Star Nursing and Care Services

People’s experience of using this service:

Staff had received training in safeguarding adults and knew actions to take to protect people from abuse. People received the supported they required from staff at the times agreed. There were procedures in place for the management of medicines and staff had received training. Risk management were available to guide staff on how to safely support people. Lessons were learned from incidents and accidents. Staff followed infection control procedures to reduce risks of infection.

People’s care needs were assessed following recommended guidelines. People were supported to meet their nutritional and hydration needs as required. People had access to health and social care services they needed to maintain good health. Staff were supported in their roles through training and supervisions.

Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. 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 support this practice. People consented to their care before they were delivered.

Staff treated people with dignity and respect; and involved people and their relatives in planning their care. Staff communicated with people in the way they understood, and people were given information in formats they understood. People received support that met their individual needs and preferences.

People and their relatives knew how to complain if they were unhappy with the service. The registered manager addressed complaints in line with their procedure. Quality checks and audits took place and actions were taken to rectify areas of concerns identified. The provider worked in partnership with other organisations to develop the service.

Rating at last inspection: The last rating for this service was Good (published 19/05/2017).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Star Nursing and Care Services provides personal care and nursing care support to people with a range of care needs who live in their own homes. At the time of our inspection there were two people using the service. The service had a registered manager in post. 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 and associated Regulations about how the service is run.

At our last comprehensive inspection of the service on 10 February 2016 we found breaches of legal requirements because risk to people's health and well-being were not always identified or assessed and risk assessments did not provide appropriate guidance for staff, peoples care records did not always detail peoples full needs, medicines were not always managed safely, staff were not always supported through regular supervision and systems in place to monitor the quality of the service were not always effective in identifying the issues we found or in improving the quality of the service. We took enforcement action and served a warning notice on the registered provider in respect of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook a focused inspection on 28 April 2016 to check that the provider had met our legal requirements to which they had met the warning notice.

At this inspection we found that the provider had made significant improvements relating to the breaches of legal requirements that the focused inspection in April 2016 did not focus on.

There were appropriate safeguarding and whistle-blowing procedures in place and staff had a clear understanding of these procedures. Assessments were in place to support people where risks to their health and welfare had been identified. Appropriate recruitment checks took place before staff started work and there was enough staff to meet people’s needs.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and received training relevant to the needs of people using the service. Care plans detailed peoples nutritional and support needs. People had access to health and social care professionals when they needed them.

People were provided with appropriate information about the service. People and their relatives said staff were kind, respectful and caring and their privacy and dignity was maintained. People were consulted about their care and care plans were in place that provided information for staff on how to support people safely and appropriately. People were aware of the complaints procedure and we saw complaints were managed appropriately.

There were systems in place to monitor the quality of the service provided to people. The provider took into account the views of people using the service through satisfaction surveys and telephone monitoring calls. The provider conducted unannounced spot checks to make sure people were supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured management support was always available to peoples using the service and staff when they needed it.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Star Nursing and Care Services on our website at www.cqc.org.uk.

We took an enforcement action by serving a warning notice on the provider in respect of more serious breaches with regards to appropriate risk assessments not being in place and the unsafe management of medicines. We required the provider to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 24 March 2016.

We carried out this announced focused inspection of the service on 28 April 2016 to check that the requirements of the regulations had been met in response to the warning notice we served. This report only covers our findings in relation to the follow-up on the warning notice we served in respect of not having appropriate risk assessments in place and the unsafe management of medicines.

The provider sent us an action plan on to tell us how and when they would be compliant with other breaches we found at the 10 February 2016 inspection. These breaches related to Regulation 17, Good governance and Regulation 18, Staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches will be followed-up at our next comprehensive inspection of the service.

There was a registered manager in post. However, they were not actively involved in the day-to-day management and delivery of the service. 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.

At this inspection we found that the provider had addressed most of the issues we raised in the warning notice. However, our rating of the key question “Is the service safe” has not been changed from ‘Required improvement’ because we found other breaches under this key question. Also the systems and processes that had been implemented have not been operational for a sufficient amount of time for us to be sure that the service is providing consistent and sustained good practice. We will follow these up at our next comprehensive inspection.

We found that the provider had put systems in place to assess risk specific to people’s needs. However these risk assessments did not include detailed information or provide adequate guidance for staff on how people should be supported to manage these risks. These risk assessments required improvement. People’s known allergies, medical diagnosis and details of healthcare professionals involved in their care were included in their care plan. There were systems in place to manage medicines safely including all staff completing medicines training.

