Background to this inspection
Updated
5 November 2020
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 and looked at the overall quality of the service.
This was a targeted inspection to follow up on breaches identified at the previous inspection published in August 2019.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
We gave the service 48 hours’ notice of the inspection visit because the service is small, and we needed to be sure that the registered manager would be in the office to support the inspection. This also supported the provider and the inspection team to manage any potential risks associated with Covid-19.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with the registered manager during the office visit. No visitors or staff came to the office due to COVID-19 restrictions.
We reviewed a range of records which included two people’s care records, as well as five staff files in relation to supervision and observations of practice. We also reviewed a variety of records relating to the management of the service, including policies and procedures, incidents and accidents, quality audits and governance records.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and policies. We spoke by telephone with three people who used the service and their relatives, as well as four members of staff.
Updated
5 November 2020
About the service
Advantage Nursing is a domiciliary care agency. At the time of our inspection, it was providing personal care to four people living in their own houses and flats. It provides a service to older adults. Every one using Advantage Nursing was receiving a 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.
People’s experience of using this service and what we found
A lack of contemporaneous and thorough record keeping and auditing meant the registered manager had not identified the shortfalls we found on the day of our inspection. Staff had completed their mandatory training , but had not completed additional training on the needs of the person they were supporting. The registered manager had not organised staff meetings where peers could share thoughts and information. Risks to people and medicine administration were not always appropriately recorded. Care plans did not always contain information around people’s likes, dislikes, interests and background, and did not include information on how to support people with their medical conditions. At the time of our inspection, no one was receiving end of life care. However, care plans did not include people’s end of life wishes.
Staff were aware of their role in safeguarding people from abuse, and people told us that staff made them feel safe. There were a sufficient number of safely recruited staff to meet people’s needs and people told us staff stayed the full length of time of their care call. Accidents and incidents were recorded and the steps taken to resolve these recorded. Although complaints were not centrally recorded to allow patterns to be identified, they were responded to in a timely manner and people were happy with the outcomes reached.
People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice. Staff told us there was an effective communication system in place, and feedback from people confirmed that referrals to healthcare professionals were made where required.
People told us that staff were kind and caring. People were involved in decisions around their care and were included in reviews of their care. Staff encouraged people to be independent where possible and respected their dignity and privacy.
People and staff were complimentary on the management of the service and felt that they could contact the registered manager at any time. People and staff were asked for feedback on the service in various forms., There were links to local organisations where knowledge and training resources could be used. 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 (report published on 28 November 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.