SPDNS Nurse Care Community Interest Company (CIC)

SPDNS is a domiciliary care agency which offers nursing care, personal care, end of life care and companionship to support people living in their own home. At the time of this inspection the service was supporting approximately 90 people with personal care.

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.

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

The registered manager had developed excellent links with local charities, hospice teams and health and social care professionals and this enhanced the quality of people’s lives.

The service had strong vision and values which placed the importance on people being fully involved in all aspects of care, where independence was promoted.

People told us staff were outstandingly caring, proactively identifying unmet needs and supporting these to be met in creative ways. They told us staff often going the extra mile to support them.

People were protected from abuse by staff who had a good understanding of how to protect vulnerable adults.

Medicines were managed safely. Care managers carried out comprehensive assessments of people’s needs and risks to people’s health were identified and managed safely in line with people’s preferences.

The service made sure there were enough staff in place to manage people’s needs. All staff had undergone a robust recruitment and induction process to ensure they had the skills needed to care for people well.

Staff promoted people’s independence in line with people’s choices. People who lacked capacity to make decisions had undergone appropriate assessments involving loved ones and other nominated people such as power of attorney for health and welfare.

Staff made sure people had access to fluids when they were not present. All staff had been trained in good food hygiene.

The service provided an excellent training programme to staff by a dedicated training manager. People commented staff had the right skills. Additional training was sourced when needed.

Care plans were task orientated, however small care teams which knew people well, ensured care provided to people was person centred and daily notes demonstrated this.

Staff supported people to maintain relationships with loved ones, and the local community to avoid social isolation.

The registered manager had robust systems in place to manage complaints. People told us they felt confident that any concerns would be managed well.

Staff were trained in end of life care. The service worked alongside carers groups to offer respite to loved ones. This meant people were supported to remain at home if they wished.

Staff and people told us the service was well managed.

Robust governance processes were in place which informed the quality of the service and when improvements were needed.

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.

Rating at last inspection

The last rating for this service was good (published 10 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider worked closely with commissioners and local authorities to develop new services in response to the needs of people in the community. This had a positive impact by helping people to remain in their own home as long as possible with the support from the ‘hospice at home team’.

The service has 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.

Robust systems and processes were in place to ensure people's safety. People were safeguarded from the potential of harm and their freedoms protected. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had up to date information about people’s needs which meant they were more effective in delivering appropriate care. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff supported people with their medication as required.

Staff had received a wide range of training so that they had a good understanding of how to meet people's needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides a legal framework to assess people's capacity to make certain decisions, at a certain time. Staff were clear about the importance of gaining consent from people. People told us their

wishes and decisions were respected.

The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including GPs, District nurse, Macmillan nurses, Marie Curie nurses, end of life specialist and the mental health team. People were supported with their nutrition and hydration needs.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Staff were attentive to people's needs and treated people with dignity and respect.

People were supported with activities which interested them. Management and staff understood the importance of responding to and resolving concerns quickly. People felt confident they could raise any concerns to the management.

The service was well led by a management team committed to providing an excellent service. The registered manager had a number of ways of gathering people’s views including talking with people, staff, and relatives. They carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

One relative told us, 'Everyone {staff} that comes here is good.' Another relative told us, 'If it wasn't for them I wouldn't have been able to manage as I have so far.'

We found that the provider had arrangements for assessing and recording consent and people's capacity to consent.

We saw that people's care and treatment was planned and reviewed with their and their relative's involvement, wherever possible. Risks to people's health, welfare and safety were identified and well managed. Our inspection and discussions with people afterwards showed us that the service was generally safe, responsive and caring.

We found that there were systems in place to ensure that cleanliness and infection control practices were good.

Staff were selected and recruited in a way that ensured they were suitably qualified and fit for the job.

We found that there were systems in place to assess and improve the quality of service provision.

We saw that records relating to people using the service, staff and day to day running of the service were accurate and easily found.

We spoke with four people and two relatives who use the service. One person told us that staff were, 'Excellent' and, 'Very caring.' Another person told us that they were very happy with staff, 'Excellent, no fault in males or females.'

People and their relatives felt that when they gave feedback if appropriate it was acted on. We were told by another relative that a staff member would come and chat to the person about topics that interested the person.

People told us that occasionally staff were late but that when this happened they usually arrived within a reasonable time and/or they were contacted by the service.