NCC Swift Response

NCC Swift Response is a domiciliary care agency providing personal care to people aged 18 and over who live in the community and require physical or practical support with daily living tasks. The service provides a response to urgent or unplanned needs. This may be for one off intervention or could provide short term support until a resolution can be found to meet that person’s needs.

During this inspection, we looked at the people who used the service in the 24-hour period of our site visit. All required one off interventions with none requiring more that one visit. Not everyone who used the service in this period 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.

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

Since our last inspection the provider had improved the governance systems with further developments planned. However, they had failed to notify CQC of several safeguarding incidents that they had been required to do so by law. Furthermore, the registered manager was not fully aware of all the events they had a responsibility to report to CQC. This meant regulatory requirements were not fully met.

People benefitted from receiving a service delivered by dedicated, professional and skilled staff who were committed to providing the best service they could. They demonstrated knowledge and passion and were supportive of each other and the service. There was an open, accommodating culture that strived to improve the service people received. Staff received regular support, training and opportunities to attend meetings which aided their development, knowledge and confidence.

Staff had been safely recruited and there were enough to meet people’s needs in a person-centred manner. There were no time limits placed on how long staff could stay with people when providing them with support and this ensured people received an unhurried, dedicated service that met their urgent, unplanned and immediate needs. Staff assisted people with personal care, after a fall, medicines administration and meeting nutritional needs as required. This included when people were at the end of their lives.

Relevant information was taken at the point of referral and risks assessed as much as possible. However, staff were responsible for continuing to risk assess when making a visit and they demonstrated they were adept at doing so. Staff had received training in safeguarding people and were knowledgeable in this area. Any concerns had been referred to the local authority as required. Accidents and incidents were recorded and analysed for trends to help prevent reoccurrence. Staff had received training in medicines administration and although training in infection prevention and control had expired for most staff, our evidence showed good practice was adopted.

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. People who used the service told us staff were considerate, kind and patient and were complimentary about the service they provided. They told us they felt safe with staff and that they were appreciative of the service at a time when they needed help urgently. People told us staff maintained their dignity and made them feel comfortable, respected and listened to.

Although no one we spoke with had the need to raise any concerns, they knew how to should the need arise. The provider had a complaints policy in place and the registered manager put emphasis on using complaints as opportunities for learning and improving the service. Audits were in place to ensure the quality of the service and strong partnership working was in place to ensure people received continuity in their care.

The service had received many compliments and the people we spoke with who used the service agreed the quality of the service was very good. One service user’s relative said, “It’s an extremely good service” whilst another told us, “[NCC Swift Response] is an amazing service.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 18 January 2019). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating at this inspection.

Why we inspected

This was a planned inspection based on when the service registered with the CQC.

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.

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 during the inspection in 2017. Whilst we did see some improvements had been made in this area the regulation was found to be in continued breach. The governance framework and structure needed more thought. The collation of evidence and intelligence for service development was limited and how this was used was not consistent or monitored to drive improvement. We were aware this was acknowledged by the county managers and was being progressed internally with the senior leadership team. We found paperwork and some policies required updating and have made recommendations about this in the report.

The service was meeting the needs of a select group of people who needed specific and focused reablement services to continue to live independently. Each of the services within Norfolk first response had clear eligibility criteria. This allowed the county hub to identify and refer suitable placements to the reablement service available within Norfolk first response. People in receipt of the domiciliary care service told us they were involved with the planning of their care and that staff respected their wishes and asked their consent.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

You can see what action we told the provider to take at the back of the full version of the report.

NCC First Support - Northern and Norwich is a service that provides intensive support to people in their own homes to help them re-gain as much independence as possible. At the time of our inspection, there were approximately 200 people using this service.

The service had two registered managers. One to manage the Northern team and the other the Norwich team. 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 managers managed a team of re-ablement practitioners across their designated areas of the county. These re-ablement practitioners then in turn, managed a team of support workers.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks to people’s safety had not always been sufficiently assessed. Records in relation to people’s medicines did not support they had always been managed safely. Furthermore, some systems in place to assess and monitor the quality of care provided had not been effective at identifying and improving these areas of practice.

You can see what action we told the provider to take at the back of the full version of the report.

There were enough staff to meet people’s needs and the provider had ensured staff were safe to work within this type of service before they had been employed. Systems were in place to protect people from the risk of abuse.

Staff had received training in a number of different subjects. They were competent to support people in a number of areas. However some staff needed further training in risk and medicine management which the registered mangers agreed to implement.

The staff obtained consent from people in line with the relevant legislation before providing them with support. Where required, people received support to eat and drink enough to meet their individual needs and with their healthcare.

The staff were kind, caring and polite. They treated people with dignity and respect and people valued their relationships with the staff. People’s needs and preferences had been assessed and were kept under review to ensure they were being met.

People were able to make decisions about their own care. They were listened to and empowered by staff to do this. Any concerns they raised were investigated and resolved.

There was an open culture within the service. People and staff felt able to raise concerns without fear and the service learnt from any complaints that people made.

Staff received good leadership. They understood their roles and responsibilities. Systems had been put in place to ensure staff felt valued and appreciated and they were supported in their roles.

The registered managers worked with other services to share best practice and improve the quality of care people received.