Archived: Nurse Plus and Carer Plus (UK) Limited - Suite 18 Ingles Manor

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

Nurse Plus and Carer Plus provides a service to adults, older adults, people living with dementia or mental health needs, physically disabled people and people with a learning disability or autistic spectrum disorder. There were 105 people receiving a service at the time of our inspection.

The registered manager had left the service in April 2018 and a new manager was leading the service. A registered manager is a person who has registered with the CQC 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.

At the last inspection on 17 July 2017, we asked the provider to take action to make improvements to the way they managed people’s medicines, mitigated risks to people and checked to make sure the service was provided to the standards they required. At this inspection we found that all the shortfalls had been addressed and the service that people received had improved.

People’s medicines were well managed. Guidance was available to staff and people received their medicines. Assessments of people’s needs had been completed and any risks had been identified with people and their relatives. Guidance was now available to staff about how mitigate risks to people and keep them safe. People received care tailored to them, in the way they preferred.

Changes in people’s health were identified and staff supported people to contact their doctor. People were supported to eat and drink enough. Staff followed safe practices to prevent infections.

Everyone we spoke with told us the staff were kind, caring and friendly, and treated them with dignity and respect at all times. They told us staff knew them well and provided their care in the way they wanted. People were given privacy. Everyone was supported to be as independent as they wanted to be. Staff supported people to take part in leisure activities they liked.

Staff were kind, caring and compassionate. People received care in the way they preferred at the end of their life. One person’s relative told us, “My loved one wants to stay at home for as long as possible and without the carers it would not be possible, it’s unthinkable really what we would do without them”.

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 practice. Everyone was able to make decisions for themselves and staff supported them to do this.

Staff knew the signs of abuse and were confident to raise any concerns they had with the manager or provider. People were not discriminated against. A process was in place to investigate and respond to complaints and small day to day issues had been resolved immediately to people’s satisfaction.

There were enough staff available to give people the support they needed, when they needed it. Staff arrived at the agreed time and stayed for the required length of time. People told us they knew if staff would be late and who would provide their care. Staff rotas were planned in advance and any gaps were covered.

Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported to meet people’s needs and had completed the training they needed to fulfil their role. Checks were completed to make sure training had been effective and staff were competent. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The provider and manager had oversight of the service and checked the service people received met the standards they required. People, their relatives and staff were asked for their feedback and this was used to improve the service. Accidents and incidents had been analysed and action had been taken to stop them happening again. The manager worked with the local authority to improve the service.

Staff felt supported by the manager, they were motivated about their roles. They shared the provider’s visions of a good quality service. An experienced member of staff was always available to provide the support and guidance staff needed, including outside of office hours. Records in respect of each person were accurate and complete and stored securely.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in their public office and on their website.

Since the previous inspection a new manager had been appointed and they were in the process of applying to the Care Quality Commission to become registered. 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.

After the previous inspection in June 2016, a warning notice for person centred care and two requirement notices were served. The provider sent the Care Quality Commission an action plan to address the shortfalls, with a timescale to become compliant with the regulations. The warning notice served for person centred planning was complied with. However, there remained two continued breaches of the regulations which had not been met at this inspection. The management team took action to address these issues at the time of the inspection.

People's medicines were not always managed safely. Some of the shortfalls identified at the previous inspection still remained. Records did not confirm that people were receiving their prescribed medicines safely.

Although people told us they felt safe using the service, not all risks had been managed safely. The guidance in the risk assessments had improved but further detail was required to ensure that staff moved people safely and staff would know how to support a person if they were to choke or have a seizure.

There were some mixed views about the communication with the office. Some people felt further improvements could be made.

The audits in place, including spot checks on the staff ensured that the quality of service was checked to assess the care being provided. However, the shortfalls found at this inspection had not been identified.

Staff had been trained how to keep people safe from harm. People told us they trusted the staff and they made them feel safer as they knew they were calling. Safeguarding policies and procedures were in place should the manager need to raise an alert.

There was sufficient staff on duty to make sure people received consistent care. Staff had permanent rotas which were geographically placed, to reduce the travel time and help people receive their call at the requested time. People told us the staff usually arrived on time and stayed the duration of the call. Staff received appropriate training to be able to perform their role and have the skills and competencies to meet people’s needs.

