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Inspection carried out on 31 January 2019

During a routine inspection

About the service: NL Group Limited is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older and younger adults who may be living with dementia, physical disability or learning disabilities or autistic spectrum disorder. At the time of the inspection, they were providing a regulated activity of personal care and support to 27 people.

This service provides care and support to a person living in a ‘supported living’ setting, so that they can live as independently as possible in their own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

People’s experience of using this service: Staff were kind, caring and passionate about their role and people were happy with the support provided. Staff were skilled and provided person-centred care to meet people’s needs.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the ways staff promoted inclusion, choice and control and supported people to gain new skills and become more independent.

People were supported by a consistent team and new staff were introduced at a time and pace that worked for people and their families. People were protected from avoidable harm and abuse by staff who could identify and report safeguarding concerns. People’s medicines were administered as prescribed and this was closely monitored. Staff understood people’s needs and risks to their safety. Risk assessments guided staff on how to safely meet people’s needs.

Staff were respectful and built trusting relationships with people. They supported people to maintain their dignity and independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were trained in mental capacity legislation and understood their responsibilities. They gained consent before providing care and supported people to make their own decisions and choices.

Care plans contained current and personalised information that supported staff to provide person-centred care. Staff worked with professionals and responded to their advice, to ensure people’s needs were met. People were encouraged to pursue their hobbies, interests and to maintain important relationships. Staff were compassionate when providing end of life care and supported people to have pain-free, dignified deaths.

People were confident their concerns or complaints would be addressed promptly and processes in place aided this.

The registered manager used their experience to provide a high-quality, person-centred service. They had an open and honest approach and supported staff professionally and personally. The registered manager used audits to monitor the quality and safety of the service. They listened to people’s feedback and responded to issues and concerns to continually improve the service.

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

Rating at last inspection: At the last inspection the service was rated Good (published 13 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Inspection carried out on 15 June 2016

During a routine inspection

NL group is registered to provide personal care to people who live in their own homes. On the day of the inspection the agency was providing a service for 24 people, both children and adults, and employed 19 care staff. The agency office is situated in Hessle, in the East Riding of Yorkshire, close to the city of Kingston upon Hull. There is ample parking space available for staff when they visit the agency office.

The inspection took place on 15 and 24 June 2016. The inspection was announced; the provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the agency office who could assist us with the inspection.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

We saw that people's needs were assessed and care plans put in place to enable staff to provide responsive care and support. People had been involved in the planning of their care and relevant people were included in care plan reviews. However, we found that care plans sometimes lacked sufficient detail in relation to specific care tasks. We made a recommendation about this in the report.

Most people using the service and agency staff told us the service was well-led. We could see there were systems in place to monitor the quality of care and support provided, however, the system required further development so that detailed analysis could take place to promote on-going improvement.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's needs. Staff had been employed following appropriate recruitment and selection processes. We found that people's needs were assessed and risk assessments put in place to keep people using the service and staff safe from avoidable harm. We found that people’s medicines were well managed by the service.

We saw that staff completed an induction process and they had received a wide range of training, which covered topics including safeguarding, moving and handling and infection control. Staff told us they felt well supported; they received supervision, appraisals and were in regular contact with the registered manager.

People were supported to make decisions and choices. Some people received support from staff with shopping, cooking and domestic tasks. They were involved in choosing what items they wanted staff to buy or what they wanted making and were satisfied with the meals prepared. Staff received training on the Mental Capacity Act 2005 and had knowledge sufficient for their role. People were supported to access healthcare support where necessary.

People told us staff were caring and that they had developed positive relationships with people who supported them and they were treated with respect by the agency's staff. People were generally happy with the service they received and told us that the staff usually arrived on time. They told us that they received support from the same member of staff or group of staff and they developed a good rapport with carers. People were supported to access their local community and go for days out.

People knew how to complain and were supported to feedback any concerns. There were appropriate complaints procedures in place should people need to raise any issues. We saw that these were investigated and the outcome recorded in the electronic care planner.

