Nomase Care Ltd

About the service:

Nomase Care Ltd is a domiciliary care agency which provides personal care and support to people living in their own homes and in supported living settings.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection 84 people were receiving support with personal care either in their own homes or in supported living settings.

People’s experience of using this service

Right support

People living in supported living settings received care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. People were encouraged and supported to identify and take part in activities and pursue interests that were tailored to them. Where appropriate, staff enabled people to take positive risks. Staff communicated with people in ways that met their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs and promoted equality and diversity in their support for people. Relatives told us their family members were happy, safe and comfortable at the service. We observed positive interactions between people and staff which corresponded to feedback we received. One relative told us, “Whenever I visit [family member] is smiling and happy. I can’t thank staff enough.”

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. There was enough appropriately skilled staff to meet people's needs and keep them safe.

Right culture

People received good quality care and support because trained staff could meet their needs and wishes. People led active lives because of the ethos, values, attitudes and behaviours of the management and staff.

We have identified some issues with the provider’s system for scheduling and monitoring care visit times. We have made a recommendation about this.

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

At the last inspection, the service was rated as requires improvement (Report published 30 April 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led and part of the key question Effective. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from ‘Requires Improvement’ to ‘Good’ based on the findings of this inspection.

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

Follow up

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

Nomase Care Ltd is a domiciliary care agency which provides personal care and support to people living in their own homes and in supported living settings.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection 70 people were receiving support with personal care.

People’s experience of using this service

People were not always safe. The provider had not ensured fire risks to people were always fully documented and mitigated. People’s medicines were mostly managed safely, however, there was insufficient information regarding ‘when required’ (PRN) medicines which were being prescribed to help people manage behaviours that challenged. The provider was not managing infection control risks. On the day of our visit to the supported living service, staff were not wearing Personal Protective Equipment (PPE) in line with current government guidance for this type of care setting.

People were not supported to have maximum choice and control of their lives and 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 this practice. The provider was not ensuring that consent to care and treatment was obtained. They did not conduct mental capacity assessments and/or best interests meetings when they identified people who lacked capacity to consent to their care and support.

Quality assurance processes were not always effective in identifying and addressing the shortfalls in safety and quality we found. We discussed our concerns with the manager and nominated individual during the inspection and they have taken action to resolve some of the immediate issues we identified. They have also submitted an action plan detailing what further improvements they will make.

We received generally positive feedback from people about the care they received and the management of the service. People told us staff were kind and caring. Staff were positive about how the provider had supported them during the pandemic. The provider worked in partnership with a range of health and social care professionals.

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

At the last inspection, the service was rated as requires Good (Report published 4 April 2020). The rating has deteriorated to requires improvement.

Why we inspected

We undertook this focused inspection to follow-up on specific concerns that we received about the risk management processes within the service. A decision was made to examine those risks. During the inspection we widened the scope to include the key questions of safe and well-led and part of the key question effective. No areas of concern were identified in the other key questions. We therefore did not inspect them.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report. The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspector after the inspection to advise of further improvements scheduled.

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 have identified breaches in relation to medicines, infection control, risk management, consent to care and treatment, submission of notifications and quality assurance processes at this inspection.

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 have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may return to inspect.

Nomase Care Ltd is a domiciliary care agency which provides personal care and support to people living in their homes.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection 42 people were receiving support with personal care.

People’s experience of using this service

Risks to people’s health were assessed but control measures were not always sufficient to mitigate the risk of harm and guidance for staff was not always clear. The provider had systems to monitor staff time keeping but these were not always effective as they did not identify the staff lateness we found.

We have made recommendations about the way the provider assesses the risks to people’s health and safety and monitors staff punctuality.

People told us they received safe care and support. Medicines were managed well by staff that received regular training. Safe recruitment practices were followed.

People’s health and social care needs were assessed, and plans put in place to meet these. The provider met people's nutritional and hydration needs. People’s ability to consent to their care and support was assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People knew how to complain if they were unhappy about their care and support. Staff had a good understanding of people’s needs and preferences. Information was not always available in accessible formats such as easy read.

We have made a recommendation about making information more accessible to all people that might use the service.

People were treated with dignity and respect by regular staff that knew them well. People told us staff were kind and caring and treated them respect.

There were quality assurance systems in place to ensure care and support were kept to a good standard. The service worked in partnership with a range of health and social care professionals to ensure people received the right care and support.

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 23 August 2017).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nomase Care Ltd provides personal care for people living in their own homes. At the time of the inspection the service was delivering care to seven people.

The service had a registered manager at the time of 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.

People were protected from the risk of abuse because staff knew how to identify and report any concerns. Staff had received training on safeguarding adults and understood their responsibilities to keep people safe from avoidable harm. Staff identified and managed risks to people’s health and well-being.

Sufficient numbers of staff deployed at the service ensured people received safe. A review of staffing levels when necessary enabled staff to meet the needs of people safely. Staff underwent a robust vetting process to ensure people received care from suitable staff. People had their medicines managed and administered safely by trained staff and in accordance with the provider’s procedures.

People received care from staff who had the support they needed to undertake their role. Staff underwent an induction and received regular training, supervisions and an appraisal of their performance.

Staff provided care to people as required under the Mental Capacity Act 2005. People gave consent to care and treatment before staff supported them. Staff delivered people’s care in line with their choices and preferences.

People received the support they needed to eat and drink. People had access to healthcare services and had their health needs met.

Staff delivered care to people with compassion and kindness. People had their rights to equality, privacy and dignity maintained by staff who provided their care. Staff supported people to maintain their independence whenever possible.

People using the service, their relatives and health and social care professionals were involved in identifying each person’s individual needs. Support plans in place provided sufficient guidance to staff on how to deliver personalised care. Staff carried out regular reviews of people’s needs and updated support plans when there were changes to ensure they provided responsive care to each person.

People had an opportunity to give feedback about their care. The registered manager addressed any concerns raised to improve people’s experience of using the service. People using the service and their families understood how to make a complaint about the service.

An honest and transparent culture at the service enabled staff to talk openly about the care they delivered to people. People using the service and staff knew the registered manager and made positive comments about how they managed the service. Staff were clear about their responsibilities and said they enjoyed good communication and teamwork.

Regular audits and checks on the quality of the service identified shortfalls in care provision. The registered manager took action in a timely manner to resolve any issues highlighted in audits and in line with the provider’s timescales. A close partnership with external agencies enabled people to receive care in line with best current practice.