Prestige Nursing - Plymouth

Updated 7 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 17 January 2019. The inspection was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has experience, or has cared for a person who has used this type of service. We told the provider one day before that we would be coming. This was to ensure the registered manager and key staff were available when we visited the agency’s office.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR and other information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we went to the provider’s office and spoke with the registered manager, the deputy manager, a care worker and administrative staff. We looked at five records relating to the care of individuals, staff recruitment files, staff duty rosters, staff training records and records relating to the running of the service. We visited a person in their home and observed support being provided to them. Prior to the inspection we spoke with 11 people who used the service, seven relatives and three healthcare professionals who had experience of working with the staff from the service. Following the inspection we spoke with four staff on the telephone.

Updated 7 March 2019

Prestige Nursing Plymouth is a service that provides both nursing and care staff to people in the independent, hospital and community sectors. This inspection only covered the regulated activity provided to people in their own homes by care staff. The service provides care and support to people of all ages, in their own homes. Prestige Nursing Plymouth provides support with people’s social, domestic and personal care needs in Plymouth and the surrounding area.

The service mainly provides care and support for people in visits at key times of the day to help people get up in the morning, go to bed at night and give support with meals. Prestige Nursing Plymouth also provides social support to enable people to access the community and their interests. This includes supporting people with physical disabilities, learning disabilities and dementia care needs. The service only provides care visits of one hour or longer. Many visits are for a few hours each day. The service also provided effective flexible urgent care which was often arranged at short notice to cover a person’s usual carer’s absence, for example when they were unwell.

At the time of our inspection 30 people were receiving a service. These services were funded either privately, through Plymouth City Council or NHS funding.

We carried out this announced inspection on 17 January 2019. We told the provider one day before that we would be coming. This in in line with our methodology for inspecting domiciliary care providers and ensures that someone will be present in the office when we visit.

The service was last inspected on the 2 September 2016. Prestige was found to be meeting the regulations and was rated overall Good at that time.

There was a registered manager in post. 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.

Everyone we spoke with, without exception, told us that the service provided by staff and management at Prestige Nursing Plymouth was outstanding. External healthcare professionals told us, “They go out of their way to facilitate what is needed for the person,” and “They were always my first choice if we needed agency cover as they always sent well trained, hardworking, thoughtful staff.”

Staff were extremely well supported by the registered manager. We noted many appreciative emails sent out to care staff by the registered manager thanking them for their valued work. Staff were very happy working for the service and told us, “Prestige is the best company I have ever worked for. [The registered manager] is always there for us 100%. I would recommend Prestige to anyone to work for,” “The one thing I love about working for Prestige is that you don’t limit me to what I can do, you have full support for me to achieve more. You’ve never doubted me for a minute, or what I am capable of and that means a lot”

The service had very happy and motivated staff who were regularly recognised for their long service, hard work and specific achievements. Care staff felt valued. They went above and beyond their day to day support and care tasks, often checking on the more vulnerable people they supported as they travelled around the local area, even when off duty. If they saw something that was not as expected, such as lights off or curtains closed inappropriately, they would take action to ensure the person was safe and well. This had often led to a person being found requiring assistance which would not have been provided had the caring Prestige staff not noticed something may be amiss.

Staff were clear about how to report any safeguarding concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The service was very flexible and responded effectively to people’s changing needs. The service was fully staffed at the time of this inspection. Staff had received training to enable them to carry out their role effectively and safely.

Care records detailed whether people needed assistance with their medicines or the arrangements for them to take responsibility for any medicines they were prescribed.

Care plans were very personalised to the individual and recorded details about each person’s specific needs and how they liked to be supported. Care plans gave staff clear guidance and direction about how to provide care and support that met people’s needs and wishes.

Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks in relation to the health and support needs of the person.

Staff provided care and support to the same people consistently each day/week. This meant people received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff, comments included, “They’re very well trained. I can’t fault them,” “The staff tell me they are always having training” and “They have good training and there is good coordination of care.” The service was flexible. One relative told us, “They came at short notice at Christmas, they’re very helpful.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. The staff and registered manager supported people to reach their personal goals and objectives. Prestige Nursing Plymouth provided extremely person-centred care. This meant that people did not just have their care and support needs met but their quality of life was improved by the support they received from the service.

Staff were kind and compassionate and treated people with dignity and respect. Comments included, “They are as good as they could possibly be. They are very conscientious,” “They have a very flexible attitude,” “The carers are second to none,” “They know me, they are very friendly and kind,” “You couldn’t wish for anybody kinder.”

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Records were kept of people who had appointed Lasting Powers of Attorney.

There were very effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered manager was constantly checking with both people, families and the staff to see if there were any areas that required improvement. If anything was identified action had been promptly taken to improve the quality of the service provided even further.

The registered manager recognised that Prestige Nursing Plymouth should have good links with the local community. This raised the service profile and assisted with recruitment. The service was part of Plymouth Dementia Action Alliance (PDAA) and staff have trained to become ‘Dementia Friends’. The service was a certificated member of Dementia Friendly Plymouth. A member of staff was being trained to become a dementia champion for the service. The service has assisted in the local area businesses becoming more dementia friendly. We noted many local shops and businesses had signs in their windows indicating that their staff were specially trained to support people with dementia.

There were very effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The provider sent people a survey, the responses to which were very positive.

Staff told us they were very happy and well supported at the service. Comments included, ”This is the best place I have worked, and I have worked for a few other agencies in the past. They [management] really make me feel I am valued and appreciated. That has not happened to me before in other jobs,” “I got a certificate recently for having worked for the service for nine years. I got a bouquet of flowers, I was so lovely. Really makes you feel good about yourself and the job we do” and “You never feel like you are taken for granted at Prestige. I am very happy working for them and have been with them many years. I have told them they have got me for the long haul!”