Archived: ANA Nursing

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

There were 25 people using the service at the time of the inspection, and approximately 60 care workers and three nurses employed. We spoke with or visited twelve people using the service and/or their relatives, and eight staff members.

Is the service safe?

People told us that they felt the service provided to them met their needs safely. Risk assessments were undertaken for people using the service, however these were not available for risks relating to pressure care, hydration and medication management.

We found that the agency's recruitment systems did not ensure that all necessary information was available about new staff to ensure that they were competent and of good character, which placed people using the service at risk. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe recruitment practices.

Is the service effective?

People told us that staff were competent at meeting their individual needs effectively. One person noted 'What I like is it's the same people each time.' Most people told us that their care workers were on time and let them know if there were any changes. People's needs were assessed and care was planned and delivered in line with their individual care plans. People told us that they were involved in decisions about their care and the majority of people were very satisfied with the agency.

Staff said that they received appropriate support and training to enable them to deliver care to people to an appropriate standard, however we noted that new staff did not always receive supervision during their first three months of work. Management were aware that further training was needed for staff in identified areas to ensure that they could meet each person's needs safely and effectively.

Is the service caring?

People spoke highly of the care workers supporting them. They said 'They are very good,' 'They fit around my needs and are very flexible,' 'Everything's perfect,' and 'My carer is excellent.' One person told us 'I want to do as much for myself as I can for as long as I can, X is good at supporting my independence.'

However one person told us that care workers did not always interact with their relative when providing care.

Is the service responsive?

People told us that their preferences were taken into account by staff, and that care workers were flexible in meeting their needs. They told us 'The assessment was very good,' 'They are good at keeping us updated about any changes,' and 'I'm very satisfied.' Care plans and risk assessments we viewed were up to date although there were some gaps in risk assessments and care records maintained to ensure that people were protected against the risks of pressure sores, and dehydration.

Is the service well-led?

The majority of people were happy with the running of the agency. They said 'They are better than the previous agency we used,' 'What they do they do well,' 'I'm satisfied,' 'They are very good,' and 'Everything's perfect, I have no grumbles.'

Where people had expressed concerns about the service provided, most said that they had been dealt with promptly. Some systems were in place to monitor the quality of care provided by the service. However the agency was not recording contact with people using the service, particularly where concerns had been raised.

At this inspection, we returned to identify what progress had been made. The provider had attempted to ensure staff were supported, and many staff had received a spot check, supervision or appraisal since the last inspection. Despite this, supervisions were still not being delivered in line with the agency's supervision policy. During and since the inspection, the registered manager reviewed their supervision policy, booked forthcoming supervision training, carried out spot checks and arranged appraisal dates for all employed staff. The manager had also worked with an external agency to provider training to supervisors to ensure that staff received regular supervision.

Overall, we found that the provider had taken steps to ensure staff were appropriately supported.

The provider had improved its systems to assess people's needs and any risks to their safety and welfare. Records relating to staff and people using the service had improved. Recruitment checks were mostly in place. However, appropriate checks of gaps in people's employment history prior to recruitment had been highlighted at our last inspection, on 28 February 2013, as an issue of non compliance. We found during this inspection that this remained a concern and was not checked, even though it was part of a new audit checklist by the provider. However, people's comments indicated that carers were suitable for the role. One person told us how their carer went the extra mile, sometimes visiting them on their way home from other appointments to check they were alright.

Whilst the performance of staff was checked through observation visits to people's homes, some staff had not received such a visit. The provider agreed with our findings that they were not following their supervision policy. A lack of adequate supervision had been highlighted at our last inspection, on 28 February 2013.

Systems were in place to identify, assess and manage risks to people using the service. The provider issued an annual survey to people, visited them if issues arose and had a system to log accidents and complaints, although none had occurred.

Care and treatment was not planned and delivered in a way that ensured people's safety and welfare. Most care plans were produced by the local continuing care team, not the agency. Risk assessments were not routinely made of people's conditions, only of their home environment. Vetting procedures undertaken on recruitment were not always carried out consistently

Staff did not receive any formal supervision, which was against the agency's supervision policy. Written records were limited, including of appraisals undertaken. This meant the manager could not adequately identify individual staff training needs. Training was however undertaken by staff and people told us 'it all seems to work OK.'

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