Nurse Plus and Carer Plus UK Ltd provide care and support to mostly older people, who live in their own homes. The services provided include personal care, and domestic work in Newton Abbot, Teignmouth, Shaldon, Dawlish, Bishopsteignton and the surrounding areas. The service also provides registered nurses to care homes, to support end of life care; this is not regulated by the Care Quality Commission.
The service had 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.
We visited the office on 21 December 2015. At the time of this announced inspection 150 people were using the service. The service moved offices and was re-registered with the CQC in December 2014. Therefore, this was the first inspection to be carried out at this office.
People and their relatives were positive about the way staff treated them. Each person we spoke with told us their care workers were kind and compassionate. Comments included “They’re kind, sweet staff, and make jokes” and “We discuss what we want done and they always meet those needs”. People told us staff were respectful and polite. One person told us “Staff are respectful and all care staff have a nice manner”. We saw staff and people interact in a friendly way. They obviously knew each other very well and care staff knew what people needed. The staff knew people’s interests and chatted with them about these.
People and their relatives told us they felt safe when staff were in their home and when they received care. People told us “I feel 100% safe” and “I have a small team that I know and trust”. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service’s safeguarding policy.
People told us they were happy that staff knew how to meet their needs. People said “They’re brilliant, they’ll do anything to help me” and “Staff work in a unhurried way, going above and beyond”. Staff told us they were happy with the training they received. The service employed a training officer who provided face to face training. New staff completed training before going out to visit people. People told us they had a regular team of staff who had the appropriate skills to meet their needs. Another person said “I know my carers and they are flexible to my needs”. People told us staff were usually on time. They said “On the whole they are pretty good”. People told us if staff were going to be late, the office phoned them to let them know. Staff told us they were usually able to get to their visits on time. The office co-ordinator told us they tried to plan visits close together so travel time was reduced.
Care plans were developed with the person. They described in detail the support the person needed to manage their day to day health needs. Staff knew people well and were able to tell us how they supported people. During a home visit, we saw staff responded to people’s requests, met their needs appropriately, and knew how they liked things to be done. In one house, we were unable to find the care plan. The daily update book was available and well completed. The registered manager put new copies in the person’s home to make sure staff had access to them.
Safe staff recruitment procedures were in place. Each staff file had a list to ensure all checks had been completed before staff started work in people’s homes. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people.
Risk assessments had been undertaken and included information about action to be taken to minimise the chance of harm occurring to people. For example, where one person had experienced a number of falls, staff told us they had discussed this with the person. The person had agreed that staff could remove a rug at the bottom of the stairs. This had reduced the risk and the number of falls. Where people were supported to have their medicines this was done safely. People had received their medicines as they had been prescribed by their doctor to promote good health. The service reviewed incidents and accidents to minimise the risk of them happening again. For example, one person was given the wrong medicines on one occasion. Staff contacted the person’s GP, and stayed with the person to make sure they were safe. Staff completed further training to prevent this happening again.
The registered manager sought regular feedback from people who used the service. For example, through questionnaires, telephone calls, and meetings. People and their relatives felt able to raise concerns or make a complaint. People said “I can’t complain at all” and “I’m perfectly happy, nothing could be better”. Where complaints had been received, these had been dealt with appropriately. One person told us the registered manager had listened to their concerns, “She sorted it out. I phoned and thanked her”.
Health care professionals told us about their experience of the service. Comments included “I have found them to have a professional and friendly approach” and “They are easy to contact and respond quickly”. Staff told us the registered manager and co-ordinators were approachable. Comments included “They’re really understanding” and “I can talk to them about anything”.
A comprehensive audit system was in place to monitor the quality of the service. The organisation employed auditors. They carried out audits every three months over three or four days. A health and safety panel met every month to look at incidents and identify any trends. The provider had reached quality standards to receive accreditation from two independent organisations. The registered manager attended regular meetings at the organisation’s head office. They met up with other managers and shared learning and good practice.