Background to this inspection
Updated
10 April 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team:
The inspection team consisted of one adult social care inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience’s area of expertise was older people.
Service and service type:
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
We gave the service 48 hours’ notice of the inspection site visit to make sure that there would be staff available to speak with us.
Inspection site visit activity started on 12 February 2019 and ended on 12 February 2019. We visited the office location on 12 February 2019 to see the manager and office staff; and to review care records and policies and procedures.
What we did: We reviewed various records including, the training matrix, recruitment files for three employees, three care plans, two audits, compliments and complaints and staffing rotas. We spoke with 11 people who were using the service, three relatives and six staff, including the registered manager, coordinator and two care staff. We contacted three healthcare professionals however we did not receive any responses.
After the inspection, the registered manager sent additional evidence including copies of photographic identification, supervision sessions and a medicines audit.
Updated
10 April 2019
About the service: Nursing Solutions is a domiciliary care service that was providing personal care to 41 people aged 65 and over at the time of the inspection.
People’s experience of using this service: The service did not have a robust auditing system in place. Audits that were completed lacked detail and were not completed regularly.
The service did not have a clear or accurate oversight of safeguarding incidents. However, people we spoke with told us that they felt safe and staff were able to tell us how they would respond if they suspected abuse.
Risks were not consistently assessed and risk assessments were not always updated when something changed. This meant that records may not include details of the most recent level and types of risk. However, people told us that they felt the care they received was safe.
No evidence of capacity assessments or best interests was available at the time of the inspection. However, one person was assessed as lacking capacity to make some decisions and relevant assessments had not been completed. The record included details of how the person may be assisted to make their own decisions. This meant that although records were not complete, people were being supported to make their own decisions rather than decisions being made for them.
Although people had experienced missed visits, there was no effective system to monitor these so that causes could be identified and actions taken to prevent recurrence.
People told us that the service responded to their needs and that visits could be changed informally by ringing the office.
People spoke positively about the registered manager and management team. People told us that they could approach the registered manager and care staff with concerns or complaints when necessary,
People told us that they received care from staff who were kind and that care visits were completed by staff that they knew.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection: Requires Improvement (March 2018).
Why we inspected: This was a planned inspection based on the previous rating.
Enforcement: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.