28 September 2018
During a routine inspection
This service is a domiciliary care agency. It provides personal care to adults who require care and support who live with their family or in their own houses and flats in the community. The service was also available to provide personal care for children, however there were no children being provided with personal care when we inspected. Not everyone using Prestige Nursing Limited Dartford service receives regulated activity; 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 inspection, 58 adults were receiving personal care in their own homes.
This was the first comprehensive inspection following a change of the providers legal entity and new location registration on 10 October 2017. Since the change there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.
The provider employed a registered manager at 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.
An assessment of risks took place for each person and risk control measures were put into place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to minimise the risk from potential hazards.
Accidents and incidents were recorded by staff, logged on a computerised monitoring system, investigated. When required incidents were followed up by the registered manager to ensure appropriate action had been taken and to identify themes to learn lessons and prevent future occurrences.
Medicines administration was monitored and overseen by a qualified nurse. Staff received training and followed an up to date policy so that people received their medicines in a safe way. Care plans, medicines administration records (MAR) and daily records showed current information about people’s medicines.
A safeguarding procedure with the information staff would need to follow if they had concerns about people was available. People told us they felt safe and knew who they would talk to if they did not.
The provider and registered manager followed safe recruitment practices to recruit suitable staff. Enough staff were available to be able to run an effective service and be responsive to people’s needs. Staff had a suitable induction period when they were new where they were introduced to people before they started to support them. The people we spoke with told us they had regular staff to support them who were on time when visiting and supported them for the time they were allocated.
Staff training was planned and monitored. A range of statutory and specialised training was available to staff based on people’s needs. Suitable training to make sure staff maintained their skills and knowledge were up to date. Nursing staff received support to maintain their nursing accreditation.
Staff had one to one supervision meetings, staff had been regularly observed while carrying out their duties to ensure they continued to provide safe care and follow good practice. Management monitored staff whilst carrying out care to people in their homes, through staff meetings and by keeping staff updated with organisational information and new health and social care guidance.
People had an initial assessment before they received a service and the assessment was used to produce a care plan personalised to them. Documentation in the care plans was fully completed. A person-centred approach had been taken in the care planning process to promote the importance of staff accessing individual information about people, which was documented.
The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). 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.
People were supported with their nutrition and hydration needs where necessary. People’s relatives took responsibility for this for most people. However, where people did require this support from staff, people and their relatives told us they were happy with the support.
End of life care was provided as part of a joint working approach with other organisations delivering end of life care to people in the community.
Many people did not require the assistance of staff to manage their health care needs as they either took care of this themselves or had a relative or friend to help. Where assistance was required, staff knew who to contact to get people the help they needed.
The registered provider had a set of values the staff understood and included protecting people's human rights.
The caring approach of staff was evidenced by people and their relatives making positive comments about the staff who supported them. People told us they had regular staff providing their care and support who had got to know them well, creating confidence and trust. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.
The provider had an up to date complaints procedure and people and their relatives told us they would know how to make a complaint if they needed to.
The registered provider and registered manager used a range of auditing systems to monitor the quality and safety of the service, these were used effectively to identify where improvements were needed and to take action. Quality auditing processes included asking people who used the service for their views. This happened either informally by the management contacting people by telephone or by face to face, and more formally with bi annual surveys taking place. The feedback we viewed indicated that people thought the service was well run and were positive about their experiences.
The registered manager and provider effectively used their quality audit system to plan improvement to the service. The management benefited from learning and meeting with other managers within the organisation.