Background to this inspection
Updated
1 December 2022
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 undertaken by one inspector.
Service type
This service is a domiciliary care agency with nursing staff. It provides personal and nursing care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced. We gave 24 hours' notice of the inspection because some of the people using it could not consent to a telephone call from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this. This was because some people needed a court appointed deputy or relative to speak on their behalf.
Inspection activity started on 28 October 2022 and ended on 8 November 2022. We visited the office location on 8 November 2022.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we had received about the service since its last inspection. We sought feedback from the local authority safeguarding team. We also reviewed incidents reported to us. We used all this information to plan our inspection.
During the inspection
We spoke with two people, two of their relatives, three other people's relatives, seven staff including the registered manager, team leaders and care staff. We received feedback from another relative by e-mail.
We reviewed a range of records. We looked at three people's care plans, various medicine administration records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were also reviewed, including training records, incident records, quality assurance processes and various policies and procedures.
Updated
1 December 2022
About the service
Ness M Care Services is a domiciliary care service registered to provide personal, and/or nursing, care to people living in their own homes. The service provides a range of support including to younger people, older people, people with mental health needs, people living with dementia and people with a physical disability. At the time of the inspection eight people were using the service, seven of whom received personal care.
Some people were also supported with live-in care. This is where staff stay in the person’s home for a large proportion of the day and were part of the person’s household.
People’s experience of using this service and what we found
There were enough staff, but not all staff recruitment was as safe as it should have been. Information for staff was limited in how to manage risks. This created a risk of harm.
Monitoring and oversight of the service was not effective. There were missed opportunities to improve the quality of service provided. Not all records had been completed or kept up to date. Staff did not always have accurate records they could rely on to provide good quality care. The registered manager had not always reported incidents as legally required, to the Care Quality Commission (CQC).
People and relatives told us staff knew how to safeguard and support people to keep them safe. People received their medicines as prescribed. People were supported by a consistent staff team who they felt comfortable with. Staff ensured they followed infection prevention guidance and good practise. The service and the staff team took on board learning when things went wrong.
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.
The registered manager led by example and had fostered an open and honest staff team culture. People's, relatives' and staff's views were sought, and this enabled them to have a say in how the service was provided. The provider worked well with other organisations, to provide people with joined up care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating
The last rating for this service was good, published on 19 April 2020.
Why we inspected
We received concerns in relation to staffing and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 has changed from Good to Requires improvement based on the findings of this inspection.
Enforcement
We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
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.