UK International Nursing Agency Limited Dom Care

UK International Nursing Agency Limited Dom Care is registered to provide accommodation for up to 7 people who may require nursing and /or personal care. On the day of this inspection there was 1 person accommodated at the home.

The building 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 continued to not be protected from the risk of abuse. The new manager and provider failed to ensure there were clear safeguarding systems and processes in place to recognise and report concerns. Protection plans for people were not implemented and they were left at risk of further abuse. Not all staff working at the service had safeguarding training.

People were at risk of harm due to poor risk management. Risk assessments were not always in place to protect people. Care plans and risk assessments had conflicting information about the level of risk for people and what measures were in place to mitigate risk.

There continued to be a lack of effective leadership in the service. The provider, although present in the service, lacked understanding about the concerns found at the previous inspection and were not knowledgeable about the improvements made. The new manager spent limited time in the service and although they had identified lack of direction and policies and procedures in the service, they had failed to implement these. The lack of effective governance systems and auditing had led to improvements needed not being identified and actioned. This continued to put people at risk of not receiving good quality and safe care.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 11 August 2022) and there were breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that improvements made were not sufficient for the areas we checked. The provider continued to remain in breach of safe care and treatment, safeguarding and good governance and leadership.

Why we inspected

We undertook this targeted inspection to check whether the provider had acted on specific concerns we had about safeguarding, risk management, leadership and effective governance systems at the previous inspection. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for UK International Nursing Agency Limited Dom Care on our website at www.cqc.org.uk.

Enforcement

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This service has been in ‘special measures’ since 11 August 2022. The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will continue to 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 timeframe 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.

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.

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 care to people living in their own homes. On the day of this inspection there were two people accommodated at the care home and one person in receipt of the regulated activity ‘personal care’ who lived in the community.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

When we inspected this service in January 2015 we found that the provider had failed to ensure there were enough skilled and experienced staff available to meet people’s needs, staff lacked knowledge and understanding of safeguarding matters and the Mental Capacity Act 2005, incidents of concern had not been reported to the Care Quality Commission as required under regulation and people’s medicines had not been managed safely. The provider had not appointed a registered manager, the provider’s recruitment procedures were not robust and restraint had been used without ensuring the appropriate authorisations and procedures had been followed. The provider’s quality monitoring systems had not been effective in identifying these shortfalls and people’s feedback was not acted upon.

Subsequent to the comprehensive inspection we undertook two further focused inspections to assess the progress that had been made towards meeting the regulations and providing people with a safe and effective service. We found that improvements had been made with some further improvement required in areas relating to the effectiveness of the care provided and how well the service was managed.

At this comprehensive inspection we found that people were not always supported to lead an active and fulfilled life.

People were safe using the service. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from the registered manager which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

We observed that the staff team were kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. We noted that where any issues were raised with the management team they were responded to appropriately and in a timely manner.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We undertook a focused inspection of UK International Nursing Agency Dom Care on 16 July 2015 and found improvements had been made, however there were continued breaches of regulations 09, 17, and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not enough staff available to provide safe care to people and management systems continued to be ineffective. We issued warning notices in relation to Regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the focused inspection, the provider wrote to us on 15 September 2015 to tell us how they would meet the legal requirements. We undertook a further focused inspection on the 03 February 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for UK International Nursing Agency Dom Care on our website at www.cqc.org.uk.

UK International Nursing Agency Limited Dom Care provides accommodation for up to seven people who require nursing and /or personal care. It also provides care to people living in their own homes. This inspection focused on the residential home. At this inspection we found improvements had been made, however we also found further improvements were required in areas relating to the effectiveness of the care provided and how well the service was managed.

There were sufficient numbers of staff available to safely support people’s needs. A system was in place to effectively monitor and review incidents to keep people safe.

Staff received training relevant to their job roles and were supported through regular supervisions and appraisals to carry out their responsibilities and meet people`s needs effectively. People whose liberty had been deprived to keep them safe, had not consistently had the conditions of their authorisation met.

People were involved in the planning of their care, and care plans individually addressed the support needs people required based upon their individual needs and preferences.

There was a registered manager in post at this inspection. People’s care records were not accurately maintained to ensure a contemporaneous note was recorded for people’s daily care.

We spoke with four staff. They told us they had had appropriate training to enable them to support the people that used the service and that they were well supported by the manager.

We looked at the care plans and associated records for three people that used the service and found that they were current and reflective of people's needs and gave clear guidance for staff to follow to ensure people's needs were met.

The service had enough skilled and experienced staff to meet the needs of the people who used the service when we visited.

The service had robust recruitment procedures in place to ensure that the staff who worked for the service had appropriate experience and credentials.

The service had an effective complaints procedure in place.

The service carried out regular quality assurance checks to ensure that feedback from people who used the service was sought and responded to effectively.

A relative said that the care worker had helped the person to cook their own meals, and had ensured that the meals were balanced and nutritious. The same relative said, "I am very happy with the service. I have no complaints. This is an excellent service. The staff are excellent and very efficient."

The relatives we spoke with said that they had been involved in the decisions about the care package on behalf of the person using the service. They said that the person's wishes and preferences had been respected. They said that the agency had always consulted them if there were changes in the person's care needs.