We carried out a review of the data available to us about Nash Alliance Ltd 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 Nash Alliance Ltd, you can give feedback on this service.
Nash Healthcare Ltd is a domiciliary care agency providing personal care in people's own homes. At the time of the inspection the service was providing care and support to eighteen people.
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
Staff training had still not been sufficiently monitored and staff records still showed a variation in staffs' completion of training.
We made a recommendation about monitoring staff training.
We found improvements to how people's care plans and risk assessments were reviewed and recorded to ensure they reflected people's needs.
Improvements had been made to how the quality of the service was monitored and improved. Quality assurance checks, observations of staff practices and feedback from people and their relatives were used to identify areas that required further development and drive improvement across the service.
Notifications of deaths of people using the service were being sent to us.
People and their relatives spoke positively about the quality of care and support they received from the service. We heard descriptions such as “Very good”, “Can’t fault them” and “No complaints at all”.
Staff understood their role to report any concerns or incidents to the nominated individual and their responsibility to protect people from abuse and harm.
Safe medicines management and infection control practices were used.
There were enough staff available to ensure people's care and support needs were met. The nominated individual worked alongside staff and monitored their care practices and skills.
People and their representatives told us they usually received telephone calls if staff were going to be significantly delayed.
Staff told us they felt well supported and received regular supervision sessions from the nominated individual.
People were supported to have enough to eat and drink as required.
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 and update
The last rating for this service was Requires improvement (published 10 March 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 29 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the inspection to show what they would do and by when to improve Fit and proper persons employed and Good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led.
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 Nash Healthcare Ltd 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.
Nash Healthcare Ltd is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection 9 people were receiving personal care provided by the service.
People’s experience of using this service and what we found
The provider and the manager had taken steps to improve the service and ensure people were supported by suitable staff recruited using robust procedures. All the requirements of the warning notice had been met.
Rating at last inspection and update:
The last rating for this service was requires improvement (published 30 October 2020) when there were multiple breaches of regulation.
Following our last inspection, we served a warning notice on the registered provider. We required them to be compliant with Regulation 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 9 November 2020.
Why we inspected
This was a targeted inspection based on the warning notice we served on the registered provider following our last inspection. 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 undertook this targeted inspection to check they had met legal requirements. This report only covers our findings in relation to staff recruitment practices. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.
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.
Nash Healthcare Ltd is a domiciliary care service providing personal care to people living in their own homes. At the time of our inspection 14 people were receiving personal care provided by 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 found all required staff recruitment checks had still not been completed on staff, before they delivered people's care. This continued to put people at risk of receiving care from those who may not be suitable to work with vulnerable people. The provider’s monitoring systems had also not identified that their recruitment policy had not been fully implemented and therefore risks in relation to recruitment had not been managed effectively. We found other improvements had been made to the provider’s quality monitoring which had resulted in improvements to record keeping. Notifications of the deaths of people using the service had not been submitted to CQC to ensure we were able to check if the correct actions had been taken.
People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Staff followed infection control procedures to protect people. People's medicines were safely managed. People and their relatives told us they felt assured that care visits would take place and staff would contact them in the event of any late calls.
Rating at last inspection and update
The last rating for this service was requires improvement (published 3 August 2019) and there were two breaches of regulation. This service has been rated requires improvement for the last two consecutive inspections.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of these regulations. We also found a new breaches in relation to Notifications of deaths of persons using the service.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 29 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Regulation 17 Good governance and Regulation 19 Fit and proper persons employed.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nash Healthcare Ltd on our website at www.cqc.org.uk.
Enforcement.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified repeated breaches in relation to Good governance and Fit and proper persons employed. We also found a new breach in relation to Notifications of deaths of persons using the service.
We issued a warning notice in relation to the repeated breach for Regulation 19 Fit and proper persons employed.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will continue to monitor the information we receive about the service. We will return to visit as per our inspection methodology to follow up the provider’s progress in relation to their compliance with necessary regulations. If we receive further concerning information we may inspect sooner.
We will continue to work alongside the provider and commissioners of the service. We will meet with the provider and ask for an action plan to understand what they will do to improve the standards of quality and safety moving forward.
Nash Health Care Ltd - Gloucester is one of two locations run by Nash Healthcare Ltd which is a domiciliary care service providing personal care and other support to people living in their own homes.
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 this inspection nine people were receiving support with their personal care.
People’s experience of using this service and what we found
We have identified concerns in relation to staff recruitment practice, record keeping and quality monitoring of the service at this inspection.
Appropriate checks had not always been completed on staff, before they delivered people’s care. This put people at risk of receiving care from those who may not be suitable to work with vulnerable people. The provider had started to take action prior to our inspection to reduce risk to people from unsafe staff recruitment practices. They had identified staff with incomplete recruitment checks and they were not being used by the agency to deliver people’s personal care.
People’s support plans and risk assessments had not always been reviewed to reflect people’s current needs and levels of risk. This put people at risk of unsafe or inappropriate care due to a lack of accurate information about their needs for visiting staff and other health and social care professionals. The risk of people receiving inappropriate care due to poorly maintained care records was also being reduced. The provider ensured people’s care was delivered by a small group of regular and familiar staff, who knew people’s needs well. People receiving care were also, either able to direct staff themselves or had a representative present who could advise. Staff knew how to report any concerns about people’s care to the agency’s office where arrangements were made to address these.
The provider’s quality monitoring processes had not been effective in identifying these shortfalls and driving necessary improvement in a timely manner. This put people at risk of receiving unsafe services. However, changes were being made to how the service was being managed and quality monitored. A representative of the provider was now based in the Gloucester office and managing the service. Processes and systems were being introduced to help better monitor the quality of services provided to people and ensure staff received appropriate training and support. Existing processes were being reviewed to ensure they were operated inline with the company’s policies, procedures and expectations. As this was work taking place at the time of the inspection, we were unable to assess whether these changes would be effective in driving improvement to the service and whether these would be sustained.
Please see the action we have told the provider to take at the end of this report.
Staff worked with people and their representatives to ensure people received the support they required and preferred. This had included adjusting the times of people’s care calls to better suit people’s needs or preferences. People told us they were happy with the care they received.
People were confident their care visits would be completed. One person told us they were informed if the care staff were going to be late, but this was now rare and, a relative commented that previous problems with care visits running late, had been resolved.
People had access to healthcare professionals and staff ensured they followed instructions given by these professionals. Staff communicated effectively with professionals to aid consistent care.
People were supported to have maximum choice and control of their lives and systems in the service supported this practice. People’s consent was sought before care was delivered and staff were aware of how to support those who needed help with daily decision making.
People receiving care told us staff were kind, caring and helpful. Where this had not been the case the staff involved were no longer used. One person said, “I think they are brilliant; my choices are met.” Another person described how staff went out of their way to support their requests and preferences. This included going to collect take away food.
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):
This service was registered with us on 5 June 2018 and this is the first inspection.
Why we inspected
A planned comprehensive inspection was brought forward due to concerns received about staff recruitment and, missed and late care visits. A decision was made for us to inspect and examine these concerns.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.