We carried out a review of the data available to us about Nissi Care Solutions on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Nissi Care Solutions, you can give feedback on this service.
Nissi Care Solutions is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, younger adults, people with a learning disability, people living with dementia and a physical disability and people with sensory impairment. At the time of our inspection there were 53 people using the service.
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.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support:
People’s visits had been scheduled with minimal travel time for staff. This meant staff were at risk of running late or having to leave slightly earlier. People’s feedback about timings and duration of visits was mixed but most felt this was an area that could be improved. Quality monitoring systems were in place to identify any areas for development; however, they had not captured people’s feedback about visits and duration of visits.
People were protected from the risks of abuse as staff understood their responsibilities to report any concerns. Risks to people’s safety had been assessed and updates carried out when needed. Safe recruitment checks were being carried out prior to staff starting work.
Right Care:
People were supported to take their medicines safely. People’s needs with regards to medicines were recorded in their care records. People’s communication needs were recorded, and guidance given on how to communicate effectively with people. Systems were in place to make sure staff followed good infection, prevention and control guidelines.
Right Culture:
Staff told us there was an open culture at the service, they felt able to voice their views about any issues or concerns. The provider met regularly with staff to discuss good practice and changes to people’s needs. People’s preferences about how they wanted their care delivered were recorded in their records. Senior staff monitored care notes to make sure staff were following the care planning.
The registered manager was open and transparent during the inspection. They responded to feedback and were keen to improve the service where needed. Staff worked with healthcare professionals to make sure people’s health needs were met.
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 15 November 2017).
Why we inspected
This focused inspection was prompted by a review of the information we held about this service. We have reviewed safe and well-led at this inspection.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nissi Care Solutions on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
At the previous inspection in October 2016 we found the provider had not taken the necessary actions to ensure that medicines were managed safely. People's Medicine administration records (MAR) did not always contain accurate information relating to the administration requirements of specific medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.
People were not always supported in line with the principles of Mental Capacity Act 2005 (MCA) . This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. The provider did not have an effective system in place to monitor the ongoing management of the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.
At this inspection we found that the registered manager had made significant improvements to address the areas of concern and bring the service up to the required standards. Where people needed support with taking their medicines we saw that medicine records were accurately maintained and up to date. People received their medicines as prescribed.
The registered manager was knowledgeable about MCA and how to ensure the rights of people who lacked capacity were protected. People were supported in line with the principles of MCA.
Regular audits were conducted to monitor the quality of service. These were carried out by the deputy manager and then checked by the registered manager. Audits covered all aspects of care. Information was analysed and action plans created to allow the registered manager to improve the service.
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.
People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.
People's care records contained up to date and accurate information and guidance for staff to mitigate the risks associated with people's care.
People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work.
Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service.
The service sought people's views and opinions. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.
People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.
Nissi Care Solutions provides personal care to people with a range of conditions, living in their own homes. At the time of our inspection there were 73 people using the service.
There was a registered manager in post. 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.
Medicines were not always managed safely and we could not be sure people were receiving their medicines as prescribed.
The registered manager and staff were not clear about their responsibilities in relation to supporting people in line with the Mental Capacity Act 2005.
The provider had not sent in notifications to the Care Quality Commission (CQC) of events they were required to tell us about by law.
Systems were not in place to assess, monitor and improve the service.
People were supported by staff who understood their responsibilities to identify and report safeguarding concerns. Where risks associated with the support people required were identified there were plans in place to manage the risks.
There were sufficient staff to meet people's needs and people benefited from a consistent staff group. This enabled staff to develop caring, positive relationships with people. People were positive about the support they received and the caring approach of staff. Staff spoke respectfully when speaking about people. We heard supportive conversations between staff and relatives.
Staff had the skills and knowledge to meet people's needs. Staff were positive about the support they received and felt valued and listened to.
People were supported to access health and social care professionals when needed. Management and staff were responsive to people's changing needs.
People were confident to raise any concerns with the registered manager and felt they would be dealt with in an appropriate manner.
The registered manager was working to improve the care plan system and was aware of the need to make further improvements.
Is the service safe?
The service was safe. People told us they felt safe. Staff personnel records contained all information required. Staff were confident to raise concerns to the manager and able to describe the different ways people might experience abuse. They understood the correct steps to take if they were concerned abuse had taken place.
Is the service effective?
The service was effective. Staff had a good understanding of people's care and support needs and they knew people using the service well. Each person had a well written care plan that detailed their support needs. There was a robust procedure for recruiting staff and for making sure they had the skills and knowledge to support people using the service.
Is the service caring?
The service was caring. We saw staff demonstrated a great deal of patience when they were supporting people and gave people plenty of time to make their own decisions. One staff member told us, 'We do our best all the time.' People confirmed to us they were not ever rushed.
Is the service responsive?
The service was responsive. There were audits in place to monitor the quality of the service. People's support needs were always assessed before they used the service. Care records reflected people's needs and ensured support was provided in accordance with their wishes.
Is the service well-led?
The service was well-led. Staff had a good understanding of the aims of the service and there were quality assurance processes in place. All staff were regularly supervised by senior staff. Care records we viewed were accurate, current and complete. The service had a robust system in place to respond to complaints and concerns.
People's care and treatment was planned and delivered in a way that met their needs. Each person had an assessment and care plan. The relatives told us that their relatives had been involved in developing their care plans which were updated when their needs changed.
The provider had policies and procedures about safeguarding and staff had received training so that people were protected from the risk of abuse. The people we spoke with told us that the carers were trustworthy and their relatives who used the service felt safe with the staff.
We saw that the each member of staff received the training they needed to do the job. This meant that people were cared for by skilled and well trained staff.
There were systems so that people who used the service and their relatives could give feedback about the service. Any concerns were acted upon. There was a complaints procedure and people knew how to make a complaint. There were also systems to assess and manage risks so that people were kept safe.