Nurse Plus UK - Truro

Updated 24 June 2022

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector 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 home care agency. It provides personal care to people living in their own houses and flats.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service three working days’ notice of the inspection. This was because we needed to be sure that staff would be available at the office to support the inspection.

What we did before the inspection

Before the inspection, we reviewed information we held about the service and the provider which included any statutory notifications sent to the CQC. A notification is information about important events which the service is required to send us by law. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all of this information to plan our inspection.

During the inspection

Inspection activity started on 29 April 2022 and ended on 5 May 2022. We visited the location’s office/service location on 4 May 2022.

During the inspection we reviewed two people's care plans and risk assessments. We looked at two staff files in relation to recruitment. We reviewed staff training and supervision. We also reviewed other records relating to the management of the service, including compliments received. We met with the registered manager, the senior recruitment manager, the home care manager and the training manager.

We spoke on the phone with one person and three relatives of people who were receiving personal care and support about their experience of the care provided. We spoke with seven staff on the telephone and two healthcare professionals.

Updated 24 June 2022

About the service

Nurseplus UK is an agency that provides personal care to people living in their own homes. At the time of this inspection six people were receiving a service and were in receipt of the regulated activity of personal care.

Nurseplus did not provide short visits. The packages of care provided at the time of this inspection included visits of several hours at a time, and one live-in care package.

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

People told us they felt safe with staff. There were systems to help protect people from abuse and to investigate any allegations, incidents or accidents.

People were protected from potential abuse and avoidable harm by staff that had regular safeguarding training and knew about the different types of abuse.

Risks were identified, assessed and recorded. Care plans were completed for each person and contained details of the person's needs and preferences. These assessments included any risks from the environment and included any emergency action needed in the event of a water leak or fire in the person’s home. Risks to staff working alone late at night had been identified.

Staff did not just focus on meeting people's assessed personal care needs. We were told repeatedly how staff went above and beyond their roles as carers to ensure people were well supported in all areas of their lives. Staff took pets to the vet, ordered heating oil when necessary and helped arrange contractors to do necessary work in people’s home.

People received outstandingly consistent support from their carers from Nurseplus, which continued throughout the COVID-19 pandemic. Many staff had been supporting the same person for many years.

Medicines were managed safely to ensure people received them safely and in accordance with their health needs and the prescriber's instructions.

There were sufficient staff to support people. Recruitment procedures were robust. Regular auditing took place of all records at the service by the area manager.

People's care and support needs were assessed before they started using the service. People were matched with specific care staff and people and their families were involved in the recruitment of their staff.

People received support to maintain good health and were supported to maintain a balanced diet where this was part of their plan of care. The service supported some people, who lived alone, with their food shopping and meal preparation. There was a strong emphasis on the importance of eating and drinking well. Positive staff relationships were used to encourage those who were reluctant or had difficulty in eating and drinking.

The service had innovative and creative ways of training and developing staff that helps them put their learning into practice delivering outstanding care that met people’s individual needs.

The staff recognised that there was some wasted food each week which was surplus to the person’s needs. So, the service designed a training package for all staff, to help reduce food wastage and focus on producing a wider variety of healthy well-balanced meals, saving people money and increasing their choice of meals.

People were supported and received effective care and treatment from competent, knowledgeable and skilled staff who had the relevant qualifications to meet their needs. Nurseplus had a robust system to monitor all staff training requirements and offered refresher training to keep them up to date with best practice. Training had been provided face to face in the training suite and competency assessments were regularly carried out throughout the COVID-19 pandemic.

The registered manager had continued to support all staff in people’s homes throughout the COVID-19 pandemic, by visiting and talking with staff and people to ensure the best service was being provided. The registered manager had recognised the staff were isolated during their shifts in people's homes and was keen to ensure they saw them face to face regularly to provide support.

Staff told us, “Working throughout the pandemic saved me, it was a life-line. My client needed me to be there and I needed to be there. It was a strange time but we got such fantastic support from Nurseplus management. We all needed each other. I cannot fault them in any way. They are amazing" and “The management come out regularly and do spot checks on us, and we have very regular medication training updates. It is surprising how quickly each update comes around again!"

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 understood the importance of respecting people's diverse needs and promoting independence. Mental capacity assessments had taken place where necessary.

The registered manager was very keen to ensure the service was as responsive to the needs of the people they supported as they could possibly be. The service was outstandingly flexible in supporting people’s needs. Staff told us, “We can be super flexible and if a person wants to change a time or a day of their visit, it is done.”

People told us, “Outstanding, all parts of the organisation are outstanding as far as I can see. All phone calls, and emails are replied to promptly and the finance department is very efficient at sorting stuff out,” “It appears to be outstanding, even when they had COVID-19 they were able to provide the same service” and "The office always get back, I’ve never had to chase them. Their communication is very, very good.”

Relatives comments included “The staff at the office are outstanding. If I email a mediation change, it’s changed immediately. The communication is also outstanding” and “I usually ring if I want extra cover or to change. If the person who deals with it is not there, they call back quite soon. They accommodate me whenever they can. They really do try.”

There were robust auditing or monitoring processes in place. The service had implemented effective quality assurance systems to monitor the quality and safety of the care provided. Spot checks were carried out to monitor staff performance. The service was regularly audited by the quality assurance advisor and was scoring ‘green’ at the time of this inspection, which meant there were no concerns.

The registered manager recognised a member of the care staff each month for an award. This was seen as motivational and recognition of staff showing commitment to good care. Staff received chocolates, flowers and a certificate to evidence their good work. Annually a member of staff was recognised to going above and beyond the call of duty and similarly rewarded.

Everyone we spoke with about Nurseplus UK told us they thought they provided an outstandingly consistent effective service. We were told staff were friendly, they were treated with kindness and compassion and their privacy and dignity was respected.

Comments included, “I only have one person and she comes at the same time, stays the right amount of time. I’ve never had anyone else; it’s always been the same one I’m pleased to say,” ‘It’s been really consistent since we started,” “They work really hard to provide a regular team” and ‘Mum’s care is outstanding, and her clothes are all clean and the flat is clean, it’s outstanding” and “The current carer is outstanding and very experienced; she has picked up on lots of bits and pieces and acted upon them.”

The service worked in partnership with other organisations to make sure they were following current practice and providing a high quality service. The service had sustained their outstanding practice since the last inspection as their previous location.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

We registered this service on 20 January 2021 and this was the first inspection for this service at a new location.

The last rating for the service at the previous premises was outstanding published on 4 April 2019.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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