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Norvic Healthcare Anglia Requires improvement

We are carrying out checks at Norvic Healthcare Anglia using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 February 2018

This inspection took place on 22 November and was announced.

Following the last inspection on 10 November 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Well-led to at least good.

This service is a domiciliary care agency. It provides personal care to 29 people living in their own houses and flats in the community. It provides a service to older adults and people who are living with a learning disability.

There was a registered manager in post. 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.

At our last comprehensive inspection on 10 November 2016 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for good governance and notification of other incidents under the Care Quality Commission (Registration) Regulations 2009. At this inspection we found the provider had taken action to ensure they were compliant with the Registration regulations. We found that whilst some improvements had been made with the governance of the service, there were still concerns about the assessment and monitoring of the safety and quality of the service. The provider was still in breach of this regulation.

The quality assurance system that was in place was not effective at identifying areas for improvement within the service. This was because there was a lack of any in depth examination of the service. Satisfaction surveys were sent to people but the responses were not collated to gain an overall picture of the service.

There was clear and visible leadership in place and staff felt supported by the registered manager. The registered manager was able to be contacted by people and their relatives and made time to listen to people.

Regular staff meetings took place and there was frequent communication in the form of newsletters, phone calls and texts between the provider, management team and the staff.

Working relationship had been fostered and maintained with other services such as local hospitals and the local authority to ensure continuity of care for people.

People’s medicines were not always managed in the safest way possible. There were no protocols in place for ‘as required’ medicines and staff did not have a good understanding of this type of medicine.

Staff had received training in the safe management of medicines and documentation relating to people’s medicines was completed fully.

Individual risks to people had been identified but there was little information to guide staff about how to mitigate them. Risk assessments for people’s homes had been completed to help ensure the safety of people using the service and the staff visiting them.

There were enough staff to safely meet people’s care needs and staff arrived to people’s houses on time. Staff had received training in safeguarding and knew how to report any concerns of abuse. There were safe recruitment practices in place and the necessary background checks had been carried out before staff started working in the service.

Accidents and incidents were recorded and these were looked at regularly to identify any patterns or trends.

Processes were in place to prevent and control infection. Staff had received training in infection control and food hygiene and knew their responsibilities in relation to these areas.

People’s care and support needs were not always holistically assessed. Whilst there was information in people’s care plans relating to their physical health, there was little detail about any mental health needs that people may require support with.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and whether the service is working within the principles of the MCA and report on what we find. We found that not everyone had an MCA assessment and decisions made for people in their best interests were not always documented. Staff we spoke with had a good understanding of the MCA and knew how to offer people choices.

Staff received training relevant to their role and they were supported to access additional training that would benefit them in their role. Staff were further supported through regular supervisions and appraisals.

People who required support with their meals were supported to maintain a healthy nutritional intake. Relevant healthcare professionals were contacted where there were concerns about a person’s health or wellbeing.

Staff were caring and took time to listen to people and involve them in making choices about their care. People were treated in a respectful way and their right to privacy was maintained.

People’s independence was promoted and people were encouraged to do as much for themselves as possible.

Care records were updated regularly and people and their relatives were involved in this process. Care plans were updated to reflect people’s current needs.

There was a complaints procedure in place and people felt happy to raise a complaint if needed and knew who they would direct their concerns to if needed.

Inspection areas

Safe

Requires improvement

Updated 2 February 2018

The service was not consistently safe.

Individual risks to people’s health and wellbeing had not been identified and documented.

People’s medicines were not always managed in the safest way possible. There were no protocols for ‘when required’ medicines.

There were enough staff to safely support people. Satisfactory checks were carried out on staff before they commenced employment with the service.

Staff had received training in safeguarding and knew how to report any concerns.

Accidents and incidents were recorded and monitored.

Staff had received training in infection control and food hygiene and knew their responsibilities in relation to these.

Effective

Requires improvement

Updated 2 February 2018

The service was not consistently effective.

People’s care needs were not holistically assessed and recorded.

People’s mental capacity was not always assessed and it was unclear what support people needed to make choices.

Staff received training relevant to their role and were able to access additional training relating to their role.

People were supported to maintain a sufficient nutritional intake.

Staff worked with other organisations to ensure that people received care from relevant healthcare professionals.

Caring

Good

Updated 2 February 2018

The service was caring.

People and their relatives were involved in planning their care.

People were supported by staff who were caring and who knew their needs well.

People were treated with respect and their privacy was upheld.

People’s independence was encouraged and supported.

Responsive

Requires improvement

Updated 2 February 2018

The service was not consistently responsive.

People’s care records did not contain information about their emotional wellbeing.

Care records were reviewed on a regularly with people and their relatives.

There was a complaints procedure in place and people knew who to raise any concerns with and felt comfortable in making a complaint.

Preferences for end of life care and treatment were documented.

Well-led

Requires improvement

Updated 2 February 2018

The service was not consistently well led.

There was a lack of effective systems in place to assess and monitor the quality and safety of the service.

People’s views about the service were not collated to generate an overall picture of the service.

Staff felt supported in their role and were actively involved in the ongoing development of the service.

The registered manager was a visible presence and was available to speak with people and their relatives.

The staff worked closely with other services to ensure that people received continuity of care.