Archived: NurseplusUK - Suite 1 Wellington Square

People’s experience of using this service:

People received support that was person-centred and met their individual needs, choices and preferences. People received support at times of their choice and systems were in place to make sure calls were not missed. Complaints had been recorded, investigated and responded to appropriately.

Staff understood people’s care and support needs. They understood people’s needs and choices and what was important to each person. People were treated with kindness, respect and understanding. They were enabled to make their own decisions and choices about what they did each day.

Staff understood the risks associated with the people they supported. Risk assessments provided further information and guidance for staff. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

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

People's health needs were met, they were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the registered manager and their colleagues.

There was a clear staffing structure and staff were aware of their roles and responsibilities. The provider had a number of quality assurance systems in place and there was a focus on further improvement and development.

Rating at last inspection:

Requires improvement. (Report published 28 June 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found the service to be good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Nurse Plus and Carer Plus (UK) Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to adults, but predominantly to older adults, including people who may have a physical disability, a learning disability, sensory loss, mental health problems or people living with dementia living in Bexhill-on-Sea, Hastings, Battle and the surrounding area. At the time of our inspection around 54 people were receiving a service, of which 44 were receiving the regulated activity of personal care.

The service did not have a registered manager. 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. There was a new manager who was present during the inspection. An application was in process for the new manager to become the registered manager for the service.

Staff told us there had been a lot of changes during the last six months. There was a new manager and office staff, and a number of care staff had also left the service. This had affected the consistency of care staff providing care calls and some systems, for example the sending out of rotas, had not been maintained. Senior staff told us of their own quality assurance audits. Through these they had identified areas of improvement and told us of the action plans which already in place to address this and of the work already completed to ensure the quality of the service delivered. Feedback from all the staff showed they were confident of the new management, they felt listened to and areas for improvement had been or were already being addressed. The service was moving forward after a difficult period. People spoke well of the care provided by their regular care staff. They told us their main concern was the lack of rotas and knowledge of who was due to provide their care and when care staff were due to complete their care call. Not everybody was sure of who to contact with any concerns. Senior staff from within the organisation were present during the inspection. They acknowledged there had been a period when staff changes had resulted in a lack of continuity of service provided. They told us they had reviewed the care provided and they had supported the manager and all been following an action plan to address issues raised.

Systems had been maintained to keep people safe. People told us they felt safe with the care provided. One person told us, “Yes I do very much so and we get on well together.” A relative told us,” Yes when regular carer visits, she has developed a good relationship.” They felt they could raise any concerns they had. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had continued to receive supervision, and be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People told us their regular care staff had the knowledge and skills to provide their care and support.

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. People told us they felt listened to, supported to be independent and they were involved in decisions about their care. They spoke of their care plans having been reviewed and of their preferences having been considered within this process. One relative told us, “We had a review one week ago, and husband’s likes, dislikes and decisions of care needs were discussed.” Another relative told us, “We have had different reviews over the past four years that viewed likes, dislikes and decisions of husbands care needs.” Staff had a good understanding of consent. One member of staff told us it was about,” Making sure they have understood what you are going to do for them.” Another member of staff told us, “It’s making sure they don’t ask too many questions and give people time to answer and don’t take their choice away.”

People were happy with the care provided and care staff had ensured all the agreed tasks were covered during their visits. Comments from people included, “Yes my carer does everything they are supposed to do and they also take me for a walk and give me a cup of tea when we get back,” and “Yes if they have done everything they sit and chat.”

People continued to be supported by kind and caring staff who treated them with respect and dignity. One person told us, “Yes my carer is lovely.” They were spoken with and supported in a sensitive, respectful and professional manner. People’s privacy and dignity had been respected. One person told us the,” Carer always knocks the bathroom door before coming in.” A relative told us, “Yes when doing personal care for husband, carers cover him with a towel for privacy and dignity.” Another relative told us, “Yes carers do always close curtains in the bedroom or close bathroom door when assisting husband with personal care.”

Staff told us the service was well led. They had had their views sought through supervision, team meetings and questionnaires as to how the service could be improved. They spoke well of the new senior staff team and of changes which had already been introduced. For example, an employee of the month award had been introduced. This was where staff who had worked above and beyond during the month were nominated for the award. One member of staff told us, “If I have something to say I know they will take it on board and be dealt with.” Senior staff carried out a range of internal audits, and records confirmed this. People and their relatives were regularly consulted about the care provided through either reviews, telephone contact and by using quality assurance questionnaires.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

We examined four people's care plans and spoke with six people who used the service and found that people's needs were assessed and regularly reviewed to deliver the support they required. One person said, "The staff all know my requirements."

We spoke with staff and examined records and found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We examined four staff files and spoke with staff to ensure that appropriate checks had been undertaken before staff began work.

We were shown the Provider's complaints policy and saw there was an effective complaints system in place.

We looked at care plans and saw that people's needs were assessed and they received care and treatment that reflected the assessed need. One person told us, 'they get on with what they are doing.' Another person told us, 'I enjoy their care.'

We looked at the training plan and saw that staff received training that was designed to help them meet the needs of the people they cared for. One member of staff told us, 'I have never felt let down by the training.' We saw that staff received training in safeguarding vulnerable adults and this was updated every year.

There was a system in place to assess and monitor the quality of service that people received. We saw that people were sent questionnaires to ask them about the service they received. People we spoke with told us that they did not have any complaints but if they did they knew how to raise them.