Archived: Choices Nursing and Care Lancaster Limited

Updated 13 September 2018

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 is 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 comprehensive inspection took place on 26 July 2018. We gave the service 24 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure they would be in.

Choices Nursing and Care Lancaster Limited is a domiciliary care agency which provides personal care to adults with a disability living in Lancaster, Morecambe and surrounding districts. At the time of inspection fourteen people were receiving a regulated activity from the registered provider. Nine staff were employed to provide direct care to people who used the service.

Before our inspection visit took place we reviewed information held about the service. This included notifications submitted by the registered provider related to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people. We used this information provided to inform our inspection plan.

The inspection team consisted of one adult social care inspector.

Throughout the inspection visits we gathered information from a number of sources. We visited three people who used the service, (with their consent) to seek their views on how the service was managed.

We also spoke with the manager, an office manager, and two members of staff responsible for providing care and support.

To gather information, we looked at a variety of records. This included care plan files related to three people who used the service. We also looked at other information related to the management of the service. This included training records, team meeting minutes, policies and procedures, accidents and incidents records and maintenance schedules. We also viewed recruitment files and Disclosure and Barring Service (DBS) certificates related to three staff members employed to work at the service.

Prior to the inspection process finishing, we received information of concern in relation to the financial status of Choices Nursing and Care Lancaster Limited. We shared this information with the Local Authority so they could respond appropriately.

Updated 13 September 2018

This announced inspection took place on 26 July 2018.

We last carried out a comprehensive inspection at Choices Nursing and Care Lancaster Limited in May 2016. The service was rated good but we identified some concerns in relation to safe recruitment processes. We asked the provider to complete an action plan to show what they would do and by when to improve the key question, ‘Safe’ to at least good.

We carried out a focussed inspection in December 2016 to check that improvements to meet legal requirements planned by the provider after our May 2016 inspection had been made. This is because the service was not meeting some legal requirements. At the December 2016 visit, we found the registered provider had made the improvements required.

Choices Nursing and Care Lancaster Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Not everyone using Choices Nursing and Care Lancaster Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of this inspection visit carried out in July 2018 there was no registered manager in place. 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. We were aware a manager was working at the service and had started the process to register with the Care Quality Commission.

At this inspection visit carried out in July 2018, we found the registered provider had not met the fundamental standards. We identified further concern in relation to safe recruitment practices and ways in which the organisation was managed and governed.

We found processes for ensuring staff were safely recruited were inconsistent. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Fit and proper persons employed).

Paperwork related to the safe running of the organisation was not always accessible. Information created electronically was not always securely maintained. Additionally, we were presented with documents which had been created by staff in response to a request for evidence.. Whilst the manager carried out audits of the service, we found these to be ineffective as they had failed to identify concerns we noted during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good governance).

Statutory notifications had not been provided in a timely manner. Prior to the inspection process concluding we were made aware the registered provider had become insolvent. The registered provider had not informed the Care Quality Commission of this in a timely manner. This was a breach of Regulation 15 Care Quality Commission Registration Regulations 2009.

Systems were in place for the safe management of medicines. We saw, however, good practice guidance was not always followed. We have made a recommendation about this.

We found risk was addressed and managed appropriately to promote peoples safety. However, we noted when some risks had been identified, measures were not consistently documented so risk could be mitigated. We have made a recommendation about this.

Systems were in place to safeguard people from abuse. Staff were able to identify types of abuse and how to report any concerns. People told us they felt safe when being supported by Choices Nursing and Care Lancaster Limited. They described staff as reliable and said they were appropriately trained. People who used the service told us they were happy with the care and support provided. Staff were described as kind and caring.

We observed staff carrying out tasks whilst visiting people within their own homes. People were treated with dignity and respect. Staff wore personal protective equipment to reduce any risk of cross infection.

Care records were person centred and focussed upon the person’s needs and wishes. Consent to care and treatment was routinely sought. Additionally, we saw people were consulted with to ensure they were happy with the service provided.

Staff received ongoing training and support to enable them to carry out their roles safely. Staff told us they were happy with arrangements for training.

We saw evidence of multi-agency working to promote effective care. People told us they were supported to have their nutritional needs were met when appropriate.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered provider liaised with health professionals when people required end of life care in their own homes to ensure people received care in line with good practice.

Staff described the service as a good place to work. Additionally, they praised the skills and commitment of the new manager. People who used the service considered the service to be well-led.

We looked at how complaints were managed and addressed by the registered provider. At the time of the inspection visit all people we spoke with were happy with the care provided and had no complaints.

This is the first time the service has been rated as requires improvement.

You can see what action we told the provider to take at the back of the full version of the report.