Archived: First City Nursing Services Ltd Salisbury

This inspection took place on 8 November 2016. This was an announced inspection which meant the provider had prior knowledge that we would be visiting the service. This was because the location provides a domiciliary care service to people in their own homes, and we wanted to make sure the provider would be available to support our inspection, or someone who could act on their behalf.

At the time of our inspection a registered manager was in place 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. The registered manager and the operations director were both available throughout the inspection.

Systems were in place to manage risk and protect people from abuse. Staff were aware of their responsibilities and knew what actions they needed to take to ensure people were protected.

Staff were well trained and knowledgeable. They received a thorough induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives. Staff were skilled at ensuring people were safe whilst encouraging them to live independent lives. People and relatives were overwhelmingly positive about the service they received. Comments included, “The staff are flexible, kind and listen to my directions. I am unsure if they could actually improve” and “It’s excellent, everybody is so nice and helpful and willing to do things beyond the call of duty”.

There was a strong emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. The service empowered people in making decisions about their own care. One person told us “My views are considered every step of the way and any suggestions I make are given proper consideration”.

People had positive relationships with their support staff who knew them well. There were enough staff available to meet people’s needs, and staff had been carefully matched with people to ensure people were comfortable with the staff supporting them. Staff had an excellent understanding of how to support people with personal care whilst maintaining the person’s dignity, privacy and independence.

Care plans were personalised and detailed daily routines specific to each person. People’s likes and dislikes were clearly recorded and captured events that were meaningful to people in the way they wanted staff to support them. The service had spent time finding out about people’s activities and routines in order to provide person centred care that met their current and developing needs.

The registered manager, senior management and staff demonstrated strong values and a desire to learn about and implement best practice throughout the service. Staff were highly motivated and proud of the service.

We saw that valid consent was obtained before care was provided. We spoke with one person who received a service from First City Nursing Services. They told us that 'I am in complete agreement with the care and support I receive because I like to direct everything which the carers do'.

We read two case files and saw that there were forms entitled 'Informed Consent'. These forms specified that the provision of personal care was agreed and the administration of medication was also agreed. In both case files these forms were signed by the people who used the service.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw two case files which had good risk assessments and risk management plans.

We saw that medication was administered safely and was well recorded.

We found that care and support was provided by sufficient staff who had the right skills, knowledge and experience to deliver the care.

We spoke with one person who used the services of First City Nursing Services'. They told us that 'the staff are brilliant, I get on with them very well, they are very flexible when it comes to meeting my needs'.

We saw that there was a good system in place to monitor the quality and effectiveness of the care provided by First City Nursing Services. We saw some results from the "service user satisfaction survey" which had many positive comments from people who used the service.

One person told us "this is the best care agency I have had. They are empowering." People were, overall, satisfied with the support they received. Care was delivered in line with plans of care.

Staff were knowledgeable about how to recognise and report abuse. They were concerned about ensuring people were safe.

Staff said they felt well supported. One person told us "they (staff) are well trained." Staff received regular supervision and training.

Records were, overall, up accurate and up to date. They were safely stored.