Archived: Nightingale Homecare and Community Support Services Ltd

Updated 1 May 2015

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 was 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 4 and 5 February 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure we are able to speak with people who use the service and the staff who support them. On the 4 February 2015 we went to the agency’s office and looked at care plans, staff files, audits and other records. On the 5 February 2015 we visited and talked with people in their own homes.

Two inspectors and an expert-by-experience, with a background of older people and domiciliary care, completed the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We normally ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. On this occasion we did not ask the provider to do this as we were responding at short notice to information and concerns that had been raised at another location run by this provider. We wanted to check whether similar concerns were happening at Nightingale Homecare and Community Support Services Ltd Canterbury. We reviewed information we received since the last inspection, including notifications. A notification is information about important events, which the provider is required to tell us about by law.

During the inspection we visited and spoke with nine people in their own homes. We spoke with the registered manager, the branch manager, two co-ordinators who organises the work for the staff and three members of staff.

We reviewed people’s records and a variety of documents. These included six people’s care plans and risk assessments, four staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys.

After the inspection the expert by experience contacted 19 people by telephone. We also contacted four members of staff by telephone to gain their views and feedback on the service.

We received feedback from two professionals who had recent contact with the service.

At the previous inspection on the 4 February 2014 there were no concerns.

Updated 1 May 2015

The inspection visit took place at the agency’s domiciliary care office on 4 February 2015. On the 5 February 2015 we visited people who used the agency in their own homes.

Nightingale Homecare and Community Support Services Ltd are registered to provide personal care to people, living in their own homes in the community. The support hours varied from one to four calls a day and start at 15 minute calls, with some people requiring two members of staff at each call. The agency office is based in a business park on the outskirts of Canterbury. The agency offer support and care to people in Canterbury, Whitstable, Herne Bay, Faversham and surrounding areas. They provide care and support to a wide range of people including, older people and people living with dementia and mental health needs.

Concerns had recently been identified by the Care Quality Commission (CQC) about the overall management of the agencies run by this provider. Since the last inspection of February 2014 the agency had expanded and now provided care and support to 130 people in the local area. The agency had not managed the rapid increase in the number of people and this had resulted in concerns being raised.

At the time of the inspection the agency had 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 and associated Regulations about how the service is run.

There were varied views from the people and staff about care planning, late and missed calls and communications between people, office staff and the management of the agency. Some people told us the agency involved them in assessing and planning their care. They said calls were usually on time and that the office staff communicated with them to let them know if there were any problems. Other people had a different experience and felt the agency could improve. People did tell us that when the staff arrived at their homes they received the care and support that they needed. Several people said that the staff who visited them ‘go over and above what they needed to do’. Comments were, “goes out of her way”, “excellent”, “very happy” and “no complaints”.

People told us they felt safe when staff were supporting them with their care. In some people’s care plans there was information and guidance to inform staff how to care and support people in a way that kept them as safe as possible and kept any risks to a minimum. There was guidance for staff in some care plans about how to move people safely or how to provide people with the individual personalised care and support that they needed. In other people’s care plans the amount of details was limited. There was little or no information about what care and support people needed to meet their needs and keep them safe.

People were not always involved in the assessment and the planning of their care. Some people told us they were not asked about the care and support that they needed. The amount of detail in some care plans was limited and the information recorded in the daily notes was not always reflected in the care plans. People were at risk of not receiving the care they needed because their needs had not been planned and reviewed. Senior staff from the agency had not visited people to make sure the care they were receiving was meeting their changing needs. Any relevant changes to their care were not recorded. People said staff were caring and treated them with dignity and respect and were kind and polite. They said that staff listened to them and gave them the care and support in the way they preferred.

People were not always responded to when they needed help and advice. There was an on-call system covered by senior staff in the office for people to use in an emergency or for staff to use for support. Staff said the communication between the staff who delivered the care and the office staff who organised the care was inconsistent and ‘depended on who you talked to’. Staff told us that office staff did not always respond to them and any queries they raised were not sorted out. They said that they were not listened to. People said that when they called the office, especially at weekends, no-one answered the phone and if they left a message it was not responded to in a timely way. They said that often messages did not get passed on.

On occasions there were missed calls to people and staff were sometimes late to calls. Missed calls and late calls were logged and investigated to reduce the risk of reoccurrence. A new system for staff was being implemented to record their arrival and departure of the call. People told us that the staff did arrive close to the time they were supposed to. Sometimes they were a bit late but people said they did not mind. They said usually the agency office staff rang to let them know if the staff were going to be late. People did not receive the care and support that they needed because sometimes calls were missed. This was usually due to people being missed from the list staff had received from the office of the visits they were supposed to do. People said that staff stayed for the duration of their call and if necessary they stayed longer. On the whole they said that they received care from a consistent team of staff but sometimes new carers came who they had not been introduced too and they did not like this.

Staff had not received regular one to one meetings with a senior member of staff. They did not have the opportunity to privately discuss any issues or talk about their training and development needs. Staff competencies were not checked to make sure they were competent and safe when caring for people. A system of recruitment checks were in place to ensure that the staff employed to support people were fit to do so. Some of these checks had not been fully completed to make sure staff were suitable to work with people in their own homes.

There was enough staff employed to give people the care and support that they needed usually at the times they wanted and in a way that they preferred. Staff had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns. Staff had made appropriate referrals and worked with health care professionals, such as community nurses and doctors, to ensure that people received the treatment and support they needed.

New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. Other staff who had worked at the service for over a year had received training to make sure they had the continued competencies, skills and knowledge to do their jobs effectively and safely. All the topics were covered in a one day refresher course. The agency had recognised that this was not enough time to cover the topics in the depth that staff needed. They were reviewing how they delivered the refresher training to make sure staff had more time and support to get up to date.

Staff did not have a full understanding of current guidance to support people to make decisions and consent to care and support. Staff had received training on the Mental Capacity Act 2005. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Staff had some knowledge of the Mental Capacity Act but could not relate it to how they cared and supported people.

People's medicines were not always handled and managed as safely as they could be. There was no guidance for staff to tell them how to give people their medicines safely and in a way that they preferred and suited them best. Some medicine records were not clear and were not accurate. There was a lack of detailed guidance for medicine needed on a 'when needed' basis

The agency had a complaints procedure and people told us they did know how to complain. People and their relatives told us that they did complain when they had any concerns. They felt that they were listened to and the agency tried to resolve the issues. The registered manager told us that they did respond to complaints which were normally about late or missed calls. Complaints were recorded but there was no information about what action was taken and the outcome of the complaints.

The systems in place to monitor the safety and quality of the service were not effective and were not improving the service. When shortfalls and concerns had been highlighted no action had been taken to make improvements. Staff were unaware of the values and vision of the agency and were not involved in the development of the service.

People were supported with their nutritional needs. People told us that they chose what they wanted to eat. Staff prepared meals or supported people to cook.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.