Archived: Choices Nursing and Care Lancaster Limited

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Choices Nursing and Care Lancaster Limited on our website at www.cqc.org.uk

This announced focused inspection took place on 21 December 2016. We gave the registered provider notice of our visit as the service is small and we wanted to be sure someone would be there to assist us.

Choices Nursing and Care Lancaster Ltd is a small domiciliary care agency which provides personal care to adults with a disability living in Lancaster, Morecambe and surrounding districts. At the time of inspection there were twenty people receiving a service from Choices Nursing and Care Lancaster Limited. Nine staff were employed.

There was a 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.

The service was last inspected on 11 and 13 May 2016. At this comprehensive inspection we found the registered provider was not meeting all the fundamental standards. We identified a breach to Regulation 19 of the Health and Social Care Act 2014. The registered provider had failed to ensure recruitment procedures were established and operated effectively to ensure that person's employed were of good character.

Following the comprehensive inspection in May 2016, we asked the registered provider to submit an action plan to show what changes they were going to make to become compliant with the appropriate Regulation. The registered provider returned the action plan to demonstrate the improvements they intended to make. We used this focused inspection to look to check if the actions set out within the action plan had been completed.

At this focused inspection carried out in December 2016, we found the required improvements had been made.

Systems had been implemented to ensure all checks were made prior to staff being offered employment. The registered manager had introduced a checklist to give direction as to what information was required before a staff member commenced work. The registered manager audited the staff records to ensure processes were correctly followed.

From the records we viewed, we noted the registered manager had carried out suitable checks so they could be assured of the potential staff member’s suitability for working with vulnerable people.

As well as implementing new processes, we found the registered provider had carried out an audit of all staff records related to staff recruited prior to the May 2016 inspection. A full audit had been carried out, all missing information was sought and files were reorganised.

Choices Nursing and Care Lancaster Ltd is a small domiciliary care agency which provides personal care to adults with a disability living in Lancaster, Morecambe and surrounding districts. At the time of inspection there were fourteen people who used the service. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure someone would be in.

There was a 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.

People spoke positively about the quality of service provision on offer. People told us staffing levels were conducive to meet their needs. Staff always had time to carry out their duties and always stayed for the allocated time.

People who used the service and relatives told us staff were caring and always willing to go above and beyond their duties. We observed interactions and noted people were comfortable in the presence of staff.

Arrangements were in place to protect people from risk of abuse. People told us they felt safe and secure. Staff had a knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Systems were in place for recruiting staff. However checks were not consistently applied to ensure staff were correctly vetted before commencing employment. This was a breach of Regulation 19 of the Health and Social Care Act (2008) Regulated Activities 2014.

Suitable arrangements were in place for managing and administering medicines. People were encouraged to self-administer medicines where appropriate.

People’s healthcare needs were monitored and concerns regarding people’s health was fed back to relevant health professionals or the person’s relatives so action could be taken.

Person-centred care plans were in place for people who used the service. Care plans covered support needs and personal wishes. People and staff told us care plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Staff told us training was provided to enable them to carry out their tasks proficiently. The registered provider kept records of all staff training completed. The registered manager said they were working with another provider to develop and improve training for staff.

People said they were supported at appropriate times to meet their nutritional needs. We saw evidence independence and choice was promoted wherever possible. Records were kept when support had been provided with eating and drinking.

Staff said they were supported in their role. People who used the service and relatives spoke highly about the management of the service and the effectiveness of the care provided.

The registered manager had a complaints policy in place which gave clear instruction on how to manage complaints. They told us they had received no formal complaints to date. One person who used the service and two relatives told us whenever they expressed any concerns they were acted upon swiftly and treated seriously.

The registered manager told us they carried out informal audits upon quality but had not kept any records to show this has taken place. We have made a recommendation about this.

You can see what action we have asked the provider to take at the back of the main report.