Destiny Nursing & Care Agency Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement: This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff gave positive feedback about the culture of the service. They felt well supported by their manager and colleagues. A member of staff said: “Management are accessible, they listen and provide support when needed.” Another staff member told us, “My line manager, very easy to approach and always ready to listen. Very open to new ideas.”

The provider had inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, the registered manager had not been as involved with the service on a day-to-day basis recently and we were not assured they had full oversight of the service.

The leadership team consisted of the registered manager and office manager. The provider had another location registered with CQC, and the manager of that service supported with this service too; we saw they completed some staff supervision and competency assessments as well as care record reviews.

The registered manager told us they were working on a contingency plan in the event they needed to take time off. There was an option for the registered manager of their other location to oversee this service too. We were concerned this may not be manageable. However, the registered manager told us they were also recruiting a deputy who could become an acting manager if required.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The service had a whistle-blowing policy. This advised staff to report any concerns to the registered manager. If they did not feel comfortable with this, they were advised to inform the local authority or CQC as appropriate.

Staff confirmed managers were approachable. A staff member said, “If I have any concerns—about someone we support or anything else—I know I can speak to my team leader or manager. They take concerns seriously.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

They had policies to support equal opportunities and inclusion.

The provider’s processes to monitor the safety and quality of the service were not always robust.

The registered manager’s system to monitor staff training and competence was not effective. The training matrix showed not all staff had completed all mandatory training and we did not see evidence of courses for additional complex needs people had. We requested moving and handling competency assessments, those we received were dated the day of our visit or just after and did not include any feedback for staff or their responses to questions; they were identical including the narrative. We reviewed medicines competency assessments and found this included prompts which would apply to care homes such as ensuring the cupboard is locked and only administering to 1 person at a time. This meant the forms had not been amended to reflect the service type.

We discussed people’s needs with the registered manager during our office visit and were told staff were not carrying out complex tasks and it was support only for those with clinical needs. We also discussed whether there were examples of input from other services, such as referrals to district nurses etc and were told there were no examples of this; the registered manager said no one had pressure injuries or were at risk of choking for example.

However, we found staff were carrying out suctioning and pureeing food for a person who had a speech and language assessment (SALT). This meant we were not assured the registered manager had full oversight of care provided by staff.

We reviewed another person’s care record and found their medicines risk assessment stated staff administer medicines, whilst their care plan stated staff assist with medicines; there was a lot of detail about how to do it here as complex which suggested staff were administering it. This would require additional training which staff had not received. We discussed this with the registered manager who confirmed staff did not administer the medicines; they prepared everything for the person who did it themselves. They told us the record to make it clearer.

Therefore, whilst people appeared to be supported by staff who knew them well and their relatives were very happy with no concerns, we felt there was room for improvement in the governance processes.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Professionals involved with the service gave positive feedback. A professional told us, “The provider considers the needs of the patient and work at the pace of the patient including leading clinical conversations with GP and other clinical professionals in the best interest of the patient.” Another professional confirmed the service worked with them to support people’s care. They told us, “They are supportive because they know the [person.]”

The provider focused on continuous learning and improvement. Whilst there were no plans to develop the service, and they were not looking to expand to include more service users, they engaged well with the assessment process and were responsive to our feedback.