Background to this inspection
Updated
1 June 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by one inspector and two Experts 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. A branch manager was employed and in the process of applying to be registered with CQC.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 27 April 2022 and ended on 13 May 2022. We visited the location’s office on 27 April 2022.
What we did before the inspection
We reviewed information we had received about the service since it registered with CQC. This included statutory notifications and other information received. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 10 people and 15 relatives about their experiences of care received. We spoke with the manager, the training manager and nine members of staff. We reviewed a range of records and documents which included 20 people’s care plans and risk assessments, multiple medication records, training information, staff recruitment files for five members of staff, quality monitoring records, health and safety records and policies and procedures.
Updated
1 June 2022
About the service
Nobilis Care Buckinghamshire is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection there were 88 people using the service. 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 had their medicines as prescribed, but improvement was needed for how the service recorded medicines. We observed the required information regarding people’s medicines was not routinely recorded on their medicine’s administration records. We also saw people’s medicines records were conflicting and not up to date. Quality monitoring of medicines records was not effective in identifying and driving improvement needed.
Risks to people’s safety did not always have management plans in place. This meant staff did not have the current safe ways of working with people recorded. Some information recorded in people’s plans was conflicting which placed people at risk of harm. The provider was moving people’s records onto their electronic systems which was taking time to complete. At the time of our inspection this process had not been completed in full which was affecting governance systems.
Whilst incidents and accidents were recorded it was not clear what management action had been taken in response to incidents. We observed some incident forms had no management response recorded to demonstrate appropriate action had been taken.
People and relatives told us the service was safe. There were enough staff available to make sure people had the care they needed. People usually had care from the same group of staff which meant there was a continuity of care provided. This helped to mitigate risks of shortfalls in record keeping. Staff had been recruited safely and trained in a wide range of areas. Staff felt supported by the manager and the office team.
Staff told us they knew about safeguarding and how to report concerns. Staff were confident the management of the service would take action to keep people safe. People had their own care plan which gave staff details on people’s likes and dislikes. Care plans included information on people’s life history which helped staff to understand their needs.
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. Where needed referrals to healthcare professionals had been made and staff worked with professionals to meet people’s health needs.
People told us staff were kind and caring and they respected people’s choices. People were involved in their care and supported to maintain their independence. Where needed staff supported people with their nutrition and hydration. This could be simple meal preparation or support to eat their meal.
Staff had stocks of personal protective equipment and had been given guidance on working safely the COVID-19 pandemic. Staff were testing for COVID-19 following the government guidance. Systems were in place to make sure good infection prevention and control practice was followed consistently.
There was a manager employed and they had started the process to be registered with CQC. Staff were appreciative of the managers approach and told us they would not hesitate to raise any concern. Systems were in place to manage complaints and the manager kept a record of all communication about complaints with outcomes. Senior staff carried out unannounced ‘spot checks’ to make sure staff were following policies and check people were happy with their care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 12 April 2021 and this is the first inspection. The last rating for the service under the previous provider was inadequate, published on 4 February 2021.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 a breach of regulation in relation to record keeping and assessing and monitoring quality and safety 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.