Nationwide Care Services Limited (Derby)

Nationwide Care Services Limited (Derby) is a domiciliary care agency. The service provides personal care to a range of people including people living with dementia, learning disability and or autism needs and mental health needs. At the time of our inspection there were 134 people using the service.

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.

Based on our review of the key questions, safe and well-led the service was able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture.”

Right support: 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’s care needs had been assessed with risks identified and actions taken to reduce these. People received safe care and the provider checked to ensure staff were suitable to work at the service. Medicines were managed in line with good practice.

Right culture: The service worked to provide people with person-centred care and involved them in their care decisions. The provider looked to continuously learn and improve people’s care and actively monitored the quality and safety of care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 23 October 2020).

Why we inspected

We received concerns in relation to the care people received. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Nationwide Care Services Limited (Derby) 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.

About the service

Nationwide Care Services Limited (Derby) provides support to people in their own homes within Derby City and the surrounding area. 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. At the time of our inspection 120 people were using the service and 92 of those were receiving personal care and support.

People’s experience of using this service and what we found

The quality monitoring systems in place had not always identified when improvements were needed. For example, we found improvements were needed to ensure people’s call times were spaced out appropriately, that they were happy with the staff who supported them, and that the management of medicines was monitored effectively. All the areas were addressed by the registered manager in a timely way; but these had not been identified or actioned before the inspection. We have made a recommendation about reviewing the length of people’s call times, to ensure sufficient time is allocated.

People told us they liked the staff and felt safe with them. Staff had received training and understood the procedure to follow to protect people from abuse. Staff received training to support people with their prescribed medicines. The recruitment practices in place ensured the appropriate checks were completed before staff started work.

Staff understood the importance of reading people’s care records before they supported them, and people confirmed this was done. Most people told us they received support from a regular team of staff and told us they had seen some improvements over recent months in getting regular care staff.

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 Good (published 16 January 2019).

Why we inspected

The inspection was brought forward due to concerns received about staff not staying for the agreed length of time, staff not following care plans, poor medicines management and concerns about pressure care management. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led key question of this full report.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nationwide Care Services Limited (Derby) on our website at www.cqc.org.uk.

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.

Nationwide Care Services Limited (Derby) provides personal care and support to people in their own homes in Derby and the surrounding areas. At the time of this inspection 102 people received personal care from the service.

Our last inspection report for this service was published on 05 December 2017 and the rating was ‘Requires Improvement’ with no breaches.

This was a scheduled inspection based on the service’s previous rating.

What life is like for people using this service:

People felt safe using the service. Care workers knew where people were at risk and what to do to keep them safe. Improvement had been made to care plans and risk assessments and the service’s staff recruitment procedure.

Improvements had been made to the way people’s mental capacity was assessed and the service was working within the principles of the Mental Capacity Act (MCA).

People’s cultural needs were identified during their assessments and care plans put in place to show how these were to be met.

Care workers were well-trained and competent. They treated people kindness, respect and compassion.

People were encouraged to make decision about their care and support and had access to their care plans.

People received personalised care that was responsive to their needs. They said care workers were mostly on time and stayed for the duration of their calls.

People knew what to do if they had a complaint about the service and staff listened to them and made improvement where necessary.

The office has been re-designed to create a welcoming and informative place for people, relatives and care workers to visit. A display celebrating equality and diversity emphasised staff member’s commitment to providing an equal and non-judgemental service to all.

There was a new registered manager in post who people and staff said was helpful and supportive.

People were involved in how the service was run and their views sought at review meetings and through regular quality assurance questionnaires.

The service’s audit system covered all aspects of people’s care and support and people were involved in through review meetings and quality assurance questionnaires.

For more information please see the Detailed Findings below.

We carried out an announced inspection of this service on 4, 5, 6 and 7 April 2017. Five breaches of legal requirements were found and we rated the service as 'Inadequate'. This was because the provider had failed to: submit statutory notifications when required; identify, receive, record, handle and respond to complaints effectively; ensure suitable staff were employed; provide people with safe care; and operate effective systems to assess, monitor and improve the service, and mitigate risks to the health, safety and welfare of the people using it.

Following this inspection we also took action to restrict new admissions to the service. We also issued a requirement for the provider to send us monthly reports on the progress they had made towards improving the service.

