Archived: Prestige Nursing

Updated 12 February 2015

We visited the agency on 21 July 2014. Our inspection team was made up of one inspector and one expert-by-experience who had experience of home visits and caring for people who used this type of service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with three members of staff and the manager during this visit. We contacted 18 people who used the service by telephone to ask them about their experience of the agency. We also sent questionnaires to health and social care professionals who provided health and social care services to people who used this agency. These included community nurses, local authority care managers and commissioners of services.

We were unable to observe care and support because this was provided in people’s own homes. We looked at a range of records about people’s care and how the agency was managed.

Before this visit, we gathered and reviewed information from notifications, health professional’s comments about the service and previous inspection reports. At our last inspection we found the agency was compliant with the five essential standards of quality and safety we looked at.

We reviewed the Provider Information Record (PIR) and previous inspection reports before the inspection. The PIR was information given to us by the provider. This enabled us to ensure we were addressing potential areas of concern. During our visit we looked at the agency’s records. These included three people’s personal records and care plans, three staff files and a sample of the home’s audits, risk assessments, surveys, staff rotas, policies and procedures.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

Updated 12 February 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We visited the service on 21 July 2014. The inspection was announced. We gave the agency 48 hours notice ahead of our inspection visit.

The agency provided care and support to people of all ages and needs in their own homes. Services ranged from 1 hour visits to 24-hour nursing care.There were 89 people receiving a service at the time of our inspection. Many of them were children and young adults with physical and/or learning disabilities. The agency also provided services to older people and people who needed end of life care.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service was safe because people who used the agency were protected from the risk of abuse. The provider had taken steps to identify the possibility of abuse and prevented abuse from happening. There were safeguarding adults and child protection policies and procedures in place, so that staff had the information they needed to help keep vulnerable people safe.

People we spoke with told us they felt safe with this agency. They told us they were treated with dignity and respect.

Risks to people’s health and welfare were assessed with them or their representatives. Staff were provided with guidance about how to manage risks safely. Systems were in place to make sure that managers and staff learned from events such as accidents, incidents and complaints. This reduced the risks to people.

The Provider employed enough staff with the right knowledge; qualifications and experience to make sure people’s individual needs were met. Safe recruitment procedures were followed to make sure that staff were suitable to work with vulnerable people. The majority of people we contacted told us that staff were reliable and always on time.

The service was effective because people were supported by staff who knew how to meet their needs in the way they preferred. Staff were provided with all essential training and any additional training they required to meet people’s specific needs. For example, assisting people who were fed through gastric tubes or required help with physiotherapy programmes. Staff told us they received opportunities to meet with their line manager to discuss their work and performance.

Staff were knowledgeable about how to support each person in ways that were right for them. Staff were able to describe the needs of people they supported and the ways in which they met those needs. The manager told us how they were careful to match people with staff who had the right skills and would be compatible with them.

People who required support with eating and drinking could be confident that all staff had appropriate training in nutrition. Some people were helped to prepare food. Other people required support to eat and drink because to their medical conditions. Staff knew how to identify risks to people such as risk of choking or not getting enough to eat and drink. The agency worked with health professionals such as speech and language therapists and dieticians to make sure people received the right kind of care and support with their nutrition and hydration needs.

People were supported with their health care needs. The agency worked in partnership with other agencies and health professionals to make sure people received their care in a joined up way. We contacted health professionals as part of this inspection. They told us that the agency provided good care. People’s care records showed regular contact with people’s GPs and other healthcare professionals where appropriate.

The service was caring because people and/or their representatives were fully involved in planning their care. People told us the staff were “kind, patient and helpful”, “They never rush me”. People commented on how consistent the care had been. They told us, “I’ve basically had the same two carers for three years so am very happy with this.” and “These girls have known X for a long time now, X knows their voices well.”

People told us they were always treated with dignity and respect. The agency had policies and procedures in place to make sure staff understood how to respect people’s privacy, dignity and human rights. People gave examples of how staff treated them and their homes; “They say, may we go in here? before entering the bedroom.” “They always clear up after themselves.” And, “I take them on trust and they more than repay this”.

The service was responsive because people received personalised care and support when, and in the way they needed it. People were invited to comment on and express their views about what was important to them. People told us they could change anything they needed to by contacting the office. They said that staff in the office responded quickly if they asked for anything to be changed such as times of visits or extra support. Staff were reliable and usually arrived on, or before time and stayed for the full length of time as agreed in their care plans. Staff were proactive in identifying and referring any changes in people’s needs so that people continued to receive the support they needed.

People’s concerns and complaints were encouraged, explored and responded to in good time. They were provided with information about how to make a complaint about the agency. Records of complaints showed that people were listened to and taken seriously. For example, the manager responded to a recent complaint by sending a letter of apology which included the action the manager had taken to deal with the complaint.

The service was well led because the agency put people at the centre of what they did. There was an open and transparent culture at the agency. People were asked for their views which were taken into account in the way the service was planned and delivered.

Staff were confident in the management team and understood their roles and responsibilities to the people they supported. Regular staff meetings gave staff the opportunity to make suggestions and raise any questions or concerns. The agency had a whistleblowing policy which was in the staff handbook.

Quality assurance systems included regular contact with people to monitor the quality of the service they were receiving. A member of the management team visited or telephoned people at regular intervals to make sure they were happy with their care and treatment. Records showed that identified shortfalls were addressed promptly.