Background to this inspection
Updated
26 February 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 5 and 19 January 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care; we needed to be sure that someone would be in.
The inspection was carried out by one inspector.
We reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We also contacted the local authority commissioners for the service and the clinical commission group (CCG).
We spoke with three people who used the service and three family members. We also spoke with the registered manager and three care workers. We looked at the care records for four people who used the service, medicines records for four people and recruitment records for five staff.
Updated
26 February 2016
This inspection took place on 5 and 19 January 2016 and was announced. The service was last inspected on 9 October 2013 and was meeting the regulations we inspected against at that time.
Prestige Nursing – Newcastle provides personal care to people living in their own homes in the North East of England. Care is provided to people with a range of specific needs. The service was registered for three other regulated activities. However, at the time of our inspection only personal care was being provided. Eight people were receiving personal care from the registered provider.
The service had a registered manager. 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.
We found the registered provider had breached the regulation about medicines. This was because medicines administration records (MARs) did not support the safe management of medicines. In particular some MARs were undated making it difficult to confirm people had received their medicines when they were due. There were unexplained gaps on all of the MARs we viewed. Medicines audits were ineffective and inconsistent.
You can see what action we have asked the registered provider to take at the back of the full version of this report.
People were happy with care they received from the service. They were cared for by kind and caring staff who knew their needs well. One person told us, “I wouldn’t know what to do without them.” Another person said, “I have had the same carers for nearly two years now.” People also told us they were treated with dignity and respect. One person said they were “treated nicely.” Another person told us, “I am treated with dignity and respect.”
People and staff told us they felt the service was safe. One person commented, “100% safe.”
Staff had a good understanding of safeguarding adults and whistle blowing, including how to report concerns. One staff member commented, “I have not had to use it [whistle blowing].” Staff told us they felt concerns would be dealt with thoroughly.
Potential risks had been assessed, such as risks associated with the person’s care and support and their living environment. Risk assessments did not always record the measures in place to control the potential risks.
Most people were cared for by reliable and appropriately recruited staff. One person said, “[Staff] stay the full length of time. They are very, very reliable.” Staff members told us they had the time they needed to care for people.
There was a business continuity plan to help keep people safe in emergency situations. The registered provider had a system for logging and investigating incidents and accidents. Action had been taken following previous incidents to help prevent the situation from happening again.
People were usually cared for by skilled and competent staff. One family member said, “[Staff] are all very keen to learn.” Records confirmed staff training was up to date. Staff said they were well supported to carry out their caring role. One staff member described the support they received from the registered provider as “really good." They said, "I can bring up concerns. There is an open door policy.”
The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA). A MCA assessment and best interest decision had been made on behalf of one person. People were asked for permission before receiving care and staff respected their right to refuse.
Support plans contained specific guidance for staff to help them support people with more specialist health conditions. People had been assessed by health professionals, such as a speech and language therapist.
The service was responsive to people’s needs. One family member commented, “Very good, nothing is a bother.” Another family member told us, “They are there for when I want them. They come straightaway.”
People had been involved in developing care plans following an assessment of their needs. One person told us, “I have a care plan. I was involved all the way.” Another person said, “We talked it over [care plan] along with [my relative].” Outcomes had been identified for people based around what was important to them.
People and family members knew how to complain, although nobody we spoke with had complained to the registered provider. One person said, “I have not raised any concerns.” Another person said, “I have no complaints at all.” One family member told us, “I have not really had a complaint. I would speak to Fay [registered manager]. She would deal with it pretty quick.” One complaint had been received in 2015 and was currently being investigated at the time of our inspection.
The registered provider had not always made the required statutory notifications to the Care Quality Commission. We are dealing with this issue outside of the inspection process.
We received positive feedback about the approachability of the registered manager. One person described the registered manager as “very, very lovely.” One staff member said the registered manager was “really approachable.”
There were regular opportunities for staff to provide feedback about people’s care through attending regular team meetings.
A quality assurance programme was in place to check people received good care. Checks included ‘client reviews’, telephone reviews, consultation with people using the service and a six monthly quality audit. These showed people were satisfied with their care with no areas of concern or areas for improvement identified. The last six monthly quality audit due in November 2015 had not been completed. We found no evidence quality assurance checks were used to promote learning or continuous improvement of the service.
People using the service and family members were consulted about the care the service provided. We saw positive feedback had been given during the most recent consultation.