Naswell Care LTD

Naswell Care Ltd is a supported living service providing personal care to people who may live in single or shared occupancy households with their own tenancy agreements. At the time of the inspection, the service was supporting 3 people with personal care living in single households of different sizes.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

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; the policies and systems in the service supported this practice. Effective systems were in place to involve people in decisions about their care or lawfully in their best interest.

People’s views about their wishes and goals were supported. Staff promoted people's choice and independence and ensured they had access to a range of individualised activities.

People’s physical and emotional needs had been assessed. Comprehensive care and medicines plans were in place which guided staff on how to support people and included strategies needed to reduce their risks which were known by staff.

Further time was needed for the provider’s systems to be developed and embedded to monitor people’s needs, incidents, records, and governance of the service. More information was needed around the management of people’s routine health assessments and their health needs as people grow older.

Right Care:

People were supported by a regular and caring staff team who knew them well. The quality of people’s life had improved.

Staff and managers were committed to providing person-centred support which focused on people’s individual needs and wishes.

Staff had been safely recruited and had received the training and support they needed to support people. Plans were in place to enhance staff development.

People’s communication needs had been assessed and were being supported.

Right Culture:

The culture of service supported people to reach their potential and achieve their goals. People were empowered to live a life of their choice. The manager and provider valued feedback from people, relatives, staff and other stakeholders to help them drive improvement and improve the quality of people’s lives.

Managers and staff were aware of current care practices when supporting people with a learning disability and autism. The manager had recognised the provider’s policies needed to be reviewed to reflect their practices.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 9 December 2022).and there were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We met with the provider regularly to discuss their progress in completing their actions.

Why we inspected

This service has been in Special Measures since 9 December 2022. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

During this inspection the provider demonstrated that improvements have been made and the provider was no longer in breach of regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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Naswell Care Ltd is a supported living service providing personal care to people who may live in single or shared occupancy households with their own tenancy agreements. At the time of the inspection, the service was supporting four people with personal care living in four different households.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Not everyone was being supported in a way that enabled them to have choice and control in their daily lives. People’s physical and emotional needs and consent to care had not been comprehensively assessed. People's views about their wishes and goals had not been fully sought. Medicines care plans were not always complete or accurate.

Staff recognised signs when people experienced emotional distress and knew how to support them; however, they did not always have access to detailed information about people’s triggers and strategies to be used to support them.

The registered manager would not be able to monitor people’s care needs and incidents effectively as staff did not always keep complete care records.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This put people at risk of receiving inappropriate support.

Right Care:

People’s communication needs had been assessed. The provider had not ensured people could interact comfortably with staff and others involved in their treatment/care and support.

People did not always receive care that supported their health needs such as access to routine health care appointments. Care practices did not always focus on people’s personal aspirations or needs. The provider was not ensuring recognised best practice was followed. This put people at risk of not receiving care which was person centred and focused on their wishes.

Right Culture:

People were not always supported to be empowered to live a life of their choice. The provider had not ensured that current care practices and policies were embedded in the care people received.

This meant people were not always supported by a service which valued and promoted people’s individuality, independence and human rights.

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

Rating at last inspection and update

The last rating for this service was Good (published 21 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about Naswell Care Ltd. We received concerns in relation to staffing and the care people were receiving. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Naswell Care Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe and personalised care and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 7 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Adamson House Business Centre’ on our website at www.cqc.org.uk.

Adamson House Business Centre also known as Naswell Care is a small domiciliary care agency that offers support to people living with attention deficit hyperactivity disorder (ADHD), learning and physical disability and autism who are being supported in their own homes. At the time of our inspection, there were 16 people using the service.

There was no 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. The provider told us they had recruited a manager who would be commencing their post in July. The provider told us the new manager would be submitting their application for registration to CQC. The previous registered manager had left their post one month prior to the inspection. The directors of the service and the deputy manager were managing the service in the absence of a registered manager.

At our focused inspection on 7 June 2017 we found the provider had followed their action plan and legal requirements had been met. The provider had implemented quality assurance systems across the service to ensure the care and support provided to people was of good quality and met their needs.

Adamson House Business Centre also known as Naswell Care is a small domiciliary care agency that offers support to people living with attention deficit hyperactivity disorder (ADHD), learning and physical disability and autism who are being supported in their own homes.

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.’

