Nurtured Care NE

Nurtured Care NE is a domiciliary care agency providing personal care to people in their own homes. They also support some people in support living care settings. At the time of our inspection there were 260 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

Medicines were not always managed safely. Some people were receiving time sensitive medicines too close together. Medicines documents were not always completed correctly. Some risks to people such as moving and handling risks were not full assessed and mitigations were not always put in place.

Robust quality assurance processes were not always in place. Some audits were in place but had not identified some of the issues we found during inspection. Opportunities to learn lessons and improve the service were not always taken, we have made a recommendation about this.

The provider employed sufficient staff who were trained appropriately. Some recruitment records were not in line with best practice, we have made a recommendation about this. Staff worked effectively with other healthcare professionals. Infection control measures were in place.

People were safe from the risk of abuse. Risks to people were assessed and regularly reviewed when people's needs changed. The building was well maintained, and health and safety risks were assessed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff said the management team were supportive. People and relatives thought the service was managed well most of the time.

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.

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 17 August 2020).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, safeguarding and the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nurtured Care NE on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, risk assessments and quality assurance processes.

We have made recommendations about staff recruitment records and incident recording.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nurtured Care NE is a domiciliary care agency providing personal care and support to people living in their own homes. 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. At the time of inspection 230 people were receiving personal care.

People’s experience of using this service and what we found

People and their relatives were happy and complimentary about the care provided by their regular staff team but some were unhappy they were not told which carers would be visiting each week. People felt safe with staff and relative’s confirmed that people had their needs met by staff.

There was enough staff available to support people during their planned visits. Staff had access to regular training and support. New staff received an induction and on-going support.

Staff were trained in medicine administration and had their competencies assessed. There were appropriate checks in place to make sure medicines were managed safely.

People and their relatives were involved in reviews of their care needs and assessments. People had visit plans in place which detailed what support was needed by staff. If people’s needs changed their care package was adjusted to support with any additional tasks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 21 May 2021).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had received about medicines management, staffing levels, staff training and people’s care needs not being fully met. The overall rating for the service has not changed following this targeted inspection and remains good.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and responsive sections of this full report.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nurtured Care NE is a domiciliary care agency providing personal care and support to people living in their own homes. 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. At the time of inspection 209 people were receiving personal care.

People’s experience of using this service and what we found

People and relatives felt comfortable and safe with staff and were complimentary about them. Comments included, “The carers are fine and always respectful. They know exactly what to do and will always ask what I need doing” and, “My [family member] would be lost without the carers.”

People felt safe with the support they received from staff. There were enough staff deployed to meet people’s needs. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19.

Staff supported people in a respectful, dignified manner. People were well cared for and were encouraged to maintain their independence.

The service was well-managed. The registered manager and senior staff promoted an open and honest culture and were approachable. One staff member said, “[Registered manager] is very approachable and understanding. I often seek support from her as she listens and gives advice I need.” The provider had an effective quality assurance process in place which included regular audits and quality surveys.

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 August 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, infection prevention and control, people’s dignity and overall management of the service. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Caring and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nurtured Care NE on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nurtured Care NE is a domiciliary care agency. At the time of the inspection, 278 people were 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

The provider had an effective recruitment procedure in place. People and family members said staff generally arrived on time, stayed as long as they should and never missed a call visit. Appropriate arrangements were in place for the safe administration and recording of medicines. People were protected from risks and the provider learned from accidents and incidents.

The registered manager monitored the quality of the service to make sure they delivered a high standard of care. People and family members spoke positively about the quality of the service. Staff said they were comfortable raising any concerns and the management team were approachable. People, family members and staff were able to feedback on the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 June 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 15, 17, 18 and 25 April 2019. A breach of legal requirements was found. We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to 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 Nurtured Care NE on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People's experience of using this service: People and their relatives told us the care and support they received from 101-102 Aidan Houses was of a good level. They told us staff knew and fully understood people's needs.

There was a lack of overall quality assurance in place. The registered manager was unable to provide evidence for some of the audits they had completed. Issues highlighted during inspection had not been identified by the provider.

Issues were identified with the lack of recording of some medication for some people. Some care plans did not include a list of people’s prescribed medication. People told us they received their medication on time and staff told us they had received training in the administration of medication.

People told us they felt safe receiving care from staff. Staff we spoke with were confident in their ability to care for people safely and they were confident in their knowledge regarding safeguarding issues . Safeguarding issues were reported to the local authority and were actioned in line with the provider’s safeguarding policy.

Staff had access to regular in-house and external training to support people’s individual needs.

People received support from a consistent team of staff and people told us this was important to them.

Staff supported and encouraged people to have enough to eat and drink.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

People had access to health care professionals and some people told us staff accompanied them during these appointments.

People and relatives we spoke with told us the care they received was both kind and respectful.

People were encouraged to provide feedback regarding their care and this was done via written questionnaires and telephone interviews.

Staff we spoke with told us they felt supported by the registered manager. They told us the registered manager was approachable and they were confident to raise any issues.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: This was the first inspection of this service since it was registered in April 2018.

Why we inspected: This was a planned inspection following the provider’s registration.

Follow up: We have asked the provider to send us an action plan telling us what steps they will take to make the improvements needed. We will return to re-inspect this service within the published timeframe for services rated requires improvement.