UK International Nursing Agency Limited Dom Care

Overall: Inadequate read more about inspection ratings

Mayapur House, 2A Station Road, Radlett, Hertfordshire, WD7 8JX (01923) 855856

Provided and run by:
U.K. International Nursing Agency Ltd

Important: We are carrying out a review of quality at UK International Nursing Agency Limited Dom Care. We will publish a report when our review is complete. Find out more about our inspection reports.

Latest inspection summary

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Background to this inspection

Updated 8 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had improved the areas we had concerns about. These included safe care and treatment, safeguarding, leadership and effective governance systems.

Inspection team

This inspection was carried out by 2 inspectors.

Service and service type

UK International Nursing Agency Limited Dom Care is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. UK International Nursing Agency Limited Dom Care is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post from October 2022 and had very recently submitted an application to register. Their application has not yet been considered.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We received feedback from visiting health and social care professionals’ as part of a Service Improvement Process. We used all of this information to plan our inspection.

During the inspection

We spoke with one person, the clinical lead and nursing staff on duty. We also spoke with the new manager and the provider, who is also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at one person’s care records, incidents and accidents since the last inspection, cleaning schedules, recruitment, training data, daily observations charts and various other management records.

Overall inspection

Inadequate

Updated 8 February 2023

About the service

UK International Nursing Agency Limited Dom Care is registered to provide accommodation for up to seven people who may require nursing and/or personal care. It is also registered to provide personal care to people living in their own homes. During this inspection there were five people accommodated at the care home with nobody in receipt of personal care in the community.

The home offers accommodation on two floors. The home had dining and communal living space for people to spend time together. Some bedrooms had en-suite facilities, with shared bathroom and toilets also available for people.

People’s experience of using this service and what we found

People were not protected from abuse. Staff’s knowledge about safeguarding was poor and the registered manager and provider failed to recognise and report safeguarding concerns. Protection plans for people were not implemented and they were left at risk of further abuse. There were not enough skilled staff deployed to meet people’s needs safely and effectively.

Fire risk concerns that the registered manager and the provider were made aware about by fire safety specialists had not prompted them to reassess the level of risk people were exposed to in case of a fire. The level of risk to people’s health and safety from living in an unsafe environment with clutter, trailing wires and poor infection control procedures were not assessed or mitigated. Risk assessments in place for identified health needs had insufficient guidance for staff to know how to lower the risk and help keep people safe.

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice. People had numerous restrictions applied to their freedom. The registered manager and the provider imposed these restrictions without having the legal authority to do so. People were cared for in bed, not supported to go out in the garden or the community. In addition, they were denied the use of their own phones, computers and denied help with on-line shopping if their behaviour was considered inappropriate by the registered manager or the provider.

People’s needs were not met at the service. The registered manager and the provider had failed to implement rehabilitation guidance people were given when discharged from hospital. People’s needs were not reviewed and, except for the GP, specialist external health professionals’ input into people’s care was not requested.

Staff were not trained to understand and meet people’s needs. Staff received “all-in-one” training consisting in 13 subjects delivered in one day. Training for staff to understand people’s mental health needs or behaviour support had not been given. Staff’s competence or understanding of their training was not assessed. The registered manager and the provider failed to ensure people received a varied and nutritious diet.

People had limited involvement in their care and support. The lack of skills staff had, and the culture promoted by the leadership in the service, prevented staff from supporting people in a kind and compassionate way. We observed that staff were respectful when talking to people. However, the language and terminology used by management when talking about people and language used in people’s care plans evidenced a labelling, discriminative approach towards people with protected characteristics. Independent advocate support had not been requested by management for people who had limited involvement from someone close to them to act as their voice.

The care and support people received was routine led, based and centred around their basic needs only. People received their personal care, food, drinks and were kept warm. For most people living in the home, the time staff were supporting them with these needs was the only interaction they had during the day. Staff were overstretched and completing task like meal preparation, housekeeping and supporting people with their care needs. This meant that they had limited or no time to organise meaningful activities, support people to go out or spend time chatting to people. People’s end of life care wishes were not recorded or explored at a time when they could voice their opinions, therefore the plans in place for any future care needs were not personalised.

The registered manager and the provider failed to comply with the legislation and regulatory requirements set out by the Care Quality Commission (CQC) at the time when they registered. They had failed to notify CQC of significant events requiring such notifications. They had admitted people to the service, without notifying CQC that the individual’s needs did not fall under their initial registration and they had failed to register their kitchen with the appropriate agency who regulates food safety and preparation.

The registered manager and the provider neglected their management duties and worked as part of the staff team as nurses. This had a negative impact on the management and oversight of the service and led to poor governance systems, lack of meaningful quality assurance processes and any audits being carried out. They failed to promote a positive culture amongst the staff team and failed to keep up to date with current best practice, legislation and regulatory requirements. This had a negative impact on people from being supported by a staff team who lacked skills and understanding of safe, effective and personalised care practices.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Whilst there were no people with a learning disability or autistic people living in the home, there is an expectation that providers and registered managers who are registered to offer this service be knowledgeable and understand best practice. The management in the home were not knowledgeable about current best practice and guidance. Neither the registered manager nor the provider recognised the signs of their service operating a closed culture. They provided a service to people without external health and social care professionals input, failed to have an open and transparent approach or effective communication with external agencies or listen to the voice of the people using the service.

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

Rating at last inspection

The last rating for this service was good (published 14 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from abuse, safe care, staffing, consent to care, personalised care and management processes.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.