Archived: Nightingale Social Care Limited

Updated 27 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service short notice of the inspection. This was because we needed to give them time to prepare for our visit due to the COVID-19 pandemic.

Inspection activity started on 29 September 2021 and ended on 13 October 2021. We visited the office location on 5 October 2021.

What we did before the inspection

We reviewed information we had received about the service since registration. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with five people who used the service and 10 relatives of people who used the service, about their experience of the care provided. We spoke with twelve staff, including the registered manager, a director, a care coordinator and nine care staff. We reviewed a range of records. These included three people’s care records and medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek any clarification we needed in relation to records we had reviewed.

Updated 27 November 2021

About the service

Nightingale Social Care Limited is a domiciliary care agency which means staff go into people’s own homes to provide care and support. 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 the inspection there were 90 people using the service.

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

People who used the service said they received safe care from Nightingale Social Care Limited. However, some of the service’s practices did not always support safe care. We identified significant shortfalls in the recording of incidents, which meant we were not assured the service was effectively managing risk or doing all they reasonably could to keep people safe. There were further record keeping issues with people’s medication charts. Most people told us the medication support they received was good however, due to our underlying concerns about incident handling, we were not assured medication errors were consistently well-managed by the service. People told us care staff stayed the full duration of their call time and they felt safe in the company of staff. Feedback showed there was a recurring theme about staff being late to planned care visits and care staff changing often. Aspects of the service which did support safe care included proper completion of recruitment checks and good practices to prevent the spread of infection. People and relatives told us staff used personal protective equipment (PPE) appropriately when providing care.

Since the last inspection the provider had implemented a new electronic care planning system. At the time of our review further action was needed to embed this system. The management team completed regular checks to monitor the quality and safety of services provided. However, these checks were not always robust at ensuring the service was meeting requirements in regulation.

The service predominantly supported older people or people living with dementia in the community. Staff received an induction and relevant training to ensure they had the skills and competence to provide effective care. We made a recommendation about the provider’s training programme should they choose to support people with other primary needs in the future. People’s needs were assessed, and care and support were reviewed as their needs changed. Appropriate referrals were made to external services to ensure people’s needs were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and promoted independence; the policies and systems in the service supported this practice.

Feedback we received from people who used the service and their relatives was complimentary about the care staff. Staff involved people in decisions about their day to day care and consulted people regarding what they wanted. Systems were in place to make sure the service complied with the Accessible Information Standards. People’s care records documented the level of care and support required.

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

Rating at last inspection:

The service did not receive a rating at the last inspection as we undertook a focused inspection to check the key questions Safe and Well-led (published 23 October 2020). This service was registered with us on 03/06/2019 and this is the first comprehensive inspection.

Why we inspected:

This was the first comprehensive inspection of a newly registered service.

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 breaches in relation to medicines, recording of incidents and the provider’s systems of governance at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.