their own homes and employed around 40 care workers. During our visit we spoke with the director, acting manager, three people working in the office and five care workers. Prior to our visit we spoke with 16 people who used the service or their relatives over the phone.

We found people had different experiences of using the service. Some people said the agency was good. Others told us they were dissatisfied with the service and things could be improved.

We reviewed the care and support being provided for four people. The care files we looked at in the office contained detailed information about the care and support each person needed. We found staff had enough information about what they needed to do to support people safely.

We looked at how medication was being managed by the agency. We could not be confident people were receiving their medication as prescribed.

We looked at a sample of work schedules and staff timesheets to see how calls were scheduled to people. We were told the allocation of people to care workers had recently been revised. We found that people had calls allocated to regular care workers at the same time each day. We found there were sufficient care workers to provide the care and support people required. The agency was in the process of recruiting senior care workers and a care co-ordinator. This would make the staffing in the agency more robust.

We looked at the procedures in place for assessing and monitoring the service. People we spoke with described varying experiences of the quality of service they received. People told us the service was not always consistent. Some people said care workers arrived when expected other said they were often early or late. Some people had experienced missed calls when care workers had not turned up. People said they were not told when their care worker was running late so were unsure if they would turn up or not. People told us the service had improved over the past few weeks. The majority of people said no one had asked if they were satisfied with the service. Most people said they had never seen anyone check on what staff did in the home. We found the procedures in place for assessing and monitoring the service needed to be more robust to make sure people received a consistent service that they were satisfied with.

We looked at how complaints were handled and if people knew how to make a complaint. We found complaints were not recorded or investigated in line with the agency policy and procedure. This meant people using the service could not be certain concerns were listened to and acted on.

We found that people had given their consent to the care and treatment to be provided. A relative told us, “I have been fully involved in decisions about his care and can always give my views and opinions, which are listened to.” People we spoke with said they were happy with the care they received. One person told us, “I am very satisfied with the service from the agency. There is a small team of regular carers that visit and I am quite happy with them.” People told us care workers usually arrived around the same time each day. One relative told us, "Sometimes they arrived after the arranged time so they had to rush....I spoke to the office and this improved." All the people we spoke with said the carers were friendly and polite.

Records showed the agency had systems in place to monitor the care provided and for managing identified risks. Records we looked at showed the agency regularly reviewed the care to people. Staff we spoke with knew how to keep people safe and what to do if they had any concerns. Staff said they would have no hesitation reporting concerns or poor practice to the manager. All the records and documents we requested to see were made available to us.