Archived: 1st Care Nursing Limited

1st Care Nursing Ltd is a domiciliary care agency registered to provide personal care and nursing care for adults and children living in their own homes. At the time of our inspection care was being provided to 53 people of whom 17 people were receiving nursing care. The service benefitted from being a subsidiary of the Active Assistance Group which provides services for adults and children with a range of physical disabilities as well as specialised services in spinal cord injury and tetraplegia and other neurological conditions such as multiple sclerosis and cerebral palsy.

The service did not have a registered manager. The domiciliary care manager was in the process of registering with the Care Quality Commission to become a registered manager. 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 provider did not have robust quality assurance processes in place to ensure the service maintained and improved the quality of care provided. Although staff felt supported by management, some staff told us they had not received regular formal supervision.

There were effective recruitment procedures in place to protect people from the risk of avoidable harm. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Accidents and incidents were recorded and monitored to identify any trends and to mitigate reoccurrence. There were systems in place for receiving, administering and disposing of medicines.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. Staff were kind and sensitive to people’s needs and ensured people’s privacy and dignity was respected. People had developed positive relationships with staff and were happy with the care and support they received. People were supported by skilled and well trained staff. Staff were trained and understood the principles of the Mental Capacity Act 2005 (MCA).

There was a strong emphasis on person centred care. Care plans were person centred, included people’s individual preferences and needs, and contained clear guidance for staff to follow. Care plans were regularly reviewed and people and, where appropriate, their relatives were involved in the planning of their care.

People were cared for by staff who knew them well. Staff shared information effectively which meant that any changes in people’s needs were responded to appropriately. People were supported to access health care services when required.

Is the service safe?

People we spoke with told us that they were well treated by staff. One of them stated, "I am more than happy with the care provided." A relative wrote regarding the care provided, "X was always in the best of care with all you lovely special people. We want to thank you so much for all the love and care you gave them. You definitely made a big difference."

Risk assessments of people had been documented in their care records together with guidance on action to take to protect people. There was documented evidence that staff had been provided with essential training to enable them to care for people safely.

Staff received training and guidance regarding the requirements of the Mental Capacity Act (MCA) 2005. The provider demonstrated to us their knowledge of the Deprivation of Liberty Safeguards (DoLs) and the MCA requirements.

Is the service effective?

Feedback from people who used the service and from correspondence received from relatives and those involved in their care indicated that the service was effective and responsive to the needs of people. One person said, "They encourage me to exercise." A second person stated, "Sometimes they are late but not very often. They never let me down." People's care needs had been assessed with the help of their relatives and representatives. Their choices and preferences were documented and staff we spoke with were aware of these. This enabled staff to respond effectively when caring for people. Care plans had been prepared and these were up to date and had been regularly reviewed. This meant that the needs of people could be met with up to date information.

Is the service caring?

We saw correspondence and feedback from relatives of people supported by 1st Care Nursing Limited which complimented staff for being caring towards people. One person said, "I have no complaints at all." A relative wrote, "What great care you gave." All staff said they were aware that all people who used the service should be treated with respect and dignity.

Is the service responsive?

People informed us that staff were attentive and responded promptly when people had any concerns. The registered manager informed us that the provision of services and care were regularly reviewed and if there were problems or suggestions made, they would respond. This included providing specific carers who got on well with certain people and informing people if carers were going to be late. When we needed information regarding the care provided and the management of the service, this was promptly provided.

Is the service well-led?

The registered manager and the lead children's nurse who were present during the inspection were knowledgeable regarding their roles and responsibilities. There were arrangements for monitoring the quality of care provided. A staff satisfaction survey had been carried out recently. The results indicated staff felt supported and were satisfied with the management of the service.

Spot checks had been carried out by senior staff to ensure that staff were providing the agreed care to a high standard. This meant that the quality of the service provided was monitored on a regular basis to maintain and improve the quality of care and treatment provided to people who used the service.

We saw that each person's care was planned and delivered in a way that met their needs and took into account their views and experiences. Risks to the health, safety and welfare of people were assessed and managed to help minimise these.

Staff were supported, trained and supervised to help ensure that people who were using the service received safe and proper care and support. People who were using the service told us that they felt safe and that they had no concerns.

1st Care Nursing Limited had systems in place to regularly monitor and improve the safety and quality of the services it provided to ensure that people received safe appropriate care, support and treatment.