• Services in your home
  • Homecare service

Archived: Nurse Plus and Carer Plus (UK) Limited

Overall: Good read more about inspection ratings

1st Floor, Chiltern House, Feathers Yard, Basingstoke, Hampshire, RG21 7AT (01256) 332070

Provided and run by:
Nurse Plus and Carer Plus (UK) Limited

All Inspections

30 June, 1 July and 3 July 2015

During a routine inspection

This inspection took place on 30 June, 1 July and 3 July 2015 and was announced.

Nurse Plus and Carer Plus provides a domiciliary care service to enable people living in the Basingstoke and the surrounding areas to maintain their independence at home. There were 97 people using the service at the time of the inspection, who had a range of physical and health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes and sensory impairments. At the time of the inspection the provider deployed 37 care staff to care for people and meet their individual needs.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous registered manager had resigned in April 2015 and a new manager was appointed on 8 June 2015. In the interim period an experienced manager from within the provider’s care group had managed the service. Records confirmed that this manager had started the process to become the registered manager of the service.

At our previous inspection on 12 and 16 September 2014 the provider was not meeting the requirements of the law in relation to people’s care and welfare and safeguarding people from abuse.

Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 14 October 2014. During this inspection we found improvements had been made to meet these requirements.

People using the service were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Care staff engaged with people to identify their individual needs and what they wanted to do in the future. Care staff were committed to promoting people’s independence and supporting them within the community.

Comprehensive risk assessments had been completed with people and where appropriate their relatives. Where risks to people had been identified there were plans in place to manage them effectively. Care staff understood the risks to people and followed guidance to safely manage these.

The care staff responded flexibly to people’s individual wishes and changing needs and sought support from health and wellbeing specialists when necessary. People’s dignity and privacy were respected and supported by care staff. Care staff were skilled in using individual’s specific communication methods and were aware of changes in people’s needs, which were reported to relevant healthcare services promptly when required. People were encouraged to be as independent as they were able to be, as safely as possible.

People told us they trusted the care staff who made them feel safe. Care staff had completed safeguarding training and had access to local authority guidance and contact numbers. They were able to recognise if people were at risk and knew what action they should take to protect people from harm. The manager had taken action when people had been identified to be at risk and learning for staff had taken place. People were kept safe as safeguarding incidents were reported and acted upon.

The manager and provider completed a weekly staffing needs analysis to ensure there were always sufficient staff with the necessary experience and skills to support people safely. Wherever possible the manager and care staff worked together with people to identify in advance when their needs and dependency were likely to increase.

People were cared for by care staff who had undergone the required pre-employment checks to ensure their suitability and had received an induction based on the social care industry requirements. The induction also took into account the specific needs of the people cared for by the service, including diabetes and dementia. Care staff had the required training updated in accordance with the provider’s policy. The provider supported staff to meet people’s needs with an effective programme of induction, supervision and appraisal. Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s care effectively and were supported with their career development.

Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed annually by the training coordinator and senior staff.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

People’s needs in relation to nutrition and hydration were documented in their support plans. We observed people supported appropriately to ensure they received sufficient to eat and drink. Meals reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice.

The suitability of staff to form caring relationships with people was assessed as part of their recruitment process. People were supported to maintain relationships with people who were important to them.

Where complaints were made they were investigated and actions taken by the provider in response. Complaints were analysed for themes and where these had been identified action had been taken.

The provider’s values focussed on treating people with dignity and respect whilst providing high quality care. People were cared for by care staff who understood and practised the values of the service in the provision of their care.

The manager and provider carried out a comprehensive programme of regular audits to monitor the quality of the service and plan improvements. The manager monitored people's support and took action to ensure they were safe and well. People’s welfare, safety and quality of life were looked at through regular checks of how people’s support was provided, recorded and updated. We found that accidents and incidents had been recorded appropriately. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented to improve the service.

People’s needs were accurately reflected in detailed plans of care and risk assessments, which were up to date. These plans contained appropriate levels of information. For example, if a new member of care staff arrived to provide support in response to staff absence after reading these plans they would be able to support people safely. Throughout the inspection the manager and office staff were able to find any information we asked to look at promptly.

Records were stored securely, protecting people and care staff confidential information from unauthorised persons, whilst remaining accessible to authorised staff. Processes were in place to protect care staff and people’s confidential information.

12, 16 September 2014

During an inspection in response to concerns

This inspection was conducted by an adult social care inspector in response to concerns raised regarding a serious safeguarding incident. At the time of our inspection this matter was still under investigation.

On the day of our inspection there were 97 people being supported in their homes by 47 care workers. The registered manager was unavailable during our inspection so we spoke with a staff member managing the service, the provider's director of training, two care coordinators, the training officer, eight care workers and two staff undertaking the induction process. During our inspection we visited seven people who invited us to their homes. We also spoke on the telephone with eight people who use the service and the relatives of two people who were unable to speak with us.

We considered our inspection findings to answer questions we always ask;

Is the service safe? Is the service caring? Is the service effective? Is the service responsive? Is the service well-led? This is a summary of what we found;

Is the service safe?

