Archived: Nurse Plus and Carer Plus (UK) Limited

The agency offers a service to people of any age who may be living with dementia or have a physical or learning disability. The agency currently supports about 30 people in their own homes.

There was a registered manager at the service. 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 described the care as being safe. The provider had policies and procedures in place designed to protect people from abuse. Staff had completed training with regard to safeguarding adults. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

The provider had a safe recruitment procedure in place which included seeking references and completing checks through the Disclosure and Barring Service (DBS) before employing new staff. New staff completed a thorough induction before they began working with people.

People’s rights were protected because the staff acted in accordance with the Mental Capacity Act 2005. People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. Staff had been trained in various topics to meet people’s assessed needs. People were supported to eat and drink adequately, to take their medicines and access healthcare when they became unwell.

People were positive about the relationships they had with staff. Staff knew people well, they knew their likes, dislikes, preferences and their daily routines. People were involved in making decisions about their care and support. People’s privacy and dignity was respected by staff who were polite and thoughtful.

Everyone had a care plan in place which was responsive to their assessed needs. Care plans showed people’s preferences, their personal histories and the support they needed throughout the day. The provider had a complaints procedure in place which outlined how complaints would be dealt with and who would investigate. A record of complaints was kept and we saw where complaints had been made, they had been investigated in a timely way.

People were happy with the quality of the service they received. People were provided with a service user guide which included information about the service and what standards people had a right to expect. The service promoted a positive culture which was open and honest and staff enjoyed working there. Effective quality assurance systems were in place to monitor the quality of service being delivered.

Is the service safe?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We found the service was safe because staff kept accurate records of the medication people were taking. People's medication needs were assessed and care plans were in place to ensure staff provided the support they needed. The medication care plans were reviewed regularly and any changes acted upon. Staff had received updated training in medication administration and their competence was formally assessed.

Is the service well led?

We found the service was well led as the provider had an effective system to regularly assess and monitor the quality of service that people received. The provider sought people's views and a system of regular audit was in place to ensure the service was well led.

The manager had taken action to address the areas of non-compliance we found during our last inspection. New systems had been put in place to ensure people's records were returned to the office monthly so they could be audited. We saw records had been audited and action taken to improve them where necessary.

At the time of the inspection the service was not providing the regulated activity nursing care in the community and therefore the service was assessed for providing personal care.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff recruitment systems were in place and were followed by the service to ensure checks of staff were in place before they were employed. They were then inducted into their roles before working with people.

Staff had been provided with guidance in good hygiene practices and cleanliness and had access the equipment needed to support people in their homes safely.

The safety of the service to people was compromised by the monitoring systems not ensuring that the overall number of missed calls when needs were not met, was identified and acted on.

Staff were required to be involved in the administration of medicines and people told us they received the support they needed. However, the records of prescribed medicines and of their administration were not accurate and had not been recognised in the provider's checks. This meant there was a risk to the safety of medicine administration.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to medicines management and quality monitoring.

Is the service effective?

People told us they had been asked about the care they wanted before it was provided and care-plans had been put in place. They said there were some changes in the staff who met their needs but their care needs were usually met by regular staff. Records of care provided showed people had received effective care in line with their care plans.

Is the service caring?

People told us they were provided with staff who had caring attitudes. Comments we received included: the staff were " all very nice and they do what I want', 'I have been very surprised and pleased with the whole thing', 'very careful and thoughtful ' , 'very good ' some I like better than others but there are none I don't like'. The two relatives we spoke with about staff attitudes told us staff were very caring. We found staff demonstrated caring attitudes when they told us about meeting people's needs. Staff told us they checked people's well-being on a day to day basis.

Is the service responsive?

Systems were in place to obtain feedback from people who used the service through individual reviews and surveys. People who use the service were confident that complaints or concerns would be, or had been dealt with. People also said they had effective communication with the agency. Staff told us they felt supported by the agency and were able to discuss issues and obtain advice to meet people's needs. The agency responded to changing needs such as in emergency situations, by requesting support from health professionals and changing staff where possible to provide more regularity.

Is the service well-led?

Systems and procedures have been put in place or developed to increase the monitoring of the service and develop the quality assurance systems. However, we found some areas for improvement. Monitoring of log books including medicine recording was not timely and delayed errors being rectified or not picked up.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of the service and making improvements.

Staff were aware of the risks of abuse and of procedures to follow if they had concerns. Staff received induction training and support into their roles. Work was taking place to increase monitoring of staff and supervision. Training needs were being identified and refresher training provided. The agency was developing the training received by staff and five were in the process of registering to complete health and social care diplomas. We spoke with six staff who said they felt supported in their work. Systems for auditing the service were in place identifying where the service met standards and where improvements were needed. Feedback was obtained from people using the service in a formal system but also through individual visits and reviews.