Inter-County Nursing & Care Services - Christchurch

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were actively involved in decisions about how risks they lived with were managed and provided with accessible information to help them make informed decisions. The agency was pro-active at using technology to find innovative ways to support people to remain living in their homes safely. Staff had been provided with training specific to people’s risks and were confident in actively mitigating risks to people’s safety including the use of medical devices. Infection control practices went beyond environmental risk factors and included risks to people who were known to be prone to infection due to health issues. NHS guidance had been shared with people and the staff team with guidance on how to mitigate these known risks. The culture of the service was open and transparent and very focused on protecting people’s diversity and lifestyle choices ensuring people’s human rights and freedoms were respected.

People had their medicines ordered, administered, recorded and disposed of safely. Staff worked with people to support them to remain independent and involved with their medicines and creams. This had included creating pictorial information so that a person could direct staff in cream administration and researching and accessing technology that reminded a person their medicines were due to be taken. Since our last inspection, in line with best practice guidance, the medicine policy now included homely remedy medicines.

Staff had been recruited safely ensuring they were able to work with vulnerable adults. Staffing levels enabled a flexible approach to meeting care needs and providing time for social interactions. Staff received an induction and ongoing training and support that enabled them to carry out their roles effectively. Training had included learning how to use medical equipment to keep people comfortable when they had complex health needs or near the end of their life.

The agency was pro-active and committed to working collaboratively with people, their families, staff and other professionals both at initial assessment and then throughout the time the agency provided care and support. The risks of social isolation had been recognised and people were signposted to community links such as social groups, local activities and specialist services for dementia or bereavement. Technological solutions were sourced to help people remain safe in their homes. This meant people received an outstanding level of care that met their individual needs, lifestyle choices and independence which was responsive to changing health and care needs.

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. Working with other professionals had enabled people to get the care and support they needed including appropriate equipment and access to healthcare. A complaints procedure was in place that people felt able to use and be listened to with actions taken to solve any issues.

People had their eating and drinking needs met and staff were knowledgeable about people’s cultural diversity. To support care staff inexperienced in cooking the staff team had got together and produced a booklet of easy to follow well balanced meals. Where risks of poor appetite were associated with social isolation the agency had sourced solutions in the community such as dining clubs. Care plans had been reviewed and rota’s adjusted so that staff had time to sit with a person and share a mealtime.

People received care that was kind, compassionate and inclusive. Care staff found innovative and practical ways to go the extra mile to make people feel valued and at the centre of their care. People had their communication needs met in order that they could contribute to decisions about their day and express their feelings and views. People had their dignity, privacy and independence respected and this was reflected throughout the agency.

The registered manager provided visible leadership and championed outstanding care both within the organisation and externally. The service was seen as an excellent role model for other services. The registered manager had provided expert knowledge at a parliamentary review on best practice as a learning tool for raising the standards of the care industry. They had also contributed to a ‘Skills for Care’ national publication ‘Good and Outstanding Care Guide’.

At our last inspection the service was rated outstanding. The registered managers commitment, leadership and governance meant that people continued to receive an outstanding service. The registered manager promoted an open and transparent culture and provided visible leadership championing outstanding care both within the service and externally. The agency was seen as an outstanding role model by health and social care professional organisations. staff team were confident, motivated and felt enabled to go the extra mile when providing care to people. Staff were confident and happy in their roles and felt appreciated by the organisation.

Quality assurance processes were effective in ensuring people received high standards of care. Audits were reviewed and updated in line with best practice guidance and regulations to sustain and further improve service delivery. People had been provided with information that explained to them the standard of care to expect. When feedback had been provided it was seen as an opportunity for reflective learning and service development.

The inspection took place on the 19 and 20 April 2016 and was announced. The service provides personal care to older people living in their own homes. At the time of our inspection there were 35 people receiving a service from the agency.

The service had a 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.

Some people had their medicines administered by care workers. One person required a daily injection. The care records indicated the staff supported the person to self-administer the injection. We found what was happening was that the care worker recorded the person’s blood sugar levels first thing each morning and the district nurse visited later and administered the injection. We discussed this with the registered manager and the care records were changed immediately.

