6 July 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 13 March 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the registered manager and other senior staff are often out of the office supporting staff or providing care. We needed to be sure that they would be in.
The membership of the inspection team included two inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was with older adults, some of whom lived with dementia.
We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
As a part of the inspection we spoke with 18 people who used the service and four relatives. We also spoke with the registered manager, nine nurses, five care staff, the managing director and founder of the service, and the head of human resources who was also the nominated individual.
We looked at records at the service related to the delivery of care to people and the administration and management of the service. We looked at 10 care plans, 10 recruitment files, staff duty rosters, quality audits and medicine administration records for five people.
We asked health and social care professionals for their views of the service after the visit. We received feedback from four professionals and we have included their views and comments of the service in the report.
6 July 2018
This inspection took place on 13 March 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the registered manager and other senior staff are often out of the office supporting staff or providing care. We needed to be sure that they would be in. Westward Consultants Ltd is also known and trading as Draycott Nursing. This service is a domiciliary care agency and provides nursing and personal care to people living in their own homes in the community. It provides a service to adults. At the time of the inspection 80 people were using the service.
There was a registered manager in post at the time of the inspection and they were present during the 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.
At the last inspection of this service on 15 and 16 October 2015 they were rated Good. The service was rated Outstanding for Caring and Good for Safe, Effective, Responsive and Well-led. At this inspection the service continued to meet and improve standards and we have therefore rated the service as Outstanding overall.
People who used the service said they received an exceptional quality of care. Staff went ‘over and above’ to ensure people received the care and support that met their individual care needs. People said staff were kind, gentle and helpful.
Staff respected people in a way that promoted their human rights. Staff delivered people’s care and support in a dignified and compassionate way. Staff treated people in a way that made them feel special.
The nurse liaisons carried out assessments of need carried out assessments of need. This ensured people’s needs and the support they required matched. People made decisions in the planning of their care which was integral to the support provided to them. Staff provided care that was person centred and people’s support was delivered taking into account their views. Care and support was flexible to meet people’s changing needs. The registered provider used evidence based practice and developed their own research to improve people’s lives. Staff celebrated people’s lives in a way that made them feel valued. Staff understood end of life care and delivered sensitive care to people taking into account their wishes. Staff developed and understanding of people’s religious and cultural needs at the time of their death.
People and staff confirmed that the service was exceptionally well led. They said that the management team were remarkable and open, honest and approachable. The management team placed people at the centre of the service.
The Head of HR and Operations monitored the quality of the service. The quality assurance systems allowed for the registered manager and office based staff to assess, monitor and review the service to ensure standards remained high. A service action plan was in place. The registered manager identified and recorded any areas for improvement with details of the action staff took to resolve the concern. The registered provider had plans in place to develop the service through an enhanced staff training programme and by using technology.
The registered manager understood their responsibilities and sent notifications to the Care Quality Commission (CQC) as required.
The registered manager had developed relationships with external organisations. This helped to improve the care people received because advice and support was obtained promptly. The registered manager was involved in raising awareness of people living with physical disabilities.
Safeguarding systems and processes used helped to protect people from harm and abuse. Staff knew what abuse was and completed safeguarding training to update their knowledge.
Staff identified risks for people. Risk management plans had enough detail so staff could manage and reduce the likelihood of harm. There was a system to record missed and late care visits, and accidents and incidents. Records showed and staff told us that training covered scenarios exploring when something had gone wrong. The office sent staff messages if something had been identified that they should be aware of. All incidents were managed effectively and actions taken to reduce incidents happening again.
Staff administered medicines to people as prescribed. Training in the safe management of medicines took place. Staff had their competency assessed to ensure their practice was safe to support people with their medicines.
There were enough staff available to support people as they needed. The Head of HR and Operations followed safe recruitment processes to ensure only suitable staff were employed to care for and support people. Checks were carried out before staff were approved as suitable to work at the service.
Staff were supported through training, supervision and appraisal. Staff explored the challenges and positive aspects of their jobs and reflected on their role working for the service.
The principles of the Mental Capacity Act 2005 (MCA) were followed by the registered manager and staff. MCA training was made available for all care staff. People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible for people. The policies and systems in the service supported this practice.
Staff sought people's consent to care and support. Care records held details of people’s agreement and consent to receiving care and support from staff.
The quality of meals provided to people met their preferences and needs. The registered provider gave staff monthly recipes to support them to make nutritional meals for people. Shopping was completed by staff when required by people.
Staff understood infection control processes. The registered provider had an infection control policy in place. There was personal protective equipment for staff to use to help reduce the risk of infection for people.
People’s choices were included in assessments in line with their views and wishes. Staff recognised when people’s health care needs changed and sought prompt advice. People were supported to access health care services to help them maintain and improve their health care needs.
The registered provider had a system for people to complain. People were provided with information on how to make a complaint about the quality of care and support. People felt able to complain if they chose and were confident that the registered manager would look into and respond to their concerns.