Archived: Nurtured Care Head Office

Updated 27 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 2,6,7, 27 February, 2 and 27 March 2017 and was unannounced.

It was carried out by an inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses a service for older people. During the inspection the inspector visited the provider’s head office to look at records and speak with staff. After the inspection the inspector visited some people who used the service to speak with them and telephoned staff who were employed by the agency. An expert by experience carried out telephone interviews with some people who used the service and some relatives.

Before the inspection, we had received a completed Provider Information Return (PIR). The PIR asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service as part of our inspection. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send CQC within required timescales. We contacted commissioners from the local authorities and health authorities who contracted people’s care. We spoke with the local safeguarding teams.

We spoke on the telephone with 11 people who used the service and two relatives. We also visited four people in their own homes to obtain their views on the care and support they received. We interviewed ten staff members and the registered manager for the service.

We reviewed a range of documents and records including; four care records for people who used the service, five records of staff employed by the agency, complaints records, accidents and incident records. We also looked at records of staff meetings and a range of other quality audits and management records.

Updated 27 June 2017

This inspection took place on 2,6,7 and 27 February, 2 and 27 March 2017 and was unannounced. This was the first comprehensive inspection of the service since it was registered. The service was formally registered with the Commission in April 2016.

Nurtured Care is a domiciliary care agency providing care and support to people in their own homes. The agency provides 24 hour personal care and support to some people with complex support needs. It is registered to deliver personal care.

A registered manager was in place who is also the registered provider. 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 were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. People received their medicines in a safe way. Vetting procedures were carried out for all staff before they began working with people. However, risk assessments were not all in place that accurately identified current risks to the person. People told us their appointments were sometimes late or missed and they were not kept informed.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Staff told us communication was effective to ensure any changes in people’s care and support needs were met. However, people who used the service told us communication with the main office needed to be improved.

Regular staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

Staff received opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal but it needed a regular audit to identify where staff had not received a recent supervision. Records were not all in place to ensure people received appropriate care and support at all times. A complaints procedure was available. Improvements were required to any complaints received to ensure they were dealt with according to the agency's complaints procedure.

People told us the management team and staff were approachable. They told us they were asked their views about the service they received. A quality assurance system was in place but it needed to be more robust. The audits used to assess the quality of the service provided were not effective as they had not identified the issues that we found during the inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to handling of complaints, record keeping and quality assurance.

You can see what action we told the provider to take at the back of the full version of this report.