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. People were protected from the risk of abuse. Staff had received training in this area. There were sufficient numbers of staff to ensure people received the support they required. Where required, medicine administration, recording and storage was safe.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA). Where required, people were supported to meet their nutritional needs.

The service was caring. People and their relatives spoke positively about the staff. Staff demonstrated a good understanding of respect and dignity. It was evident people were receiving a service which was personalised to their individual needs.

The service was responsive. Care plans were person centred and contained sufficient detail to enable staff to provide safe and quality care to people. People and their families informed us they were involved in the planning of their care. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was not always well-led. Quality assurance checks and audits were not taking place. Staff, people and their relatives spoke positively about the registered manager. The service endeavoured to seek the opinion of those using the service, their families and staff through regular surveys.

We were unable to talk with people who used the service as no-one was available to speak with on the day of our visit.

Our inspection of June 2014 and July 2014 found there were flaws in the recruitment and selection procedures which related to peoples safety being placed at risk. We found that the staff team had not received appropriate training, professional development, supervision and appraisal on a regular basis which had been in line with their training schedule which at the time of our inspection was not in existence. The purpose of this current inspection was to answer two of our five key questions; is the service safe and effective?

Is the service safe?

Our previous findings in June and July 2014 demonstrated that recruitment procedures were not safe and effective enough to ensure that people who used the service were being cared for by staff who were of good character and had the qualifications, skills and experience which are necessary for the work to be performed.

Since the last inspection the provider and the manager had implemented suitable recruitment practices to protect people they were supporting.

Is the service effective?

At the time of our previous inspection in June and July 2014 w we found that people were not benefiting from a staff team who were properly trained to deliver personal care and were not being properly supported with their personal development through regular supervision and appraisal in a consistent and timely manner which was in line with their training schedule. This is to ensure that employees are working effectively and delivering of personal care safely to meet people's needs. Therefore, we found during our previous inspection that improvements had not been made to the training of staff and support practices and procedures which would enhance staff knowledge and skill.

During our follow up inspection visit one member of staff told us of the improvements that had been made which included regular training. We saw that there was a training matrix and people were supported with specialist training which was provided by the local authority. We saw that training in medicines was planned over the remaining months of 2014. There was planned further education at the local college and we saw evidence from the college tutor welcoming the staff team onto the NVQ level 2 in Health and Social care.

Is the service caring?

People were given appropriate information and support regarding their care and treatment. People had family involvement which was regularly encouraged and this had a positive impact for people who used the service.

We saw one member of staff demonstrated respect and compassion when providing care and treatment in a person's own home. We observed the manager spoke respectfully to people in their home for example the manager would ask if we could review their care plans whilst in their home; people gave us their permission and we were able to discuss the contents.

Is the service responsive?

People's needs were assessed and personal care and support was planned and delivered in line with their individual care plan. The care plans we saw were detailed, personalised and contained sufficient information about the support people needed, such as personal hygiene, mobility and communication. We saw an example of this where people were given support with their personal care and encouraged to live independently.

Is the service safe?

People told us they felt safe and that their carer workers were 'brilliant'. We observed that people's privacy was respected by staff when providing people with personal care in their own homes. People were relaxed with the staff who assisted them with personal care. We spoke to one staff member who demonstrated an understanding of safeguarding people from the risk of abuse and neglect. We reviewed the provider's policies and procedures in relation to safeguarding.

We saw that one member of staff had been providing care without a DBS check and another staff member without a completed risk assessment as a result of their previous personal history. This demonstrated that there were poor recruitment practices which could compromise people's safety.

Is the service effective?

During a home visit as part of our inspection we observed that staff provided care according to people's individualised need. Four of the people's care plans which we saw at the nominated individual's office; contained sufficient information about the support people needed as part of their care package and this included personal care.

Is the service well-led?

People told us they could exercise choice and their wishes were respected. We saw an example of this with regards to their personal choice to care. One person told us, 'I choose when to have a bath'.

The provider had an effective system to regularly assess and monitor the quality of service that people received however people would benefit from more regular monitoring of the service standards of care. At the time of our inspection the provider did not have a registered manager in post.

At the time of our inspection the provider did not have a registered manager in post. During our visit we saw that a new manager had been in place for less than a week and told us they were in the process of applying to register with the Care Quality Commission. They continued to say that they were keen to make changes to ensure that people's needs were met and the service was operating to it statement of purpose.