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Archived: Nightingale Homecare and Community Support Services Ltd

Overall: Requires improvement read more about inspection ratings

Unit 39, Folkestone Enterprise Centre, Shearway Business Park, Shearway Road, Folkestone, Kent, CT19 4RH (01303) 271959

Provided and run by:
Nightingale Homecare and Community Support Services Ltd

Important: This service was previously registered at a different address - see old profile

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Background to this inspection

Updated 16 September 2015

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 was 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.

This inspection took place on 29 and 30 July 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure we are able to speak with people who use the service and the staff who support them. We went to the service’s main office and looked at care plans; staff files, audits and other records and we visited and talked with people in their own homes.

Two inspectors and an expert-by-experience, with a background of older people and domiciliary care, completed the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We reviewed information we received since the last inspection, including notifications. A notification is information about important events, which the provider is required to tell us about by law.

During the inspection we visited and spoke with thirteen people and two relatives in their own homes. We spoke with the branch manager, two co-ordinators who organised the work for the staff and fourteen members of staff. We reviewed people’s records and a variety of documents. These included twenty-one people’s care plans and risk assessments. Thirteen care plans were looked at in peoples own homes and eight care plans were looked at the service’s office. We looked at five staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys.

After the inspection the expert by experience contacted twenty five people by telephone. We also contacted three members of staff by telephone to gain their views and feedback on the service.

Health and social care professionals told us that they were working closely with the service and being regularly updated with the progress the service was making with their action plan to improve the care and support delivered to people.

The previous inspection of this service was carried out in February 2015. At this inspection we found that the provider was in breach of three regulations. These were ongoing breaches since September 2014.

Overall inspection

Requires improvement

Updated 16 September 2015

The inspection visit took place at the service’s office on 29 and 30 July 2015. On both days we visited people who used the service in their own homes.

Nightingale Homecare and Community Support Services Ltd are registered to provide personal care to people living in their own homes in the community. They provide care and support to a wide range of people including, older people, people living with dementia, learning disabilities and mental health needs. The support hours varied from 24 hour support to one to four calls a day, with some people requiring two members of staff at each call.

The service also provided care and support through the supported living scheme. These people lived in shared accommodation such as two/three bedroom houses where they shared communal areas with other people. Staff also supported people with their personal care who lived in extra care units, in purpose built accommodation. Each person had a tenancy agreement and rented their accommodation.

At the time of the inspection 109 older people were receiving care and support in the community, 59 in the extra care housing units and 33 people in the supported living accommodation.

The service’s office is based in a business park on the outskirts of Folkestone and offers support and care to people in Folkestone, Hythe, Dover, Deal and surrounding areas.

The previous inspection of this service was carried out in February 2015. At this inspection we found that the provider was in breach of three regulations, safe care and treatment, person centred care and good governance. The provider had sent an action plan to CQC in March 2015 with timescales as to when the service would be compliant with the regulations.

At this inspection the plan had not been fully actioned by the provider and the three breaches of the regulations issued at the previous inspection in February 2015 had not been met. The service continued to be in breach of three regulations, safe care and treatment, person centred care and good governance. We have started the process of taking enforcement action against the provider.

The service had improved in several areas, such as continuity of staff, communication with people, and supporting staff.

There was no registered manager in post. The registered manager had recently resigned from the position. 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 and associated Regulations about how the service is run. The provider told us that a new manager had been appointed who was in the process of applying to CQC to become the registered manager. There was a branch manager in post who dealt with the day to day running of the service and supported the inspectors with the inspection.

Risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff to keep people safe.

There was a lack of risk assessments in place to ensure that people received their medicine safely. Medicines were not listed or recorded safely so it was not clear what medicines people were taking. Some medicine records were not clear or accurate.

Everyone using the service had a care plan in place; however these varied in detail to show how people’s needs were being met. A new system of care planning covering the assessment process, was being introduced, which was due to be completed in June 2015 but at the time of the inspection there was less than half of the 109 older people living in the community who had the new care plan in place. Therefore some people’s care plans were not up to date and did not have all of the personalised information staff needed to make sure people received the care they needed, in line with their choices and preferences. There was also a lack of information in the care plans for staff to support and monitor people living with medical conditions such as diabetes.

Staff understood how to support people to make decisions and consent to care and support, however mental capacity assessments were not always completed. Staff had received training on the Mental Capacity Act 2005. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

Records were stored safely but were not always accurate. Some medicine records were hand written and not double checked to make sure the correct medicines had been recorded. Care plans and risk assessments were not consistently signed and dated by the staff who had completed them.

People were supported with their nutritional needs. People told us that they chose what they wanted to eat. Staff prepared meals and made sure people had enough to drink.

There was enough staff employed to give people the care and support that they needed. Staff had received training in how to keep people safe and demonstrated a good understanding of what constituted abuse and how to report any concerns. Accidents and incidents were reported and action taken to reduce the risk of further occurrences.

New staff had induction training which included shadowing experienced staff, until staff were competent to work on their own. There was an ongoing training programme in place. Staff had a range of training specific to their role, but there was a lack of specialised training being provided such as, learning disability and epilepsy.

Staff had regular one to one meetings with a senior member of staff. At these meetings they had the opportunity to discuss any issues or concerns. Staff competencies were being ‘spot checked’ to make sure they were caring and supporting people safely.

People were treated with respect and their privacy and dignity was maintained. People we visited told us the staff were kind and respectful. They told us that staff listened to what they wanted and always asked if there was anything else they needed before they left. Families also told us that the staff had a good relationship with their relatives and knew their daily routines and how they wanted their care to be delivered.

People and their relatives were confident to raise concerns and complaints about the service. Complaints were logged and responses given explaining what action had been taken to address the issues raised.

There was a lack of oversight and scrutiny to monitor, support and improve the service. The timescales within the action plan were not met, and the provider remained in breach of the regulations. The provider was open and transparent and acknowledged that the action plan had not been completed; therefore not all of the required improvements had been achieved in the agreed timescales.

Staff said they understood their role and responsibilities but due to the changes in the management structure of the service they were unsure who was responsible for the different areas of the organisation.

The service had systems in place to audit and monitor the quality of service but there was a lack of evidence to show how the results of these checks had been actioned to continuously improve the service.

The provider had made sure that people were able to feed back about the quality of the service. Telephone and quality assurance visits had been carried out to ask if people were satisfied with the service. People confirmed that this process had taken place and at the time of the inspection everyone we spoke with or visited was satisfied with the service. However, feedback had not been sought from a wide range of stakeholders such as staff, visiting professionals and professional bodies to ensure continuous improvement of the service was based on everyone’s views.

We found three ongoing breaches and two additional breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.