Background to this inspection
Updated
23 July 2019
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 Care Act 2014.
Inspection team
This inspection was carried out by an inspector, an inspection manager 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 domiciliary care agency. It provides personal care and nursing support to people living in their own houses and flats.
The service should have a manager registered with the Care Quality Commission. 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. However, the registered manager had left the service shortly before this inspection. One of the lead nurses in the agency had agreed to act as the manager whilst the recruitment of a new manager was undertaken.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. We also needed consent to speak to people using the service to be gathered.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, NHS continuing health care team and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service and seven relatives about their experience of the care provided. We spoke with nine members of staff including six care staff, a nurse specialising in dementia support, the acting manager and the regional quality and compliance manager.
We reviewed a range of records. This included five people’s care records and medication records. We looked at five staff files in relation to recruitment and staff supervision and reviewed the providers training records. A variety of records relating to the management of the service, including audits, quality assurance records, complaints and incident records, policies and procedures were reviewed.
Updated
23 July 2019
About the service
Prestige Nursing Norwich is a domiciliary care agency that provides personal care and nursing support to adults living in their own home. It is owned and operated by Prestige Nursing Ltd. There were 41 people using the service at the time of this inspection. The service specialises in providing palliative care and complex care funded by NHS Continuing Health Care. The agency also supply staff to other providers, but this is not covered by this inspection.
People’s experience of using this service and what we found
Feedback from people using the service was unanimously positive and all the people we spoke with recommended the service.
The registered manager had recently left. The provider had in place temporary management whilst they recruited a new manager. We found governance and auditing processes were not sufficiently robust to minimise risk and ensure best practice was appropriately promoted and recorded. We have made a recommendation about their recording and auditing processes. The service was organised, and management was found to be open and accessible. The management dealt with any concerns or complaints quickly and appropriately. The views of people and staff were actively sought by managers to develop and improve the service.
People were protected from abuse, neglect and discrimination. Staff ensured people's safety and acted when necessary to prevent any harm. We found risks assessments were mostly thorough. However, we made a recommendation to the provider to review their risk assessment practice to ensure all risk were considered and sufficient details were recorded. People received their medicines according to prescriber’s instructions.
Recruitment practice was thorough and ensured there were sufficient staff of appropriate character to provide consistent support. Staff received comprehensive training and nurse led support ensured they were competent to carry out intensive and complex, health and social care. Staff monitored people’s health and helped them access health care services when they needed them.
People were usually 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. The provider had a specialist nurse to support best practice in caring for people living with dementia.
Staff were described as professional, reliable and caring; they promoted people’s independence and dignity. The provider completed comprehensive person-centred care plans; they completed regular reviews and were responsive to changes in needs. The provider regularly sought feedback from people using the service to ensure the service was meeting people’s preferred outcomes. The provider was skilled and experienced at providing end of life care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 4 August 2016).
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.