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NCC First Support - Northern & Norwich Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 25 January 2019

We inspected the service on 18 and 19 October 2018. The inspection was announced so we could ensure someone would be available at the office to support the inspection.

At the last inspection we found the service in breach of two regulations of the Health and Social Care Act. Concerns were noted around the risk management systems in place and the management of medicines. We also had concerns around governance arrangements which would help the manager and provider to identify concerns and continuously drive improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. We found some action had been taken but further action was still planned to further improve standards and meet the requirements of the regulations.

Norwich First Support domiciliary service is a short-term service providing personal care to people in their own homes. The service was provided normally for no longer than six weeks. People’s need for the service was assessed at each visit. If it was assessed the service would be needed for longer than the anticipated six weeks, people were referred to different longer-term services for ongoing support.

The domiciliary care service was part of Norfolk First Response which included three other services. One service in partnership with Norfolk Community Health & Care (NCH&C), met more complex and clinical needs, another met urgently required support including support following falls or other accidents and the third provided residential based reablement. Each service was registered in isolation but were managed by the same senior leadership team and the registered managers worked closely together to ensure people’s shorter-term needs were met.

The newly developed service had been added to the Norfolk first support domiciliary care which included intensive seven-day support provided to people with more complex needs including support with pressure areas, urinary tract infections and falls. People could require more intensive observations and some funding was provided from Norfolk Community Health & Care (NCH&C) who recruited the clinical staff to support people's needs as required. Each partner agency worked to support people under their own registrations.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

The Norwich and Northern first support team was managed by two registered managers. At the time of this inspection one of the previous registered managers was acting up into a county manager role and an acting manager was managing the Norwich side of the service. 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.

Since the last inspection improvements have been made across the board in relation to how the service is run and how it fits into the provider group. However, there is still some work to do. The management of medicines has improved with more focus on training and audit of records. This has allowed for inconsistencies to be recognised and addressed with the provider addressing issues in staff supervision and if required with additional training. This has meant the service is no longer in breach of this element of the regulation. However, the service was still in breach of the safe care and treatment regulation in respect of how they managed and mitigated risk. We continued to find inconsistencies in this area and some risks which were not suitably addressed or managed.

Good governance procedures and systems were also found to be in breach of the associated regulations du

Inspection areas

Safe

Requires improvement

Updated 25 January 2019

The service was not consistently safe.

Risk assessments were not always an accurate reflection of people’s needs and there were inconsistencies in records

Medicines were safely managed and staff were appropriately trained

Staff were recruited safely and there were enough staff to cover the support needs of people using the service

Staff understood their responsibilities to keep people safe and there was available information to address any safeguarding concerns

The service followed nationally recognised guidance for the prevention and control of infection and people told us staff used appropriate equipment safely

We saw action was taken where concerns were noted and steps were taken to ensure staff were made aware of important and updated procedures

Effective

Good

Updated 25 January 2019

The service was effective.

More holistic assessment or review was to be undertaken to ensure the provider met the needs of the people it supported.

Policies and procedures were being updated to ensure staff had information that was in line with current guidance. Staff training was also to be delivered to introduce changes in legislation as it happens.

Staff told us they felt supported and we saw they received comprehensive induction and regular supervision.

The service shared senior management with four other reablement and support services. Referrals and access across these services enabled a range of available support to meet people’s immediate needs. Access to other services was managed when required.

People supported by the service took primary responsibility for their own nutrition and hydration needs

We saw consent was acquired at start of service provision and people told us they were consulted throughout provision. At the time of the inspection there was no one using the service who lacked capacity.

Caring

Good

Updated 25 January 2019

The service was caring.

Everyone we spoke with told us the staff were caring and they were appreciative of the support they received.

People told us and we saw that people were involved with agreeing their care and reviewing it regularly

People told us staff treated them with dignity and respect

People had choices as to how and when they received support, increasing it or decreasing it as they choose and their needs changed.

Responsive

Good

Updated 25 January 2019

The service was responsive.

Person centred care was delivered which included people’s contributions to planning their care considering their recognised strengths and contributions

Complaints procedures were in place and accessible to people. When complaints were made they were investigated and managed in line with expected procedures.

Well-led

Requires improvement

Updated 25 January 2019

The service was not consistently well led

The service vision was developing whilst other partner services were procured across Norfolk first response.

Staff felt involved in the developing vision and were clear of their role.

They felt supported.

A comprehensive and effective quality assurance system was still to be developed. Quality audit was in its infancy and not embedded to allow complete service review and continuous improvement.

Governance procedures were beginning to develop. A clearly defined quality approach was to be introduced.

People were asked for their feedback on the service they received but the findings of this was not shared. A newsletter was to be developed to be shared with staff and more considered use of the data was developing.