Star Nursing and Care Services provides personal and nursing care to people with a range of care needs who live in their own homes. At the time of the inspection, three people were using the service.

The service had a registered manager in post. However, they were not actively involved in the day-to-day management and delivery of the service. 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.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risk to people’s health and well-being were not always identified or assessed and risk assessments did not provide appropriate guidance for staff in areas such as moving and handling, eating and drinking, skin integrity, medication and bedrail risk assessments. People’s care records did not always include their medical diagnosis, allergies and information about healthcare professionals involved in their care to ensure care staff were aware and provided care that was safe and appropriate. People’s medicines were not always managed safely and people’s care records did not include information on medicines prescribed by healthcare professions and information on the location of where their medicines were stored. Staff were not always supported through regular supervision to ensure they performed their roles and duties safely. The provider had systems in place to monitor the quality of the service such as unannounced checks but these systems were not always effective in improving the quality of the service.

We found that other areas also required improvement. The provider had a safeguarding adult’s policy in place and staff were aware of how to protect people in their care from abuse. However, the registered manager was not aware of the local safeguarding reporting procedure to ensure that all safeguarding allegations were appropriately reported and investigated. Both staff and the management team were aware of seeking consent from people before providing the care and the need to carry out mental capacity assessment and best interests meetings if a person could not make specific decisions for themselves. However the registered manager was not aware of the legal requirements under DoLS to apply to the Court of protection to deprive people of their liberty where required. The provider had a complaints policy in place and people knew how to make a complaint if required. However information on how to make a complaint to relevant external organisations such as the local authority were not included the complaints policy. People’s care plans did not always include their likes and dislikes to ensure their individual preferences were respected.

There were robust recruitment and selection processes in place and appropriate numbers of staff were deployed to provide the care and support people required. There were arrangements in place to deal with foreseeable emergencies. People were supported to eat and drink adequate amounts to maintain their wellbeing. Staff received training and an induction into the service. Other healthcare professionals were involved in people’s care to ensure their care and treatment needs were being met. People’s privacy and dignity were maintained and people were involved in the planning of their care.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments had been carried out for each person and plans were put in place to minimise risks.

People who used the service were protected from the risk of abuse. Staff had received training in preventing abuse. The deputy manager could describe what might constitute abuse, the strategies in place for preventing abuse, and what steps they could take to escalate concerns.

Appropriate checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references. The service carried out checks of nurse's professional registration status with the Nursing and Midwifery Council (NMC).

Is the service effective?

The provider effectively accommodated special requests, for example, in relation to the abilities of the care workers they provided. They had been able to provide care workers who could speak the same languages as the people they worked with.

The service carried out spot checks of staff's competency. They supported staff to carry out their work well through access to appropriate training and professional development.

Is the service caring?

We spoke with one person who was using the service and two relatives of people using the service. They told us they were pleased with the care being provided. Staff arrived on time and stayed for the correct length of time. One person said, "The care workers are nice and the nurses are lovely. They arrive on time and are very good." One of the relatives we spoke with said, "They listen very carefully and it matters to them that my [relative] is happy."

Staff spoke to people in a way they could understand and asked permission prior to providing any personal care. One of the relatives we spoke with said, "The care workers are very good. They always explain what they are going to do in case my [relative] doesn't want it."

Is the service responsive?

The service had not been involved in any adverse incidents with people who used the service. They had received two formal complaints since the last inspection. In both cases the provider had carried out an appropriate investigation and worked to resolve the problem in a timely manner.

Is the service well led?

The provider had systems to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people using the service, their relatives, and members of staff.

The deputy manager carried out audits, for example, of staff training needs, to ensure care was provided to an appropriate standard.

The provider had written policies, including those relating to safeguarding and whistleblowing. The provider involved staff in an induction process which included a review of these policies.

We found that appropriate pre-employment checks were undertaken before staff began work. Staff were supported through regular supervision and an annual appraisal by the provider.

We found people using the service were involved in decisions about their care and were treated with dignity and respect. They experienced care that met their needs. However, the provider had not completed all appropriate checks for one care worker before they began work and some care workers did not receive formal one to one supervision or appraisals in accordance with the agency's policy and procedure. The provider had systems in place to monitor the quality of the service people received including spot checks to ensure people received consistent care.