5 October 2018
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.
The inspection of Right Nurse Care Services took place on 18 September 2018. The inspection was announced a few days advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. The inspection was carried out by one adult social care inspector.
We reviewed the Provider Information Record (PIR) and previous inspection reports before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed the information we held about the service and notifications of incidents we had received. A notification is information about important events which the service is required to send us by law.
During the inspection we went to the provider’s office and spoke with the registered manager/provider and the deputy manager. We looked at four records relating to the care of individuals, three staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service.
Due to people’s complex health needs they were unable to us about their experiences of using the service. Following the visit to the provider’s office we spoke with five relatives and four care staff.
5 October 2018
We carried out this inspection on 18 September 2018. The inspection was announced a few days in advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. At the last inspection, in April 2018, the service was rated Good. At this inspection we found the service remained Good.
Right Nurse Care Services provides personal care to people living in their own homes in the community. Services are provided across Cornwall to adults of all ages who have a range of complex needs, including physical disabilities, learning disabilities, mental health needs and dementia. At the time of our inspection the service was delivering 475.5 hours per week for eight people. These services were funded either privately, through Cornwall Council or NHS funding.
People were unable to us about their experiences of using the service due to their complex health needs. However, people’s families told us they were happy with the care their relative received and believed it was a safe reliable service. Comments included, “The service is very reliable and I am confident that the team can deal with any unforeseen circumstances” and “Very happy with the service provided.”
People were treated respectfully and staff asked how they wanted their care and support to be provided. Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. People who needed help taking their medicines were appropriately supported by staff.
Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.
People were supported by dedicated staff teams who were employed and trained to work specifically with each person using the service. There were suitable arrangements in place to cover for staff absences, this included office staff covering shifts and a group of care staff who had been trained to work in multiple teams. Relatives told us, “The team are very ‘stable’ and dad is very familiar with them all” and “Generally speaking there is a consistent team caring for my sister, some of whom have been doing it for years.”
The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
The service had robust recruitment practices, which meant staff were employed suitable to work with vulnerable people. Training records showed staff had been provided with all the necessary training which had been refreshed regularly. Staff told us they found the training to be beneficial to their role. Staff said they were encouraged to attend training to develop their skills, and their career.
Staff told us they enjoyed their work and received regular supervision, appraisals and training. Staff were complimentary about the management team and how they were supported to carry out their work. The management team were also clearly committed to providing a good service for people.
There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. Relatives told us they knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.