Archived: Nurses Friend

Nurses Friend is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 6 people were receiving support with personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location provided care and support for 1 person with a learning disability. We assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

Improvements had been made to risk assessments and care plans. However, some improvement continued to be required to ensure that risk assessments were in place in relation to pressure ulcers and falls and that care plans and risk assessments for people who may require physical intervention were sufficiently detailed. Other areas of risk were effectively assessed, for example the environment, eating and drinking and continence. People and staff told us how staff effectively worked with them to mitigate risks in all areas of their lives.

Medicines management had improved; medicines were safely managed, and people received their medicines as prescribed.

Systems and processes to protect people from the risk of neglect due to missed carer visits had improved, these now needed to be sustained and embedded. Staff understood how to protect people from poor care and abuse.

Staff recruitment procedures had improved, and staff were recruited safely in line with regulatory requirements. People received their care calls on time and told us they were supported by consistent staff who knew them well.

People's health needs were recorded in their care plans, and they were supported to access relevant health and social care professionals. People were supported to have enough to eat and drink to maintain their health and well-being.

People were protected from the risks associated with infection because the service had processes in place to reduce the risk of infection and cross contamination and these were followed by staff.

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.

Right Care:

Staff had received the training and support needed to ensure people's needs could be met. Systems and processes supported smooth transitions into emergency care.

People told us they felt well treated and supported. Care was person-centred and promoted people's dignity, privacy and human rights. Staff had received training on supporting people with a learning disability, and autistic people. Staff understood how to protect people from poor care and abuse.

Right Culture:

The systems and processes in place to ensure and monitor the safety and quality of the service had improved.

Improvements made to the system in place for the oversight and monitoring of people’s risk assessments and care plans meant that in the main all known risks to people had been assessed. These improvements need to be further embedded to ensure risk assessments were consistently in place and were sufficiently detailed.

Where the provider had identified issues with the quality of the service, they had implemented the changes required.

There was a positive and inclusive culture at management level, the management team worked well with partnership agencies. The provider had sought feedback from people to help with driving improvement and staff had opportunities to share ideas, which were listened to and acted upon.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 April 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 14 December 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety of care provided, staffing and recruitment of staff and the managerial oversight of the safety and quality of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nurses Friend on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about risk assessments for people who require support to mitigate the risk of pressure ulcers and falls.

Follow up

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

Nurses friend is a domiciliary care service providing personal care to people with dementia, learning disabilities, mental health, physical disabilities, autistic people, older people, younger adults and children. At the time of the inspection 10 people were being supported.

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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Risk assessments and associated care plans were not consistently in place to mitigate risks to people. Medicines were not managed safely. Systems and processes had not consistently protected people from the risk of neglect due to missed carer visits. However, staff understood the signs of abuse and how to report it to protect people.

Staff were not recruited safely in line with the regulatory requirements but disclosure and barring [DBS] checks and reference checks were completed.

People were protected from the risk of infection and staff used personal protective equipment [PPE] appropriately in line with the latest government guidance. Accidents and incidents were recorded and action taken where needed to prevent reoccurrence.

People were leading their care and making their own decisions. Regular teams of care staff meant that care staff understood people’s needs and people were listened to and their independence supported. People were supported to take part in social activities of their choosing.

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.

Right Care: Staff had not consistently received the training and support needed to ensure people’s needs could be met. Systems and processes did not support smooth transitions into emergency care, a system was implemented following the inspection. People told us that they felt well treated and supported. However, some improvement was required to ensure person centred information was consistently recorded for everyone to ensure staff had the information and guidance they needed.

There was evidence of partnership working and seeking guidance from other health care professionals to meet people’s needs. People were supported with eating and drinking where required. Initial assessments took place to ensure that the service could meet people’s needs prior to admission into the service.

Right Culture: Systems and processes were either not in place or not effective in maintaining oversight of the safety and quality of the service and identifying concerns and areas for improvement. The provider had not always sought feedback from people to help with driving improvement and staff did not always have opportunity to share ideas. Peoples communication needs were not consistently clearly recorded for care staff guidance.

A process was in place for managing complaints that hadn’t been fully followed. However, people told us they would be comfortable to raise complaints with the provider and felt they would be listened to. Information could be made available in other formats to ensure it was accessible to all. The provider understood the requirement of the duty of candour. The provider had worked with other professionals where required to support people and was keen to work in partnership to drive improvement in the service.

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 was inspected but not rated (published 12 April 2017). This was because the service was only supporting 1 person with personal care so there was not enough evidence or information available to support a rating at that time.

Why we inspected

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to the safety of care provided, staffing and recruitment of staff and the managerial oversight of the safety and quality of the service 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager in post at the time of our inspection. 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 were unable to rate the agency as there was not sufficient information available to us to fully assess how safe, effective, caring, responsive and well-led the service was.

People told us that they felt safe. There were policies and procedures in place which ensured that the staff had the guidance and support they needed to ensure that they protected people from any harm or poor practice.

People had care plans and risk assessments in place which ensured that they received the support they had asked for in a safe way. At the time of the inspection there were sufficient staff to meet people’s needs; more staff were to be recruited as and when more people requested the service.

There were systems in place to ensure that people were protected from being cared for by unsuitable staff. Staff received training and support which ensured that they had the skills and knowledge to provide the care that was needed.

There were systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and the provider was aware of their responsibilities in relation to ensuring people gave their consent to care.

The provider had systems in place to monitor the quality of the service as and when it developed and had a process in place which ensured people could raise any complaints or concerns.