In response the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we found that action had been taken and the breaches had been met. As a result we have lifted our requirement to restrict new admissions to the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Nationwide Care Services Ltd provides personal care and support to people in their own homes in Derby and the surrounding areas. At the time of this inspection 50 people received personal care from the service.

The service did not have a registered manager. A registered manager 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 manager told us they were in the process of applying to CQC to be the next registered manager.

We found significant improvements to the service. Medicines were managed safely and people told us they received them at the right times. Staff were trained to administer medicines safely and medicines records were audited to ensure they were of an acceptable standard.

Care plans and risk assessments had been re-written and improved so that risks to people were safely managed and they were protected from harm. Care plans were personalised and included an explanation of what people wanted to achieve with the support of their care workers People told us they were involved in making decisions about their care and had access to their care plans.

The provider’s recruitment procedure, which helped to ensure the staff employed were safe to work with the people using the service, had been followed. An improvement was needed to the staff risk assessment procedure to ensure it was fit for purpose.

The provider’s complaints procedure had been followed and people who raised concerns had been listened to and told of the outcome of their complaints and what was being done to improve the service in response. Most people said they were satisfied with how staff responded to complaints.

Most people said they were happy with the staff who supported them and said they provided safe care. Staff knew how to protect people from harm. They were well-trained and had completed a range of courses designed to give them the skills and knowledge they needed for their work. Some improvements were needed in the way the Mental Capacity Act was implemented at the service.

The service promoted equality and diversity and management followed the provider’s policy on delivering a culturally appropriate service. The staff team was made up of people with a range of skills including the ability to cook culturally appropriate food and speak a number of local languages.

There were effective systems in place to monitor quality. The managers carried out regular audits of all aspects of the service. If these revealed shortfalls the managers and staff took action to bring about improvements. Statutory notifications were submitted to the CQC when required and these showed that the staff had taken appropriate action to safeguard people when incidents had occurred.

The results of the provider’s latest quality assurance survey showed that people’s satisfaction with the service had increased in all areas. Some people said they would recommend the service to others and praised the caring nature of the staff.

The service provides personal care and support to people who live in their homes in and around the Derby area. At the time of this inspection 61 people received support from the agency, 48 of whom received support with their personal care needs.

The service is required to have 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 persons could not demonstrate medicines were managed safely and administered as prescribed.

The registered persons could not demonstrate people received care that was safe and consistent as care plans and risk assessments were not always in place. Monitoring of people’s health was not always completed in line with the provider’s own guidance.

The registered persons could not demonstrate all the required pre-employment checks had been completed on staff employed at the service.

Staff received training, however staff did not always follow good practice guidance in relation to medicines and their knowledge of other areas relevant to peoples’ care was not always in place.

Not all staff understood local safeguarding procedures and potential safeguarding incidents had not always been recognised and referred to the local safeguarding authority.

Not all staff were confident the support they received from their managers had been effective at resolving concerns or improving services.

Most, but not all people and their family members thought staff were caring; some staff practice did not always support the care and welfare of people.

Care was provided in ways to respect people’s privacy and promote their dignity. People were involved and felt listened to when their care was discussed. People’s care was reviewed with them, however this did not always lead to their care plans and risk assessments being updated when their care needs changed.

Complaints were not well managed or always investigated appropriately. Concerns and complaints were not used to improve the service. Not everyone felt confident to raise concerns.

Systems and processes designed to assess, monitor, improve and reduce risks in the quality and safety of services were either not in place, or where they were in place they were not effective. Actions taken to improve services had not always resulted in improvements. Staff were not always confident support from their managers would lead to improvements. Not everyone felt the service was led with an open style of leadership.

Policies and procedures did not always ensure quality services for people.

The registered persons could not demonstrate accidents and incidents were always recorded as appropriate and that any subsequent investigation and actions to reduce future risks had been taken.

Other healthcare professionals had not always been informed of changes to people’s needs in a timely manner.

The provider had a policy in place on the Mental Capacity Act 2005. We found mixed evidence on whether people’s rights had always been upheld and their views respected.

There were sufficient staff deployed to meet people’s needs.

People received care with their nutrition and hydration needs. Staff provided care and support to help people with their meals and drink in a way that met their known preferences.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.