Inspection carried out on 25 February 2015

During a routine inspection

This inspection took place on 25 February 2015 and was announced. We gave the registered provider notice of the inspection to make sure that the registered manager was available on the day of the inspection. However, the registered manager was not present on the day but other managers were available to assist with the inspection. We previously visited the service on 28 January 2014 and found that the service met the areas that we assessed.

The service is registered to provide personal care to people who live in their own home. On the day of the inspection the agency were providing a service for 33 people, both children and adults, who lived in their own home and employed 30 care staff, 135 nurses and 2 personal assistants. The agency office is situated in Hessle, in the East Riding of Yorkshire, close to the city of Kingston upon Hull. There is ample parking space available for staff when they visit the agency office.

The registered provider is required to have a registered manager and there was a registered manager in post who was registered with the Commission. 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 training matrix recorded that all staff had received training on safeguarding vulnerable adults and children from abuse. Care workers displayed an understanding of the action they needed to take if they became aware of a safeguarding incident.

There was a complaints procedure in place and people told us that they would not hesitate to contact the agency office if they had a concern. We were told that care coordinators and managers at the agency office did not always respond appropriately when concerns were raised with them. However, this was not explored further with the registered provider.

Staff were recruited following robust recruitment practices and there were sufficient staff to meet the needs of people who received a service.

Risk assessments had been completed that recorded individual risks to people and risks associated with a person’s home, and how these should be managed. However, some care workers told us that some people who received a service from the agency had not received the support of two people to assist them when this was recorded in their care plan as a need. We have made a recommendation about this in the report.

Staff received induction training and on-going training although the training matrix did not clearly record whether staff had completed training on the Mental Capacity Act 2005 (MCA).

People were happy with the assistance they received with the preparation of meals.

People told us that staff cared about them and supported them to be as independent as possible. Most people told us that staff respected their privacy and dignity.

People’s needs were assessed and recorded so that their individual needs were known by staff. Care plans were regularly reviewed to make sure that staff had an up to date record of a person’s needs.

We did not see sufficient evidence that systems were audited to ensure that the service was operating in accordance with the agency’s policies and procedures.

One person told us that a care worker had made a medication error and that they had identified missing medication. They said that agency staff had been informed but no action had been taken.

This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 28 January 2014

During a routine inspection

We spoke with the registered manager and a registered person on the day of the inspection. Following the inspection we spoke with five people who used the service and three care workers on the telephone.

People who used the service told us that they were satisfied with the support they received from agency staff. They told us that staff were reliable; they usually arrived on time and always stayed for the right length of time. People also told us that they received support from a regular group of staff. Care plans were reviewed on a regular basis to ensure that staff had up to date records to follow.

Some people received help with the administration of medication. Staff had received appropriate training to enable them to carry out this task safely.

Staff had been recruited following robust recruitment and selection procedures. New employees completed induction training to ensure that they had the skills needed to carry out their role. There were sufficient numbers of staff employed to meet the needs of the people who used the service.

There were robust quality monitoring systems in place that measured the overall quality and safety of the service provided. The systems also gave people who used the service and staff the opportunity to express their views about the service. This included a satisfactory complaints procedure.

Inspection carried out on 25 June 2012

During a routine inspection

As part of our inspection we asked people who used the agency about their experiences of the service provided by N L Group. We visited one person in their own home and spoke with a further four people on the telephone.

People who met with us and spoke with us were very satisfied with the service being provided to them. Individual comments made to us included

“Overall the agency is good, and the initial teething problems with different staff all the time have all calmed down now.”

“The agency tries hard to provide me with the same care staff each day and they arrive on time. They also let me know if there are going to be any changes.”

“The staff are very good and never let me down. I have a care plan and they talk to me about my care. I am very satisfied with the agency”.

“Nothing is too much bother for the staff. They follow my care plan and respect my wishes and choices. The staff listen to my needs around pain relief and hygiene care.”

“I have a variety of equipment to help me maintain some independence; the staff are confident and competent when using this. The staff help me to stand and walk around and I feel the staff are well trained and know what they are doing. “

People told us that the agency carried out reviews of their care on a regular basis. People were also aware of the complaints procedure and knew how to use this if needed. People said they had completed satisfaction questionnaires and were part of the care planning process.