Allcare Nurses Agency Limited

Allcare Nurses Agency Limited is a domiciliary care service providing personal care to adults and children. At the time of the inspection they were supporting 28 people with personal care. 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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

People told us they felt safe and staff knew what to do if abuse was suspected. Staff had received safeguarding training. Risks were 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. Care records identified that people’s capacity had been considered. People and relatives told us they had agreed to their care.

People told us they had been involved in peoples assessments and professionals were positive about the care the service provided. Activities were being supported to most people. Some people told us more consistency with visits would increase access to activities. Care records were in place and records of daily care provided was completed. People told us they had been involved in the development and reviews of care plans.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

We made a recommendation in relation to recording of medicines. Some people said that there was sufficient staff in place.

People’s individual care needs were met and they were treated with dignity. People were positive about their care. The nominated individual told us about the actions they had taken as a result of the concern raised by one person. Staff told us they felt people received good care.

The service worked in partnership with professionals to achieve good outcomes for people. Guidance, policies and information was available to support continuous learning and improvements.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Training, supervisions, spot checks and competencies had been completed. Most people told us they were confident in the skills of the staff. The deputy manager and nominated individual confirmed the actions they had taken to monitor, support and provide extra training for a staff member. We received mostly positive feedback about the service. Policy and guidance was available to deal with complaints. People’s views were sought and team meetings were undertaken.

People were positive about the management and the staff team. The nominated individual told us they had commenced the recruitment process for a new manager.

Audits had been completed but they required more detail to demonstrate what had been reviewed and the actions taken as a result. The audits did not always identify the findings we found at this inspection. The nominated individual provided evidence of more detailed audits and the actions they were taking to ensure they were more robust.

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

The last rating for this service was requires improvement (published 5 February 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider consulted best practice guidance in relation to the training and support offered to staff, and that the service considered best practice guidance on the management of complaints. During this inspection we found some improvements had been made however we made recommendation in relation to medicines management and the operation and oversight of the service.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up from the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Allcare Nurses Agency Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have made recommendations in relation to medicines management and the operation and oversight of the service.

Follow up

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

Allcare Nurses Agency is a domiciliary service which was providing personal and nursing care to 15 people 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

The service was not always effective. 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.

We have made a recommendation about training and support

People’s end of life needs, and wishes had not always been adequately assessed to meet their needs. Staff had not received training in end of life care. Care plans were not always person-centred however, the registered manager was in the process of reviewing the systems in place to make improvements.

We have made a recommendation about the management of complaints.

People did not consistently achieve good outcomes because records were not always complete or appropriate. We have identified breaches of the regulations which reflect failings. There was a lack of confidence in the management of the service.

There were systems and processes in place to protect people from abuse. People told us they felt safe. Medicines were managed safely. People were protected from the risk of infection. Recruitment systems and processes were not always robust however, the provider took immediate action to address this.

The service was caring. People and their relatives gave us very positive feedback about the kind and caring nature of staff who supported them. They told us staff respected their privacy and dignity and supported them to be independent. People had access to advocacy services.

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 8 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to seeking consent, end of life care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Allcare Nurses Agency is located in Blackburn Lancashire. The agency is registered to provide nursing care and support to adults and children with complex medical needs in their own home. On the day of our inspection there were twelve people using the service. We were not able to verbally communicate with these people during our inspection.

At the time of our inspection 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 2008 and associated Regulations about how the service is run.

Staff members had received safeguarding training and were aware of their responsibilities to report any concerns. Safeguarding policies and procedures were in place to guide staff. A whistleblowing policy was also in place to protect staff should they report poor practice.

Risk assessments had been completed to keep people safe. We saw risk assessments had been completed to address risks such as choking, moving and handling, infection control and the use of oxygen.

There were robust recruitment systems and processes in place. We looked at staff personnel files and saw that application forms had been completed, where any gaps in employment could be checked, references were gained and Disclosure and Barring Service checks had been undertaken.

Medicines were managed safely. We saw that only those staff members trained to do so were permitted to administer medicines to people. Competency checks were regularly carried out to ensure staff members remained competent. The medicines policies and procedures that were in place did not contain up to date information in relation to nationally recognised good practice guidance. We discussed this with the registered manager who assured us the policies and procedures would be reviewed as soon as possible.

Staff told us they had access to personal protective equipment (PPE) such as gloves and aprons and confirmed they had received training in infection control. There was a nominated individual responsible for infection control within the service.

Records showed that when commencing employment at Allcare Nurses Agency, all staff were to complete an induction. The induction covered training the provider deemed necessary for the role, policies and procedures and shadowing more experienced members of staff.

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 supported this practice.

We saw staff members had regular one to one supervisions and appraisals. Supervisions discussed people they were supporting, roles, training needs/wishes, staffing levels, colleagues, uniforms and additional hours.

The service had a complaints policy and procedure in place. Whilst the service had not received any complaints since our last inspection, the registered manager was able to tell us the process they would follow should they receive a complaint.

All staff members we spoke with were able to describe how they supported people to remain as independent as possible whilst being supported.

There were detailed person centred care plans in place which directed staff members to ensure the individual needs of people who used the service were met. We saw care plans were regularly reviewed with the person and/or their family member to ensure they remained current.

Robust quality assurance systems and processes were in place to ensure the quality of the service was regularly monitored.

We received positive feedback in relation to the approachability of the registered manager. Staff members told us they felt able to approach the registered manager with any concerns or issues they may have.

The registered manager was able to identify key achievements and challenges for the service since our last inspection. They also had a clear focus for further improvements they wished to make.