11 August 2015
During a routine inspection
The inspection was announced and took place on 11 August 2015. We give domiciliary care providers 48 hours’ notice to ensure we can access the information we need.
Nurse Plus and Carer Plus (UK) Limited is a large nationwide care agency. However, the majority of their work is in providing registered nurses to registered services. A smaller portion of their work is providing care workers to provide personal care services to people in their own homes. This is the area which is registered with the Care Quality Commission (CQC) and features in this inspection. The Exeter branch of Nurse Plus and Carer Plus (UK) Limited currently provides personal care and support to 12 people in their own homes in Exeter and the surrounding areas.
During our inspection we met with the registered manager of the Exeter branch. 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. The registered manager said they were well supported by the provider and at the time of the inspection we were able to speak with the Director of Compliance and Training who was present to support the registered manager.
There were good systems in place to ensure risks to people’s safety and wellbeing were identified and addressed. There was a robust recruitment, induction and training process to ensure people benefitted from receiving care from suitable staff who had the skills and knowledge to meet people’s assessed needs.
The feedback we received from people was all positive. Those people who used the service expressed satisfaction and spoke very highly of the registered manager and staff. For example, people consistently praised the agency for the individualised way in which they were cared for. One person particularly praised the way in which they had been cared for as a relative of the person receiving the service. They said “The staff are really outstanding and supportive; they have helped me too during a difficult time. We have lovely, regular carers who go to great pains to ensure [my relative] is comfortable and maintains their wellbeing.”
The registered manager ensured that staff had a full understanding of individual people’s care needs and had the skills and knowledge to meet them. People received consistent support from care workers who knew them very well. People felt safe and secure when receiving care and had been able to build positive relationships with their regular care workers and were confident in the service. People who used the service felt they were treated with kindness and said their privacy and dignity was always respected.
People received a service that was based on their personal needs and wishes. Staff arrived for visits in a timely way, knew what to do and were reliable. Changes in people’s needs were identified and their care package amended to meet their changing needs. The registered manager gave us examples of situations where they had identified a need and involved various relevant health professionals to ensure the person received appropriate care. For example, increasing the hours a person received, timings or identifying safeguarding issues.
The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views. People said they knew who to talk to if they had any concerns but had not needed to. The registered manager was open to improvement and feedback from people, whether positive or negative, which was used as an opportunity for improvement. For example, a past safeguarding issue had been used to amend the agency safeguarding policy so that staff were more aware to identify where people were at risk from self- neglect and how to manage this safely and in the person’s best interests. One example showed how this had been put into practice to ensure a person was not losing weight.
The registered manager demonstrated a good understanding of the importance of effective quality assurance systems such as spot checks, appraisals and surveys. There were processes in place to monitor quality and understand the experiences of people who used the service.
Staff were proud of the service and enjoyed their work. They said they were supported by the registered manager and a programme of training and supervision that enabled them to provide a good quality, person centred service to people.