Staff were recruited safely with the necessary checks being carried out to make sure they were suitable to work at the service. All new staff received an induction and shadowed senior staff before they started to work on their own. Staff received support through one to one supervision meetings, staff meetings and spot checks.

People told us that the staff asked for their consent before providing their care. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. People were supported to make decisions and when required best interest meetings involving the person, relatives and health care professionals were held.

People told us the staff supported them with their health care needs. Records showed that when required, staff contacted the relevant health care professional such as doctors and community nurses.

People’s dietary needs were assessed and staff supported people with their meals and left drinks and snacks for people to eat later when they needed them.

People told us the staff were kind, caring and respected their privacy and dignity. Staff described how they supported people to remain as independent as they could and people told us that they were encouraged to do as much as they could for themselves. People told us that staff knew them well and were able to chat to about their lives and family.

People and relatives told us they were involved in their care plans when they started the service and personalised care plans were now in place. The plans were regularly reviewed and updated.

People knew how to complain but did not have any issues. They had the opportunity to feed back about the service, through, surveys and spot checks. Any negative feedback was used to drive improvements to the service.

People, relatives and staff told us that the service had improved since the new manager was appointed. Some staff felt communication could be improved by telling people when they were running late or the timing of the calls had changed.

Staff understood the visions and values of the service and how people should be treated as equals with dignity and respect.

We found two continued breaches 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 end of this report.

Nurse Plus and Carer Plus (UK) Limited provide care and support to people in their own homes. The service is provided to mainly older people and some younger adults. At the time of the inspection there were approximately 229 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Folkestone, Hythe and surrounding areas. The service can also provide 24 hour support to people.

The service is run by 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.

People told us they received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Risks associated with people’s care had been identified, but some risks lacked guidance about how to keep the person safe. Guidance in relation to moving a person had been improved, but further work was required, to ensure people were moved safely.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. However care plans still required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

The provider had undertaken some work to address the shortfalls identified at the previous inspection and audits had identified the shortfalls found during this inspection. However action had not ensured full compliance.

People had their needs met by sufficient numbers of staff. People did not always receive a service from a team of regular staff. Staffing numbers were kept under constant review. New staff underwent an induction programme, which included relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role, although further training in diabetes would enhance staffs knowledge skills. Some staff had gained qualifications in health and social care.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. Some people were subject to an order of the Court of Protection and some people chose to be supported by family members when making decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health. People told us staff were observant in spotting any concerns with their health. The service worked jointly with health care professionals, such as occupational therapists.

People felt staff were caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.

People told us that the communication with the office had not always been good and some felt there was still room for further improvement. People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided. Any negative feedback was used to drive improvements to the service. People felt there had been many changes at the office, which had impacted on the service delivery.

The provider had a set of values. This included providing and maintaining a high quality of care and support to each person based on person centred care and individual needs. Staff were aware of these and felt they were followed through into their practice.

We found a number of breaches 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 end of this report.

People felt they were able to make their own decisions and choices regarding their day to day care and support. People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started.

Most people said they were generally satisfied with the care and support they received. One person said, “I think Nurse Plus is excellent I would recommend them to anyone”. Another person said, “They do their best”. People knew about their support plans or said they had discussed their care and support with staff. Two people had some issues with the service provided and we agreed in one case, with the person’s permission, to bring this to the attention of the manager.

People felt they received safe and coordinated care and support where more than one provider was involved.

Most people were generally complimentary about the staff and felt the service recruited the right calibre of staff to meet their needs. One person said, “We worked together and have got our own routine now”. Another person said, “One the whole they are OK, 95 per cent are good”.

Most people said they had been asked for their views and feedback on the service provided. Most people told us they felt confident that any concerns would be addressed. There were systems in place to monitor the quality of the service.

People told us that their care and support was personalised to their needs. People said their preferred names were always used.

People were aware of their care needs assessment and care plan. They confirmed that they, or sometimes their family, had been involved in discussions about their care and support. One person said: “I am often asked if my care is right for me, if anything needs changing or could be improved”.

People felt that the service had recruited the right calibre of staff and that staff had the right skills and experience to meet their needs.

People told us that they felt safe when staff visited their homes. One person told us “I have never had any concerns about any of the staff who have come to my home”. People confirmed they had been asked to give feedback on the service provided. One person said “I am delighted, the quality of care cannot be faulted”.