Archived: Community Nursing & Care Agency Limited

The inspection took place on 7, 8 and 9 July 2015, and was an announced inspection. The previous inspection on 2 May 2013 found no breaches in the legal requirements.

Community Nursing & Care Agency Limited provides care and support to children and adults in their own homes. The service is provided to children as young four years old; adults and people aged 65+. At the time of this inspection there were less than 20 people receiving support with their personal care. Community Nursing & Care Agency Limited provides two types of services, supported living and domiciliary care. Within the domiciliary care service visits range from half an hour up to two hours to support people. Within the supported living service people were receiving up to 24 hours support per day unless they were attending day centre activities. The supported living service operated in Hythe, Tenterden and Smeeth and the domiciliary care services covered the geographical area of central Ashford.

The service is run by an established registered manager. 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 they received their medicines safely and when they should. However we found shortfalls in some areas of medicine management.

Most risks associated with people’s care and support had been assessed, but not all. The guidance in place for staff was not always sufficient or clear to ensure people remained safe.

People did not all have their needs met by sufficient numbers of staff. Two people told us the service had not been able to cover the full hours of their care and support for some time. The service did have several vacancies and were actively recruiting. People received continuity of care and support from a team of regular staff and senior staff also covered care and support shifts or visits. People knew who would be undertaking their care and support in advance.

People had equipment in place to aid their mobility. People told us the equipment used to aid their mobility, such as hoists had been serviced regularly, which they arranged. However there was no system within the office to ensure that equipment was serviced according to manufactures guidelines.

People were involved in the assessment and planning of their care and support. Care plans contained information about people’s wishes and preferences. They detailed people’s skills in relation to tasks and what help they may require from staff, in order that their independence was maintained. People had reviews of their care and support where they were able to discuss any concerns.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People were protected by safe recruitment procedures. Staff files contained most of the required information. New staff underwent a thorough induction programme and shadowed experienced staff, until staff were competent to work on their own. Staff training included courses relevant to the needs of people supported by the service. Staff had opportunities for one to one meetings, team meetings and appraisals, to enable them to carry out their duties effectively.

Most people were satisfied with the service they received. They felt staff had the right skills and experience to meet their needs. People felt staff were kind and caring.

People told us their consent was gained at each visit. People had also signed a consent form as part of their care plan. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people had a Lasting Power of Attorney in place and some others chose to be supported by family members when making decisions. The Mental Capacity Act 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health. People told us staff were observant in spotting any concerns with their health. The service made appropriate referrals and worked jointly with health care professionals, such as speech and language therapists. There was information about people’s health conditions, such as diabetes and epilepsy to ensure people remained healthy.

People felt staff were caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their preferences. People’s individual religious needs were met.

People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided both informally and formally.

Most people had mixed views about whether the service was well-led and communication with the office. There had been changes in the senior staff team and there remained a vacancy. Senior staff worked shifts or covered visits to people. The registered manager took action to try and address any concerns or issues straightaway to help ensure the service ran smoothly. Staff felt the senior team motivated them and other staff.

The provider had a set of aims and objectives, which included treating people as individuals and being respectful, promoting people’s independence and supporting people to the best of their ability to live a fulfilled life. Staff were not always aware of these and how they followed through into practice.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.