Archived: Essential Nursing and Care

The service had 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.

When we last inspected the service in March 2014 we had concerns about the assessment and quality of service provision and respecting and involving people who use services. We asked the provider to take action about these concerns. At this inspection we found that improvements had been made in both areas.

People and their relatives told us they felt safe with the staff who provided their care and support. Staff were aware of their responsibilities in protecting people from harm and knew how to report any concerns about people's safety or wellbeing. People had individual risk assessments giving staff the guidance and information they needed to support people safely.

People were supported by staff who were familiar to them and we saw that staff had enough time with people to meet their assessed needs

Medicines were administered safely and gaps in recording were highlighted and managed by regular audits. Staff undertook medicines competency and refresher training.

People received care and support from staff who had the skills and training to meet their needs. Staff spoke highly about the training offered and as well as mandatory subjects, undertook training in specific topics including Parkinsons, Diabetes and Respiratory Awareness.

Staff sought consent from people before providing support and they were aware of the principles of the Mental Capacity Act and had received training in this area.

People were supported to have enough to eat and drink by staff who understood what support they required. We observed staff offering people choices about what they wanted and preparing food and drinks in the way people preferred.

People were supported to access healthcare services when required and staff communicated any requests for referrals to the office.

People told us that staff knew what their preferences were and how they liked to be supported. Staff were kind and caring and we observed that they had a relaxed and comfortable rapport with people we visited.

People had input into their care plans and these contained details about people’s likes and dislikes. Staff offered people choices about how their received their support and knew what was important to them.

We observed staff treating people with dignity and respect and encouraging people to be independent with the support they received.

People were not always told about changes to their care and did not consistently receive a rota telling them who would be visiting. The service had already identified this gap from feedback they had received and had put measures in place to improve this.

People and relatives were involved in regular reviews about their support and encouraged to feedback through surveys and telephone calls. Feedback was also sought from staff using regular surveys and information was used to develop and improve practice.

People, relatives and staff felt that the management of the service was good and told us that they were able to contact someone in the office when they needed to; support was also available out of hours. People were aware of who to contact if they were unhappy about any aspect of their care and support and there was a system in place to manage complaints.

Communication between staff and management was positive. Staff were encouraged to raise issues and discuss queries and felt valued in their role. There were regular staff meetings where practice and ideas were discussed and staff also received regular newsletters keeping them up to date with changes and recognising achievements.

Quality assurance systems at the service were regular and information received was used to identify trends or areas for development.

Assessments were carried out and these were sufficiently detailed to ensure people's welfare. The agency worked with other professionals to assess, review and manage risks to people. Changes in people's care needs were noted and acted upon by the care staff.

People were safeguarded as the agency had ensured staff were trained and understood how to spot signs of abuse. Staff knew who to contact if they had concerns. People had been given information about the service told us they knew who to contact if they had any concerns.

Staff told us they felt supported by training and supervision, which helped them to provide a competent service. Although the agency had methods to capture the views of people's experience of the service, these were not always effective. Whilst some people told us the overall quality of the service was good, seven out of 13 people told us they were not satisfied and thought improvements were needed.

Everyone we spoke with said they knew who they could speak to if they did not feel safe or had a complaint. All the people we spoke with said that staff were professional and helpful.

The provider has systems in place to keep people safe and to monitor the quality of the service they provide. There were plans in place to further improve this system.

The staff we spoke with were clear about their duties and how to meet people's needs.