We found that people were not always cared for safely. One person with complex health and emotional needs was being supported by various health professionals. However we found that care workers had no detailed guidance about how to support the person with their complex needs. Risk assessments had not sufficiently identified potential risks and how these could be balanced. This meant that the provider could not be assured that people had experienced safe and appropriate care that met their needs.

During an incident, involving a risk to a person's health, the provider had failed to ensure a person's safety by contacting emergency services. Some staff had not acted in accordance with the provider's safeguarding policy as they had failed to contact emergency services when they found a person to be unresponsive. This meant that people's care and welfare had not always been provided safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to promoting people's care and welfare.

Some staff had failed to act in accordance with the providers safeguarding policy as they had failed to notify the safeguarding authorities about concerns regarding a person who had been identified at significant and increasing risk of self-harm and self-neglect. This meant the provider had failed to protect people from identified risks.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to domiciliary care agencies. We found the service to be meeting the requirements of the DoLS. Whilst no applications had been submitted, the director of compliance and training told us they were reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service caring?

We found the service was caring. We saw that one care worker had worked during planned leave to support a person when there was an urgent staffing issue.

People were supported by kind and compassionate staff, who spoke with people in a friendly, caring manner. One person told us 'I look forward to seeing the carers. Not so much for the care but their company is wonderful. They are always happy to have a chat'.

The care staff we spoke with enjoyed working with people they supported. One care worker told us, 'It is really gratifying when you see people's trust and confidence in you grow. They feel safe and secure. That's why it's really important to provide continuity whenever we can.'

Is the service effective?

The service was effective. Staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge.

Staff had received training to meet the people's specific needs, for example blood sugar monitoring to support people with diabetes. People's health and care needs had been assessed with them. People we spoke with told us their support plans reflected their current needs. People's involvement was documented in annual reviews of their care.

The provider had ensured that people received appropriate care from competent staff who had been supported in their personal development by an effective system of supervision and appraisal.

We found that the service effectively promoted a good quality of life and placed people at the centre of all decisions regarding their care and support. Where a person lacked capacity best interest meetings were held with people who knew and understood them, which ensured their human rights were protected.

Is the service responsive?

We found that the service was responsive to people's changing needs. These had been continually reviewed. Where it had been identified that staff required further training this had been planned or arranged immediately.

During a provider's spot check with a person's next of kin it became apparent that they were unable to visit their relative often, due to the large distance between their home addresses. The provider therefore arranged an increase in the number of field supervisions they conducted to monitor the person's well-being and to keep the relative informed about their welfare.

People's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each person's needs and how they should be met. For example we saw that people had been supported with their spiritual and religious needs.

People knew how to make a complaint if they were unhappy. They told us that they frequently received calls and visits from the care coordinator, where there was an opportunity to discuss any concerns they may had. One person told us, 'I only have little niggles but every time I've had a problem it has been sorted out.'

Is the service well-led?

The service was not always well led. In relation to a serious on going safeguarding incident we found that staff had not received clear and direct leadership in relation to coordinating an effective safeguarding strategy to protect a person from self-neglect. Following this incident the provider has taken action to ensure that all staff are fully aware of action to be taken in emergency situations. All people with complex needs have had their risk assessments reviewed.

The person managing the service and staff we spoke with were clearly passionate about the health and wellbeing of people being supported by the service. Care workers spoke positively with genuine pride about the service they provided for people.

Quality assurance systems were in place, which demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

14 November 2013

During a routine inspection

We found that the service fully assessed people's needs and then explained all of the care options available to them in a way they understood. When people refused their support staff told us that they explained the risks and benefits of refusing and discussed alternative options with them.

We observed that care plans had been developed with people to reflect their personal needs and preferences. People who used the service told us that the staff were, "excellent" and "really cared" for them. One person told us, "They always ask me what I need and take a real interest in me. It makes me feel special." Another person said, "You can gaurantee they will be there on time and will even do an early call just for me."

The provider had an effective medication policy which ensured that people received their medicines safely, as prescribed and that this was accurately recorded. We noted that there had been no medication errors since the last inspection.

People had their health and welfare needs met by staff who had been subject to a robust recruitment and selection process. Staff told us that they had not been allowed to work for the agency until all of the relevant checks had been completed.

The manager effectively operated a series of self auditing systems to assess and monitor the quality of the service provided. This ensured that people were protected from harm and risks to their health and welfare had been minimised.

3 January 2013

During a routine inspection

People who use the service understood the care and treatment choices available to them. We found the service placed people at the centre of their care by enabling them to make decisions. One relative said, "They are so flexible. They always talk to him and really understand his needs, which makes him feel safe and happy."

People's needs were assessed and care was planned and delivered in line with their individual care plan. This reduced the risk of people receiving unsafe or inappropriate care. We spoke with people using the service or their representatives who made positive comments. One person said, 'I would definitely recommend their take a break service. It's really, really good.' One person said, 'I look forward to her visit. She is always willing to do more than I need.'

Service users were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The staff we spoke with told us in detail about the procedures relating to safeguarding and whistle-blowing.

Care staff said that they were happy in their work and felt supported by the manager. They had received appropriate training to deliver the care and support needed.

There was an effective auditing system which identified areas of good practice and those for improvement, together with robust action plans. Analysis of these audits highlighted potential risks to compliance with the essential standards.