We checked medicine administration records (MAR) which staff used to record any medicine they had administered. We found that on one record there were missed signatures for five evenings for two creams a person had been prescribed to receive. All other medicines had been recorded correctly. Previous audits had highlighted missed signatures. In response the registered manager had put extra training and supervision in place which had led to improvements. They told us they would investigate the missed signatures and take any necessary actions.

Some medicines were prescribed for people as and when they were required (PRN). Additional records had been kept for these medicines. This meant these PRN’s were being safely administered. Staff had received training and had their competency checked. Care workers had a good understanding of the risks associated with the medicine people were taking.

People, their families and other professionals told us they felt the service was safe. Staff had received safeguarding training. They were aware of the types of abuse that could happen to people, what signs to look out for and their responsibilities for reporting any concerns.

Risk assessments had been completed for people and their environments. Risk had been managed with the minimum restrictions on the person’s freedom and choices. Staff demonstrated a good knowledge of the risks people lived with and any actions needed to minimise these risks.

A business continuity plan was in place and included managing risks associated with extreme weather, pandemics such as the flu virus, computer failure and financial problems.

Staffing levels met the needs of the people using the service. Staff had been recruited safely.

Processes were in place to manage any unsafe practice.

New care staff completed the Care Certificate. The Care Certificate is a national induction for people working in health and social care who did not already have relevant training. New staff with care experience completed the care certificate standards self- assessment tool. This then formed the basis for the persons’ individual induction training programme. Staff received on-going training which was relevant to the people they supported. Staff told us they felt supported in their role and received regular supervision and a yearly appraisal. Supervisions also took place with staff when they were supporting people. They included checking staffs dress code, their knowledge of the people they were supporting and any risks they lived with, health and safety and a check of record keeping.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We found the service was working within the principles of the MCA. Staff had received training on the MCA. People had signed forms consenting to their care plans. Files contained copies of power of attorney legal arrangements for people and staff understood the scope of decisions they could make on a persons’ behalf.

People were supported with their eating and drinking by staff who understood their likes and dislikes and any potential risks.

People had good access to healthcare services.

Care workers worked in partnership with people and provided the personal care and support they needed in a way that enabled a person to stay in control and maintain their dignity and independence. Care workers considered the support family carers may also need. People wherever possible had care workers who shared common interests and had gained the knowledge to understand people’s individual health challenges. They also had a good knowledge of people’s families and others important to them. Care files included a privacy statement which explained to people the information that the service collected about them and why they kept it and staff understood their role in protecting a persons’ privacy.

People’s wishes about the end of their life were understood and respected.

Assessments had been used to create care and support plans that addressed people’s individual identified needs. Staff demonstrated a good understanding of the actions they needed to take to support people. Care and support plans had been reviewed regularly.

The service was pro-active in supporting people to feel part of their local community by promoting links with local businesses and events. People were supported to continue with activities they enjoyed.

A complaints process was in place. People and their families knew how to make a complaint and felt they would be listened to if they raised a concern. Complaints and there outcomes were shared with staff to reflect on practice and learn lessons when appropriate.

People, their families, staff and other professionals all told us they felt the service was well managed. They told us the registered manager and office staff were approachable, knowledgeable, that there was good communication and they were efficient. Staff were supported and encouraged to share ideas about how the service could be improved and had been pro-active in supporting changes. They spoke enthusiastically about the positive teamwork and support they received.

The registered manager had a good understanding of their responsibilities for sharing information with CQC and our records told us this was done in a timely manner. People and their families had been given information so that they knew what to expect from the service.

New legislation had been shared with staff and incorporated into policies and service delivery. The service used the expertise of other recognised professional organisations to support practice development and continually improve the quality of service people received.

Staff told us that they felt their achievements were recognised. Staff had a clear understanding of their roles and responsibilities. We observed staff confident in performing their jobs and when speaking with people, other staff and the registered manager.

Audits had been completed and were linked to CQC’s regulatory standards of ensuring a service is safe, effective, caring, responsive and well-led. The audits effectively captured the level of detail sufficient to provide reliable data and lead to positive change. We saw that audits and there outcomes were shared with staff at team meetings and through individual supervisions.

An annual quality assurance survey had been completed in November 2015. This had gathered feedback from people using the service, their families and staff. We saw that people rated the skills, knowledge and competency of staff as good or excellent and that staff rated their training and support as excellent.