Archived: Newcross Healthcare Solutions Limited (Southampton)

The registered manager had identified actions to take to improve staffing levels. The provider needed more time to demonstrate these improvements were effective and sustainable.

People’s relatives told us there had been frequent changes in the management, which had a negative impact on the quality and consistency of the service. Relatives told us that communication from the provider required improvement and that they were often unaware of who to contact to discuss their family members care. The registered manager was addressing these issues and was in the process of recruiting additional office based staff.

The registered manager was committed to their role and understood the key challenges to improve the quality of the service. They started working for the provider in 2018 and had implemented improvements in care planning, reporting of safeguarding and staff training. The changes made in these areas had been effective and sustained.

The registered manager had auditing and monitoring systems in place to assess the quality of key aspects of the service. Senior management from the provider had oversight of the service through regular reports and meetings with the registered manager.

Staff had access to training relevant to their role, including specific training to meet people’s individual needs. The provider had systems in place to support staff and assess their competence in their role. The provider had robust recruitment policies and procedures in place to help ensure only suitable candidates were employed.

People’s relatives were involved in developing and reviewing people’s care plans. Where people had complex medical conditions, input from other professionals was also incorporated into plans of care. The provider had a team of clinical staff who oversaw the writing and review of care plans and guidance. People had access to healthcare services as required.

People’s care plans included details about their routines, preferences and communication needs. There were systems in place to help ensure the service ran safely outside of office hours.

Staff understood the need to gain appropriate consent to care. 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.

People were supported appropriately with their medicines and there was guidance in place to mitigate the risks associated with people’s health and medical conditions. People’s nutritional needs and preferences were identified in their care plans and where people required specialist techniques to gain nutrition, staff had relevant guidance and training in place.

Staff were knowledgeable about the people they cared for and relatives told us that their permanent members of staff were kind, reliable and treated their family members with dignity and respect. People were given a choice about their staffing and the provider had systems to ensure only suitable staff were allocated to work with people.

There were systems to ensure people’s concerns and complaints were dealt with appropriately. The registered manager listened to feedback from people to identify where they needed to make changes. Relatives told us that historically the provider had not always acted responsively to their concerns, but told us the registered manager had made some improvements in this area.

The provider had policies to help safeguard people from avoidable abuse and harm. Where concerns were raised, the registered manager understood their responsibilities in reporting to local safeguarding teams. The provider had policies in place which detailed how staff could raise concerns, which including external organisations they could contact if required.

The provider had policies and procedures to protect people from the spread of infections.

No-one using the service was receiving end of life care at the time of inspection.

We found one breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there were not sufficient numbers of staff in place to meet people’s needs.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection was conducted between 23 and 30 June 2016 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was not a registered manager in place. The manager was due to leave the service the week after inspection and the deputy manager was in the process of applying to CQC to be registered as the 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 received highly personalised care and support that met their individual needs. Care plans provided comprehensive information to enable staff to provide effective care and staff encouraged people to remain as independent as possible.

People and their families felt safe and trusted the staff who supported them. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. Risks relating to the environment or the health and support needs of people were assessed and managed effectively. There was a business continuity plan in place to deal with foreseeable emergencies.

Medicines were given safely by staff who had been suitably trained. Staff recruitment practices were robust and helped ensure only suitable staff were employed. There were enough staff to support people. Staff were reliable, usually arrived on time and stayed for the agreed length of time.

Staff were knowledgeable and had received training to support the complex care needs of the person they supported. They felt confident and competent in the use of specialist equipment. They completed an effective induction programme and were appropriately supported in their work by supervisors, managers and a registered nurse.

People were encouraged to maintain a balanced diet based on their individual needs. Staff monitored people’s health and referred them to other healthcare professionals when needed. Staff were familiar with, and followed, legislation designed to protect people’s right.

Staff were sensitive to the fact that they were working in people’s homes and took care to be as discreet and unobtrusive as possible. People described them as “dedicated” and “kind”. Staff protected people’s privacy and involved them in decisions about their care.

The provider sought and acted on feedback from people. There was a suitable complaints policy in place and people knew how to complain. Complaints were welcomed and seen as an opportunity by senior staff to identify and make improvements.

People told us the service was well-led and said they would recommend it to others. There was a clear management structure in place and staff were required to work to a clear set of values. To help clinical staff keep up to date with best practice, two of the service’s nurses had set up an online discussion group.

There was a comprehensive quality assurance process in place which focused on continually improving the service provided. A wide range of audits was completed to assess and monitor the service, together with surveys of people and their relatives.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led

This is a summary of what we found.

Is the service safe?

People were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. People were assessed prior to receiving care and care plans developed to show how their needs would be met. Risk assessments were completed and measures to reduce risks were put in place.

We found the service had systems in place to ensure people were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults as part of their induction. There was system to supporting the staff in raising any concerns. Staff were confident in reporting any concerns and felt this would be dealt with. People told us they felt safe and staff treated them with care and respect

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us staff there was no one who was receiving care under this safeguard. Staff were aware of people's rights to make choices and supported them to be involved in their care.

Is the service effective?

The service was effective because people told us told us they were satisfied with the care and support they were receiving. People said the staff had 'perfect time keeping' and were well informed of who would be providing their care and support. We saw care plans included risk assessments were completed which were individual to people's needs.

Is the service caring?

Staff were aware of people's diverse needs and the support they needed. Our discussions with people and their relatives confirmed staff were respectful and caring. Comments from people included 'The girls really understand and are empathetic'. Another person told us 'I can't speak highly enough of them'. The records we looked at showed the staff took into account individual's wishes and these were respected, when providing care.

Is the service responsive?

People told us they been involved in their own or their relative's assessments and care planning. This meant their views and preferences were taken into account when providing care. Arrangements were in place to support people out of hours. People were confident that any concerns raised would be dealt with and responded to as needed. There was a process to support the staff in responding to people's needs.

Is the service well-led?

Staff told us they felt supported and could contact the office or out of hours service for advice. They said they could raise their concerns with the manager or senior staff, and they felt these would be dealt with appropriately. Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed including the environment and appropriate action plans were developed.