Background to this inspection
Updated
22 September 2018
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 28 July 2018 and 10 August 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is a domiciliary care agency and we needed to be sure that someone would be in.
Inspection site visit activity started on 26 July 2018 and ended on 10 August 2018. It included reviews of records, telephone interviews with people and relatives, healthcare professionals and staff. We visited the office location on 26 July 2018 and 10 August 2018 to see the registered manager and office staff; and to review care records and policies and procedures.
The inspection was carried out by one inspector, a specialist nurse and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
As part of our planning we contacted the local authority and placing authorities for feedback on the service. We reviewed feedback from people and relatives submitted to CQC and we also checked online feedback. We reviewed notifications that the provider had submitted to CQC to identify any areas that we would need to follow up on during our visit. Notifications are information about events and incidents that providers are required to tell us by law.
We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
As part of the inspection we spoke with one person and 12 relatives. We spoke with the registered manager, the regional manager, a clinical lead, two nurses and one healthcare assistant. We received email feedback from one community nurse.
We looked at the care plans for eight people, three staff files, accident and incident records, complaints and minutes of staff meetings. We looked at the provider’s audits and surveys and reviewed records of staff training and supervision.
Updated
22 September 2018
This inspection took place on 28 July 2018 and 10 August 2018 and was announced. This was the first inspection of the service since they registered with CQC in July 2017.
This service is a domiciliary care agency providing specialist nursing care. It provides personal and nursing care to people living in their own houses and flats in the community. It provides a service to people with cancer and long term medical conditions. The service regularly provided end of life care.
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 received safe care. The provider had considered risk and there were systems in place to ensure all care provided was tailored to people’s individual needs and risks. Where incidents had taken place staff escalated them appropriately and took action to reduce the likelihood of them recurring. Staff understood how to safeguard people from abuse and acted in line with local guidance when they identified concerns.
People received their medicines safely. Staff had received training in how to manage medicines and we saw evidence of staff working closely with healthcare professionals where medicines were required. Staff had strong links with local community nursing organisations which people benefited from. There was regular communication between these organisations which had helped to identify and respond to changes in people’s health. Staff were trained in how to provide care in a way that reduced the risk of infections spreading.
Staff had received appropriate training and support for their roles. Nursing staff received clinical supervision and support to maintain their knowledge. Staff felt supported by management and there were systems in place to enable good communication between staff and the provider. Staff had regular supervision and appraisals to discuss their work and their performance.
People told us that staff were kind and caring and supported them in a way that enabled relatives to have breaks from their caring roles. Staff involved people in their care by offering choices. The provider asked people questions about their preferences and diverse needs so that care could be tailored around these. People told us that staff were respectful when visiting their homes and staff were knowledgeable about how to provide support in a manner that promoted dignity. Staff arrived at the times that they were expected and the provider was in the process of improving the system for receiving referrals to speed the process up for people.
End of life care was delivered in a sensitive and person-centred way. People’s wishes for their end of life care were identified and reviewed regularly by staff and community healthcare professionals Changes to people’s needs were quickly identified with prompt action taken. Staff gathered important information about people’s routines and preferences. People and their relatives were regularly asked about the quality of the care they received and asked if they wanted to make any changes. There was a complaints policy in place and complaints had been responded to in line with the provider’s policy.
Regular checks were undertaken on the quality of the care that people received. The provider carried out a variety of checks and audits to monitor care and people and their relatives were involved of this. Staff practice was frequently observed to ensure best practice was being followed. People had consented to their care and staff understood what to do if people were unable to provide informed consent.