Nomase Supported Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff maintained records of incidents and when things went wrong, with details of what happened, individuals involved, nature of the incident, and actions taken.

The registered managers had oversight of incidents and when things went wrong, ensuring transparency and accountability. They reviewed incident reports and addressed them as appropriate. Where appropriate they raised safeguarding alerts, updated the risk assessments for the individuals involved and shared learning with staff through handover meetings and team meetings. One staff member commented, “The managers keep staff up to date with what has happened. We also have an application on our phones where we can read about updates and any changes or risks. And they also talk about incidents during team meetings.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered managers assessed people’s needs and evaluated whether the service could meet them based on its criteria and staff expertise. For instance, if a person had a physical disability requiring equipment, they ensured appropriate equipment was available. Where specialist care was required, the service collaborated with relevant professionals. For example, the Home enteral nutrition (HEN) team was involved in managing one person’s care who required feeding through percutaneous endoscopic gastrostomy (PEG) feeding, a method of delivering liquid nutrition, fluids, and medication directly into the stomach via a tube.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were supported by staff who understood the provider’s policies and procedures in relation to safeguarding adults. Staff had all received training in safeguarding people from abuse. All the staff we spoke with showed knowledge of how to recognise signs of potential abuse and they understood the process for reporting their concerns and escalating these to external agencies if needed. One staff member, “If I suspect abuse, I will instantly report it to any of the managers and follow up with them if they had taken actions. If they have not, I will go to the director.” The registered managers were clear about their responsibilities in safeguarding people from abuse including investigating any concerns of abuse, involving the local authority safety team and notifying CQC.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Assessments considered individuals’ mental and physical health, communication, use of community facilities, road safety, and their ability to carry out daily living tasks. One person’s relative mentioned, “The staff know the risks my loved one faces, and they know how to keep them safe.”

Management plans were developed to outline how staff should provide support in order to minimise risks identified in these areas. People also had Positive Behaviour Support (PBS) plans, created by specialist professionals, to guide staff in supporting people. These plans detailed potential triggers, early warning signs of mood changes, and the interventions staff should use to prevent or reduce the impact. We reviewed comprehensive risk management plans addressing issues such as epileptic seizures and moving and handling risks.

Staff we spoke with demonstrated a clear understanding of people’s triggers in different situations and the appropriate actions to take. One staff member commented, “We have been trained in positive behaviour support, and we use behaviour strategies to support people with their behaviours in a calm and respectful way.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out risk assessments of people’s home environments to ensure safety for both individuals and staff delivering care. These assessments considered factors such as, fire and electrical hazards, and the equipment used in providing care. Care plans reminded staff to conduct a visual check of the environment and equipment at the beginning of each visit and to report any concerns promptly.

The service kept detailed records of maintenance and safety checks on equipment used in people’s care, including moving and handling devices and transfer aids. This process helped minimise the risk of harm arising from faulty or unsafe equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People’s support was planned according to their needs and people and their relatives confirmed that their loved one received the support they needed as planned. One person told us, “There is staff available, and they support me with things I need support with.”

Staff told us and the rota showed that people received their care and support at the time they needed it. One staff member said, “We have enough staff to support service users. We are aware of what each service user needs. We provide some people 1:1 support or 2:1 support. Staff do not feel stressed out.” Another staff member said, “We have a rota that tells us what shift we are doing. We are not short of staff but if a staff cancels their shift a replacement is found swiftly.”

The service had taken necessary steps to ensure people were supported by staff who were fit and safe to support them. Recruitment records showed that staff underwent robust checks before they started working with people. Checks undertaken included checking the Disclosure and Barring Service (DBS) database for any criminal records. Satisfactory references were also obtained, and applicants employment histories were explored for any unexplained gaps. Staff files also contained evidence of their right to work in the UK and proof of address. Staff were supported with necessary training, regular support and supervisions and appraisal to be effective in your roles. One professional commented, “The staff demonstrate appropriate experience and knowledge to deliver effective care.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had completed infection control training and demonstrated a clear understanding of the procedures required to prevent and minimise the risk of infection. They reported being supplied with personal protective equipment (PPE), which they used appropriately whenever necessary. Care plans highlighted the importance of wearing PPE during personal care tasks or when handling bodily fluids.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Care plans outlined the level of support individuals required in managing their medicines and identified who was responsible for providing that support. Training records showed that staff had received appropriate training, and their competency had been assessed. Staff we spoke with were able to explain how they managed medicines safely in accordance with organisational procedures, covering storage, administration, recording, and disposal. Our review of Medicine Administration Records (MAR) confirmed they were completed in full with no gaps. For people prescribed PRN (as-needed) medicines, clear protocols were in place to guide staff on when and how these should be administered.