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Inspection carried out on 4 April 2018

During a routine inspection

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 carried out on 17 March 2017

During a routine inspection

This inspection took place on 17 March 2017 and was announced. The provider was given 48 hours' notice. This meant the provider and staff knew we would be visiting the service’s office before we arrived. This was the first inspection since the provider's registration on 7 July 2016.

Nash Healthcare Ltd is a domiciliary care agency providing personal care to older people and younger adults in their own homes across Derby and surrounding areas and Gloucester. This included people with physical disabilities and mental health. The agency is located close to Derby city centre. At the time of our inspection there were 14 people using the service.

There was a registered manager in post; they were also the service provider. A registered manager is a person who has registered with the Care Quality Commission. 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 provider's arrangements for staff recruitment were unsafe and did not ensure suitable people were employed. We found that the required pre-employment checks were not in place.

People who were supported with their medicines were not always protected against the risks associated with poor medicines management. For example, a person’s medicine was being crushed and there was no information to confirm it was safe to administer the medicine this way.

We found that the provider’s quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvement.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting concerns. Staffing levels were adequate to meet people’s needs.

Staff had a good understanding of how to reduce the risk of harm to people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. However one relative told us on a couple of occasions, only one staff member had turned up even though it had been identified their family member required the assistance of two staff. This did not ensure people were always supported safely. Some people told us that sometimes their calls were later than the agreed times and staff did not always stay for the agreed call duration.

People were not consistently involved in planning and reviewing what support they needed.

People were supported by staff that were kind and caring The registered manager and staff we spoke with were caring and respectful in the way they spoke about people who used the service. Staff demonstrated a commitment to providing person-centred care.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint.

People, relatives and staff felt the service was well managed. Staff felt supported by the management team.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.