Archived: Nurseplus UK - Ashford

Nurseplus UK – Ashford is a domiciliary care agency. It provides personal care to adults who want to remain independent in their own home in the community. At the time of the inspection not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 130 people were receiving the regulated activity personal care. The service is also registered to provide treatment for disease, disorder or injury. However, no one was in receipt of nursing care when we inspected.

At the last inspection on 6 and 7 November 2017 the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that the rating remained requires improvement. This is the third consecutive time the service has been rated Requires Improvement.

There was a registered manager at 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 the time of the inspection the registered manager was on planned leave and the deputy manager was the acting manager.

At the previous inspection we found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were not always administered safely and the provider had failed to ensure care was provided in a safe way. At this inspection some improvements had been made to medicines management but there continued to be concerns relating to the recording of medicines and dating when bottles and creams were opened. We made a recommendation relating to the administration of medicines.

At the last inspection the service we found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014, in that systems and processes had been not been consistently effective in identifying shortfalls and driving improvements in a timely way to ensure compliance and make sure people received a quality service. At this inspection, audits undertaken by the service had identified that there continued to be concerns relating to the recording of medicines and actions taken had not resolved all of the concerns. Further improvements were needed to be made and the service remained in breach There continued to be concerns about communication between the people who used the service and office staff.

Risks to people and from the environment were assessed and there was information for staff on how to lessen these risks. People were protected from the risk of infection and personal protection equipment such as aprons and gloves were available for staff and were used.

People were protected from abuse. Staff had a good understanding on what abuse was and reported concerns when they had them. Concerns were reported to the local authority and CQC and dealt with appropriately. Staff understood the principles of the Mental Capacity Act 2005 and supported people to make choices for themselves.

There were sufficient numbers of staff to cover care calls. Staff were recruited safety and the appropriate pre-employment checks had been carried out. Where things went wrong the service took action where this was needed. Staff had the skills, training and knowledge they needed to support people effectively. Staff received appropriate levels of supervision, underwent competency checks and had an annual appraisal. New staff undertook appropriate training and a period of shadowing.

Where people needed support to eat and drink this was provided. People also had the support they needed to access healthcare services. Staff had the information they needed to share with healthcare services if someone was taken ill.

People were treated with kindness, compassion and respect. Staff communicated well with people and asked their permission before providing care. People’s dignity and privacy were respected and promoted. People were supported to maintain their independence and continue to do things for themselves where possible.

People’s needs were assessed before they started to receive a service and this assessment was used to plan people’s care. People and their relatives were involved in reviews of their care and people were supported to express their views. Care plans were personalised and contained information about people’s preferences and cultural and religious needs where people had these.

There was a complaints policy in place which was shared with people who used the service. People knew how to complain, and complaints were recorded and investigated appropriately.

The service was not currently supporting people at the end of their life. The acting manager was aware that they needed to discuss people’s end of life preferences if they supported people in the future. Where people had “do not resuscitate” forms in place these were in people’s care files. There was also information about any advance decisions people had made about care and treatment.

The acting manager was committed and passionate about the service and had the skills and experience they needed to undertake this position. The acting manager was supported by the area manager and was aware of their responsibilities.

The staff we spoke to told us that they enjoyed their role and were listened to. There were regular staff meetings. Attendance at these meetings had not been high, however, there were plans in place to address this. There were annual staff surveys and surveys for people and their relatives. Where issues were identified these were added to an action plan for completion.

The acting manager planned to access local forums to meet with other managers and share best practice. The service had access to best practice information and guidance which was sent out by the provider.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and some younger adults.

Not everyone using Nurse Plus and Carer Plus (UK) Limited – Ashford receives a regulated activity; the Care Quality Commission only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Nurse Plus and Carer Plus (UK) Limited Ashford provide care and support to people in their own homes. The service is registered to provide personal care and treatment of disease, disorder or injury. At the time of the inspection there were approximately 200 people receiving support with their personal care and none in receipt of treatment of disease, disorder or injury. The service undertakes visits to provide care and support to people in Ashford, Tenterden, Romney Marsh and surrounding areas. The service can also provide 24 hour support to people.

The service is run by a registered manager. Their registration had been confirmed the week before our inspection. They were not present at the inspection as they were on leave. A registered manager is a person who has registered with 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.

