Care-Nursing Alliance Recruitment

Care-Nursing Alliance Recruitment is a domiciliary care service that provides personal care and support to people living in their own homes. This includes people who require 24-hour care and support. The service provided support to people living in Gloucestershire. The service was known know as accomplish by people, their representatives and staff. The provider took over the service in 2018. The manager was in the process of reviewing the registration for the services, however ensured that people and their relatives knew the name the service was registered with to CQC. In the last 12 months the manager had worked to combine the service with another service operated by the provider. This is to ensure systems and processes were in line with the providers systems. The service supported one person at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were safe when receiving support from staff. Staff understood people’s risks and had the support and knowledge they required to keep people safe. People received the support they needed with their prescribed medicines. Staff followed infection control practices and ensured people’s premises were suitable.

Staff received appropriate training which supported them to carry out their role. Staff received the support, training and encouragement they required to develop professionally and meet people’s needs. Staff told us the management were approachable and responsive to their requests. Staff supported people with their food and drink and were aware of their risks.

People’s relatives told us staff were kind and compassionate. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff understood people’s needs and what was important for them.

The manager acted on incidents or concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.

The manager and provider monitored the delivery of care and support people received. Quality assurance systems were operated to monitor and improve the quality of the service being delivered. The service worked with healthcare professionals to ensure people’s needs were maintained and they received safe and effective care in their own homes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 16 September 2017). At this inspection, we found the service was now Good.

Why we inspected

This was a planned inspection based on the previous rating of “Outstanding”.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected on the 4 and 5 December 2014. At the December 2014 inspection the service was meeting all of the requirements of the regulations and was rated as “Good”.

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.

People and their relatives spoke extremely positive about the outstanding care they or their relatives received. The service often went above and beyond their contractual obligations to ensure people had a good quality of care. People were placed at the centre of their care and were supported to develop their independence, meet their individual desires and live their lives to the fullest.

People and their relatives were heavily involved in their care and spoke extremely positively about the professional relationships they had with all staff employed by the provider. The registered manager contracted healthcare professional support and guidance at the provider’s cost to ensure care staff had clear and comprehensive guidance to provide high quality person centred care in accordance with people’s needs. The service had strong links with healthcare professionals and all healthcare professionals spoke highly about the quality of care people received.

People were cared for by committed care staff who were supported by a dedicated management team including care co-ordinators, registered manager and provider. People’s relatives were involved in providing training to care staff which enabled them to provide exceptional person centred care. Relatives spoke positively about the support they received to provide this training.

There was a strong structure of leadership within the service. Staff were supported to professionally develop and be responsible for additional duties. Staff felt valued by the service. The registered manager and provider knew the needs of staff and had systems to ensure staff had access to the training and support they needed.

Staff and other professionals spoke very highly of the registered manager and gave positive feedback about their approach to caring for people. The service was passionate about providing high quality person centred care for people. All staff understood the providers and registered managers caring values.

At our last inspection in June 2013, we found the provider to be non-compliance in four outcomes. We took enforcement action and told the provider to become compliant by 30 September 2013. This visit was to check the provider had taken appropriate action for each of the four outcomes.

During this inspection looked at the care files for 11 people who used the service. We spoke to three people who used the service. We spoke to six relatives of people who used the service and spoke to 14 members of staff. We found that the care files had been brought up to date with accurate care plans and risk assessments. Six monthly reviews had started and feedback had been obtained from people who used the service. We noted that the provider had made significant improvements since our last visit and had achieved compliance in all four outcomes.

We looked at documents held by the provider, spoke to staff and people who used the service. Whilst we acknowledge that the provider had undertaken work to achieve compliance, we found care plans / risk assessments that had not been reviewed. We also found people who used the service without any care plans in place. A number of staff had not been trained in adult safeguarding, although we did note that during a recent safeguarding incident the staff acted appropriately.

Staff had not received supervisions or appraisals. The provider had implemented a lone worker and recruitment policy. No formal quality monitoring was in place at the time of our inspection. We were told that this was due to start in September 2013.

We talked to two people who used the service, two parents of children who used the service and two social care professionals. Generally this feedback was positive with the comments including 'we are generally happy with the care provided'. 'I am very satisfied with the care that is being provided to our client. The staff are very flexible'. 'We find the care workers very accommodating and nothing is too much trouble'.

We found a lack of care plans and risk assessments in place. Not all staff had received safeguarding training. No quality monitoring system appeared to be in place. Staff were not protected from the risk of violence in peoples homes and the provider's recruitment processes were not robust. Having said that, the comments from people in the yearly satisfaction survey was mainly positive about the care they received and the staff. We saw no evidence that suggests people are receiving poor care from the staff.