NDH Care Ltd

NDH Care Ltd is a home care agency providing personal care to people in their own homes. NDH Care supported 309 people aged 65 and over at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Risks to people’s safety had not always been assessed or guidance provided to staff on how to reduce those risks. Medicines were not managed in a safe way and records were not maintained accurately.

The governance systems were ineffective in identifying where improvement was needed. The systems did not support continuous improvement and development of the care provided. People were supported to provide feedback on their experience of the service, but this was not consistently acted upon.

People received support from a consistent team of staff who understood their responsibilities to report any concerns of abuse. Staff had been recruited safely.

Improvements had been made to infection control practices and people told us staff took action to reduce risks relating to COVID-19.

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 15 May 2019).

Why we inspected

We received concerns in relation to infection control practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for NDH Care Ltd on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risk and medicines as well as breaches relating to the provider’s monitoring of the service. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

NDH Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. The service was providing personal to 190 people at the time of the inspection.

People’s experience of using this service:

• Staff understood how to protect people from the risk of harm or abuse. People were supported in a way that reduced risks to their safety.

• People had not experienced missed calls and the majority of people had their care calls at the preferred times. People were very complimentary about the staff who supported them on a regular basis. Some people had experienced shorter call times and a number of different staff which made it difficult for them to form relationships. The provider was reviewing call duration and trying to establish consistency of staff teams to improve people’s experiences. People had effective support with their medicines and were happy with staff practice in relation to infection control.

• People were supported by staff who understood their needs and had support and training to meet their needs effectively. People's consent to care was sought and they were supported to access healthcare professionals when needed. People were happy with the support they had with their meals and risks related to people's dietary needs were known.

• People described staff as kind, patient and caring and felt staff protected their dignity and independence.

• People had been actively involved in deciding their care and personal routines. Care plans were personal to the individual and included people’s preferences, goals and care needs. There was a system to manage complaints and people were confident of a response. People’s end of life needs had been considered and planned for.

• People, staff and relatives were positive about the service, their views were sought and reflected positive experiences. The provider carried out regular audits and checks on the service and on the competency of staff to ensure people received a quality service.

Rating at last inspection: Good. Published 09December 2016.

Why we inspected: CQC had been advised of two incidents of alleged theft from people’s homes and a concern related to staff recruitment. This inspection was brought forward to enable us to look at how these were being managed by the provider. The incidents of theft had been investigated and not substantiated and the provider had taken appropriate action. The provider had followed safe recruitment procedures although in one instance references were not followed up. The provider told us they would improve their audits to ensure this did not happen again.

Follow up: We will continue to monitor the service through intelligence we receive about the service until we return to visit as per 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

We last inspected this service in January 2016 when we found the registered provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not being safely managed. They were also in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because there weren't adequate systems in place to check on the quality and safety of the service. After our last inspection the provider sent us an action plan telling us how they would improve the service. These improvements had been effective, and we found the provider was now compliant with the regulations and consistently meeting people’s needs.

A registered manager was in post, and was present throughout our inspection. 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.

We met and spoke with six of the 37 people using this service. Either in discussion or through our observations we were confident that people felt safe. We observed people looking relaxed and appearing to feel comfortable around staff within their own home, and people and their relatives told us people felt safe whilst receiving personal care. Staff understood their roles and responsibilities to protect people from the risk of potential harm. Staff were aware of the provider’s processes for reporting any concerns. There were enough staff to support people safely and recruitment checks were in place to help ensure staff that were employed were safe to work with people.

Staff had been trained to support people effectively. Training had been tailored to ensure staff had the skills they needed to meet the needs of the people they supported. The training also provided staff with the specific skills to provide care in people's own homes. Staff told us that they received regular supervision and felt supported. More senior staff were always on-call for them to seek advice and guidance.

People had access to a variety of food and drink which they enjoyed. Staff followed care plans to ensure people stayed healthy.

Staff had a basic knowledge of their responsibilities under the Mental Capacity Act 2005. We observed staff working consistently in line with people's care plans, promoting people's independence and choice and seeking consent before offering any care.

People were relaxed in the company of staff and people described many positive, compassionate interactions they had experienced from the staff who were supporting them. Staff ensured people’s privacy and dignity was maintained.

People knew how to raise complaints. Where complaints had been raised the registered manager had taken prompt and appropriate action. There was a range of systems and opportunities for people to provide feedback about all aspects of the service.

There was a registered manager in post who was aware of his responsibilities, and who had the skills and experience required to develop and lead this service.