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Inspection Summary

Overall summary & rating


Updated 9 May 2018

This inspection took place over two days commencing on 5 April 2018. The provider was given 24 hours’ notice of our visit. This was so people who used the service could be told of the inspection and asked if they would be happy to speak with us.

Nash Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in Derby and Gloucestershire. At the time of our inspection there were 13 people using the service, which included people receiving end of life care. It provides a service to adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

Following the last inspection on 17 March 2017 we asked the provider to take action to make improvements in the management of people’s medicine and in its staff recruitment practices. The provider submitted an action plan outlining their planned improvements and this action has been completed.

Nash Healthcare Limited had a 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.

The registered manager did not take part in the inspection as they were on leave.

The overall rating for the service awarded at the previous inspection which took place on 17 March 2017 was requires improvement at which time we identified two breaches of the regulations. This inspection has found improvements have been made and the overall rating for the service to be good.

The provider’s recruitment procedures ensured pre-employment checks were carried out on prospective employees to ascertain their suitability to work with people. We found there were sufficient staff employed to meet people’s needs, who had the appropriate training and support to delivery good quality care, which included tailored training to meet people’s health care needs.

Systems to provide and support people with their medicine safely had been introduced. Medication Administration Records (MAR’s) were for a majority of people provided by pharmacists, which meant staff were no longer having to write MAR’s, thus reducing the potential for error. We found people were supported by staff that had undergone appropriate training and had their competency assessed to manage people’s medication.

An electronic system had been introduced, since the previous inspection. The system supported the management team by monitoring and recording the time of arrival and departure of staff from people’s homes. This provided a clear audit trail as to whether staff were providing care and support based on the times as detailed within people’s care plans.

People told us they felt safe when they were supported by staff and trusted them. All staff had undertaken training in safeguarding to enable them to recognise signs and symptoms of abuse and knew how to report them. Potential risks to people were assessed and plans were put into place to minimise risk, which staff understood and followed.

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. People’s rights were upheld and decisions about their care were sought as part of the assessment process to identify their needs. The management team had focused on improving the involvement of people using the service or family members in the assessment process and development and review of care plans.

People’s health and welfare was promoted as staff supported people with the preparation and cooking meals. Staff liaised and worked with health care professionals to promote people’s health, which included provi

Inspection areas



Updated 9 May 2018

The service was safe.

People were safeguarded from abuse as systems and processes were in place, which were understood and adhered too by all staff. A system of staff recruitment was in place to ensure people were supported by suitable staff.

People�s safety was monitored, with risk assessments and care plans providing clear information for staff as to how people�s safety was to be promoted. This included the use of protective equipment to reduce the potential risk of spreading infection.

People�s needs with regards to their medicine were identified within their care plans and they received their medicine at prescribed times.

The registered manager learnt from accidents and incidents and implemented systems and processes to reduce the risk of them re-occurring.



Updated 9 May 2018

The service was effective.

People's needs were assessed and were met by staff that were skilled and had completed the training they needed to provide effective care, which included training specific to meet people�s individual health care needs.

Staff received regular practical supervision when providing care and support to people and received support through appraisal and attendance at team meetings.

People were supported to maintain, their health and well-being as staff liaised with health care professionals. This included support with the preparation and cooking of meals.

The principles of the Mental Capacity Act 2005, including gaining consent to care and people's right to decline their care was understood.



Updated 9 May 2018

The service remained caring.



Updated 9 May 2018

The service was responsive.

People�s and family members contributed to the development of care plans. Care plans were followed by staff to promote people�s well-being and to achieve their wishes. This included supporting people to remain at home by staff providing End of Life Care.

People and family members were confident to raise concerns. Concerns received had been investigated and used to further develop the quality of the service.



Updated 9 May 2018

The service was well-led.

Staff expressed confidence in the management of the service and were committed to the visions and values of Nash Healthcare Limited. The leadership of the service was valued by staff, who in some instances worked alongside managers in the delivery of people�s care.

People�s views were sought and their views acted upon. People did not receive an overall outcome to the consultation process and the proposed response of the service.

The service worked in partnership with commissioners to bring about improvement and to further develop the service in providing good quality care for people.