Archived: Advantage Nursing Agency Limited

Advantage Nursing Agency Limited is a domiciliary care agency. At the time of our inspection, it was providing personal care to three people living in their own houses and flats. It provides a service to older adults. Everyone using the service received support with personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Since our last inspection we found improvements had been made to the service, which meant people received safe care. Risks to people had been reviewed; care plans were updated to reflect people's personalised health needs and detailed guidance was made available to staff with key information about the person's needs.

Other improvements included those of the management oversight of the service, due the introduction of a consistent auditing and quality assurance programme, as well as monitoring of staff training needs.

People told us they felt safe with staff and that staff knew them well.

Feedback from people was sought on how the agency could improve, and people told us they thought the agency was well managed and they felt comfortable raising concerns. Staff told us they felt valued and supported by the provider. The registered manager recognised the shortfalls identified at our last inspection and had worked to improve the service they provided and meet the requirements of their registration. They continued to look at ways to improve to enable them to provide the most appropriate care to people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 August 2019) and there was a breach of Regulation 17 due to a lack of management oversight and poor record keeping. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found sufficient improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

Breaches of legal requirements were found when we carried out an announced comprehensive inspection of this service on 07 June 2019. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this targeted inspection to check the provider had followed their action plan and to confirm they now met legal requirements in relation to safe care and treatment, staffing, and management of the service. This report covers our findings in relation to the key questions of safe and well-led which contain those requirements.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We undertook this targeted inspection to follow up on breaches and one recommendation identified at the previous inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Advantage Nursing Agency LTD on our website at www.cqc.org.uk

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.

Advantage Nursing Agency Limited provides personal and nursing care to people who live in their own homes. The service employs both registered nurses and care workers to provide support to people. At the time of our inspection the provider confirmed they were providing personal and nursing care to 3 people.

There was a registered manager in post. 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse. Staff told us they were confident that if they reported abuse, the correct actions would be taken by the service.

People had detailed risk assessments in place to enable staff to support them with all their healthcare needs, and be able to remain as independent as possible. Staff understood positive risk taking and promoted this with people..

Staffing levels were adequate to meet people's current needs. We saw that enough staff were being employed to cover people’s needs appropriately.

The staff recruitment procedures were robust and ensured that appropriate pre-employment checks were carried out. This meant that staff suitable to the role worked at the service.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were confident that the training they received enabled them to work safely with people.

People told us that their medicines were administered safely and on time. Staff were all trained in medication administration.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. Staff were happy that they were being regularly supervised and supported.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

Where possible, people were able to choose the food and drink they wanted and staff supported people with this. People were supported to access health appointments when necessary and receive input from a variety of health professionals as required.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff understood people’s likes, dislikes and preferences.

People were involved in their own care planning and were able to contribute to the way in which they were supported. When people could not be involved in their own care planning, family members were involved on their behalf.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed. The service regularly sought feedback from staff and the people using the service.

We telephoned one person using the service and one relative of a person using the service. One person told us the staff 'were all very good'. Another person told us that "staff always checked with them regarding their care.'

We looked the risk assessments and care plans of three people using the service. We found that risk assessments and care plans were detailed and developed with the person and/or their relatives indicating their preferences and consent for how care was provided.

People were protected from abuse or the risk of abuse. We noted the provider liaised with other professionals and complied with the local authority safeguarding policies and procedures.

We found the provider had systems in place to quality assure its services and was able to identify and manage risks related to the health, safety and welfare of people using the service.

We looked at seven staff files and spoke with four staff. We found the provider had effective recruitment and selection procedures in place and evidenced staff were skilled and experienced to provide the care required.

We telephoned a person who used the service and a relative of a person receiving services. The people we spoke to said they were happy with their regular health care assistants and gave us positive feedback about them. They told us their regular care worker knew their needs well and how they liked things to be done. A person who used the service said about the care they received, "They are quite good and meet my requirements."

The people we spoke to said that they had never had any concerns about the treatment they received from care workers. A person who used the service told us, "They are very approachable."

We found that the agency considered people's individual needs and circumstances when providing care. The staff at the agency reported that they were well supported by the management team. We also found that the agency had policies and procedures in place that quality assured the services they provided to people.