Nomase Care Ltd - Chadwell Heath

This service is a domiciliary care agency based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to 24 people.

People’s experience of using this service

Robust risk assessments were in place to ensure people received safe care at all times. This included risk assessments for people with specific health conditions. Medicines were being managed safely. Systems were in place to manage accidents and incidents.

Systems were in place to ensure staff attended care calls on time. Pre-employment checks were carried out to ensure staff were suitable to support people safely. Systems were in place for infection control.

Quality assurance systems were in place to identify shortfalls and take prompt action to ensure people always received safe care. Feedback was sought from people and staff to make improvements to the 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 previous rating was Requires Improvement, this service has been in Special Measures since our last inspection on 4 July 2023 [published 11 August 2023] due to their rating of Inadequate under Well-Led. We found breaches of regulation on risk assessments and good governance.

During this inspection, the provider demonstrated that improvements have been made.

Why we inspected

We undertook this focused inspection to check if the service had made improvements on the breaches of legal requirements found at the last inspection. This report only covers our findings in relation to the key questions of Safe and Well-led, which contain those requirements. The service continued to be in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive inspections since being placed on special measures. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. The service does not have an Inadequate rating in any key questions now and has come out of special measures.

For those key questions not inspected and rated, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service remains Requires Improvement.

We have found evidence that the provider had made improvements and met the requirement notices. 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 reports’ link for Nomase Care Ltd - Chadwell Heath 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.

This service is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to 27 people.

People’s experience of using this service

Robust risk assessments were not in place to ensure people received safe care at all times. This included lack of robust risk assessment for people with specific health conditions. Medicines were not always managed safely.

Quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people always received safe care.

People and relatives told us staff were punctual and systems were in place to monitor time keeping. Systems were in place to ensure staff attended care calls on time. Pre-employment checks were robust to ensure staff were suitable to support people safely. Systems were in place for infection control.

Care plans were personalised to ensure people received person centred care. Systems were in place to obtain feedback from people and relatives.

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

Rating at last inspection

This service has been in Special Measures since our last inspection on 12 December 2022 [published 23 June 2023]. We found breaches of regulation on risk assessments, medicine management, care planning, staff timekeeping and good governance. During this inspection, the provider demonstrated that some improvements have been made. However, concerns with risk assessments and good governance remains.

Why we inspected

We carried out an announced comprehensive inspection of this service on 12 December 2022 and breaches of legal requirements were found and the service was placed in special measures due to their rating of Inadequate.

We undertook this focused inspection to check if the service had made improvements on the breaches of legal requirements found at the last inspection. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led, which contain those requirements.

For those key questions not inspected and rated, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections since being placed on special measures. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nomase Care Ltd - Chadwell Heath on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk assessments and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nomase Care Ltd - Chadwell Heath is a domiciliary care agency based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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 the inspection, the service was supporting 56 people with personal care.

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

We continued to find that robust systems were not in place to ensure staff attended calls on time. Robust risk assessments were not in place in relation to people’s health conditions to ensure they received safe care at all times. Medicines were not being managed safely.

Pre-admission assessments and care plans were not robust to ensure people’s preferences with support and care were captured. Care plans lacked evidence that people were being involved in decisions about their care.

Robust quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people received safe and effective care at all times.

Pre-employment checks had been carried out to ensure staff were suitable to support people. Staff had completed essential training to perform their roles effectively and felt supported in their roles. People had choices during mealtimes and were supported to access healthcare services. People were encouraged to be independent and to carry out tasks without 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. Feedback was sought from people and staff.

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 27 January 2022 and there were 5 breaches of regulation specifically on Regulations 9 (person-centred care), 11 (need for consent), 12 (safe care and treatment), 18 (staffing), and, 17 (good governance). At this inspection, not enough improvement had been made, the provider continued to be in breach of regulations 9, 12, 18 and 17 for the for the second time.

Why we inspected

We undertook this inspection to check if there were improvements regarding the concerns we identified at the last inspection and if the service was compliant with the requirement notices on Regulation 9, 11 and 12 and warning notices we served on Regulation 18 and 17.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last inspection report, by selecting the ‘all reports’ link for Nomase Care Ltd - Chadwell Heath on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk assessments, medicine management, staffing, person centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is Inadequate and the service is therefore in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Nomase Care Ltd - Chadwell Heath is a domiciliary care agency based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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 the inspection, the service was supporting 48 people with personal care.

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

People and relatives had concerns about the care people received and staff not staying the allocated times. We found robust systems were not in place to ensure staff attended calls on time.

Not all risks were identified and assessed to ensure people received safe care. Pre-admission assessments and care plans were not robust to ensure people’s preferences with support and care were captured. Care plans did not include how staff should communicate with people effectively. Medicines were not being managed safely in some areas.

People were not 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. Robust systems were not in place to analyse and learn from complaints and incidents to minimise the risk of reoccurrence.

People were not involved in decisions about their care. We made a recommendation in this area.

Robust quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people received safe and effective care at all times.

Pre-employment checks had been carried out to ensure staff were suitable to support people. Staff had completed essential training to perform their roles effectively and felt supported in their roles. People had choices during mealtimes and were supported to access healthcare services. People were encouraged to be independent and to carry out tasks without support. Feedback was sought from people and staff.

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 good (published 10 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about care planning, staff attending calls late and staff approach. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk assessments, medicine management, staffing, need for consent, care planning and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service provided personal care to 74 people in their homes. This was the first inspection of the service since it registered with the CQC.

The service had two registered managers. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Some risks to people were not always robustly managed. We found some care plans did not contain suitable and sufficient risk assessments to effectively manage risks. We made a recommendation in this area.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and were aware of the principles of the act. Records showed that one person did not have capacity to make decisions and an assessment of their capacity using the MCA principles had not been carried out. We made a recommendation in this area.

Quality assurance and monitoring systems were in place to ensure there was a culture of continuous improvements. However, this had not identified the shortfalls we found in relation to risk assessments and MCA assessments. The registered manager informed us that they will ensure the systems would be made more robust.

Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

There were arrangements in place to ensure staff attended care visits on time. Staff told us they had time to provide person centred care and the service had enough staff to support people.

Pre-employment checks had been carried out in full to ensure staff were suitable to provide care and support to people safely.

Staff had been trained to perform their roles effectively. Staff had also been trained in specialist training to help support people with complex care needs.

Pre-assessment forms had been completed to assess people’s needs and their background before they started using the service. Reviews were held regularly to identify people’s current preferences and support needs.

People were being cared for by staff who felt supported by the management team.

People were supported to access to healthcare if needed.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

Staff, relatives and people were positive about the management team. People’s feedback was sought from surveys.

Complaints received had been investigated and relevant action had been taken. Staff were aware of how to manage complaints.