Nurses Friend Limited

Updated 30 June 2023

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 Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 1 inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 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.

Inspection activity started on 25 May 2023 and ended on 02 June 2023. We visited the location’s office on 30 May 2023.

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 the last inspection. We sought feedback from the local authority. We used this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and the representatives and relatives of 2 people who used the service about their experience of the care provided.

We spoke with 7 members of staff including 2 care staff, 2 care co-ordinators, 2 administration staff and the registered manager.

We reviewed a range of records. This included 3 people's care records and 2 people’s medicines records. We looked at 4 staff files in relation to recruitment. A variety of records relating to the management of the service, including quality assurance surveys and audits were reviewed.

Updated 30 June 2023

About the service

Nurses Friend is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 6 people were receiving support with personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location provided care and support for 1 person with a learning disability. We assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

Improvements had been made to risk assessments and care plans. However, some improvement continued to be required to ensure that risk assessments were in place in relation to pressure ulcers and falls and that care plans and risk assessments for people who may require physical intervention were sufficiently detailed. Other areas of risk were effectively assessed, for example the environment, eating and drinking and continence. People and staff told us how staff effectively worked with them to mitigate risks in all areas of their lives.

Medicines management had improved; medicines were safely managed, and people received their medicines as prescribed.

Systems and processes to protect people from the risk of neglect due to missed carer visits had improved, these now needed to be sustained and embedded. Staff understood how to protect people from poor care and abuse.

Staff recruitment procedures had improved, and staff were recruited safely in line with regulatory requirements. People received their care calls on time and told us they were supported by consistent staff who knew them well.

People's health needs were recorded in their care plans, and they were supported to access relevant health and social care professionals. People were supported to have enough to eat and drink to maintain their health and well-being.

People were protected from the risks associated with infection because the service had processes in place to reduce the risk of infection and cross contamination and these were followed by staff.

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.

Right Care:

Staff had received the training and support needed to ensure people's needs could be met. Systems and processes supported smooth transitions into emergency care.

People told us they felt well treated and supported. Care was person-centred and promoted people's dignity, privacy and human rights. Staff had received training on supporting people with a learning disability, and autistic people. Staff understood how to protect people from poor care and abuse.

Right Culture:

The systems and processes in place to ensure and monitor the safety and quality of the service had improved.

Improvements made to the system in place for the oversight and monitoring of people’s risk assessments and care plans meant that in the main all known risks to people had been assessed. These improvements need to be further embedded to ensure risk assessments were consistently in place and were sufficiently detailed.

Where the provider had identified issues with the quality of the service, they had implemented the changes required.

There was a positive and inclusive culture at management level, the management team worked well with partnership agencies. The provider had sought feedback from people to help with driving improvement and staff had opportunities to share ideas, which were listened to and acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 April 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 14 December 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety of care provided, staffing and recruitment of staff and the managerial oversight of the safety and quality of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

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 remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nurses Friend on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about risk assessments for people who require support to mitigate the risk of pressure ulcers and falls.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.