At the last comprehensive inspection in November 2016 the overall rating for the service was Requires Improvement. Four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider had failed to have proper and safe management of medicines, mitigate risks to people’s health and safety, mitigate risks in infection control, ensure people were treated with dignity and respect, ensure care plans reflected people’s preferences and ensure systems and processes were operated effectively.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, caring, responsive and well led to at least Good.

At this inspection we found that some improvements had been made and three of the breaches had been met. However, checks on the quality of the service continued not to identify and address shortfalls in the service. Further improvements were required in relation to the recording of medicines and responding to people’s concerns.

Checks and audits had been completed but were not consistently effective in driving improvements in a timely way to ensure compliance and make sure people received a quality service.

People’s medicines were not consistently managed safely. Staff did not complete medicines records correctly. We have made a recommendation about the management and recording of some medicines.

People knew how to complain and the provider followed their policy to handle complaints. Some people told us they had raised concerns in the past and they felt the provider had listened but had not been effective in ensuring the same issues did not arise again.

Communication between the care staff and the office and between the office and people was inconsistent. Some staff had noted that there had been improvements since the new manager had been in place.

People told us they felt safe in the company of the care staff. Action had been taken and risks to people were now assessed, managed and reviewed. People were now protected against the risk of infection. People were protected from the risks of discrimination, abuse and avoidable harm.

People were supported by sufficient skilled and knowledgeable staff who had been safely recruited. Staff completed regular training to keep their knowledge up to date. People’s preferences, choices and needs were assessed with them before they began using the service.

Staff knew how to report concerns about people’s safety. They understood their responsibilities regarding infection control and used protective personal equipment.

People’s needs were assessed, with them, to ensure they received the care and support they needed in the way they preferred.

People were supported to eat a healthily and special diets were prepared when people needed them. They were supported to stay as healthy as possible. Staff helped people arrange appointments with health professionals when required.

People received care and support from regular care staff who knew them well. People told us that staff stayed for the agreed length of time. Some people had concerns about the timeliness of their calls. No-one we spoke with had experienced a missed call.

People were supported to make choices. Staff understood the requirements of the Mental Capacity Act (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

People said staff were kind and caring and knew them and their preferences well. Staff promoted and maintained people’s privacy and dignity. People’s preferences and choices for their end of life care were discussed, recorded and reviewed.

People and their loved ones were involved in the planning, management and reviewing of their care. Care plans included information about people’s life history and background, people that were important to them and their preferences.

Staff felt supported by the management team and were proud to work at Nurse Plus. There was an open culture where people’s views were valued. People, relatives, staff and health professionals were asked to provide feedback to the service. Action was taken to address any areas of concern. Staff worked with health and social care professionals.

Notifications had been submitted to CQC when they were required. The rating from the previous CQC report was displayed in the office and on the provider’s website in line with guidance.

You can see what action we told the provider to take at the back of the full version of the report.

The service is run by an established 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.

People felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Risks associated with people’s care and support had been identified, but not all actions in place were recorded on risk assessments to help ensure people remained safe. People were not fully protected against the risk of infections as there were inconsistencies in staffs use of personal protective equipment.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. Most care plans were detailed reflecting people’s preferred routines. However not all tasks undertaken by staff were always incorporated into the care plan and not all care plans were up to date reflecting people’s current care and support. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

People felt most staff were caring and respected their privacy and dignity. However people gave examples where they felt this was not the case.

There were audits and systems in place to monitor that the service ran efficiently. These had been effective in identifying the shortfalls highlighted during this inspection, but were not effective in driving improvements in a timely way. People felt the timing of their visits, continuity of staff that visited them and communication within the service were all areas that required improvement.

New staff underwent an induction programme, which included relevant training and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role and a high percentage of the staff team had gained qualifications in health and social care or were working towards this.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection although some people had made Lasting Power of Attorney arrangements and others had a Do Not Attempt Resuscitation (DNAR) in place. Some people chose to be supported by family members when making decisions. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health and they told us staff were observant in spotting any concerns with their health and taking appropriate action.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Where there was continuity staff had built up relationships with people and were familiar with their personal histories and preferences.

People had opportunities to provide feedback about the service provided. Complaints had been investigated and responded to appropriately.

There was an open and positive atmosphere in the office and staff were receptive to improving services people received. Changes and new systems were being implemented, which should impact on the quality of service people receive.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.