We carried out a review of the data available to us about Nwando Domiciliary Care on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Nwando Domiciliary Care, you can give feedback on this service.
Nwando Domiciliary Care is a domiciliary care agency providing personal care to 14 people aged 65 and over at the time of the inspection.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
The recording of creams applied to people needed to be consistent.
We have made a recommendation about the management of medicines.
People told us they received their medicines on time and staff were trained in this area with their competence assessed.
People told us they felt safe with staff and they arrived on time. People were protected from coming to harm as they had appropriate risk assessments and staff were always updating the main office with information if they thought someone was unsafe.
Staff were aware of their safeguarding responsibilities and knew the different signs if they thought someone was at risk of abuse.
Assessment of people’s needs was carried out to ensure people could be fully supported by the service. People told us staff asked for their consent before care was delivered. People told us they were offered choices when they received care and support.
People and their relatives told us staff were kind and caring. Staff respected people as individuals and did not discriminate against people when providing care. People’s privacy and dignity was respected.
People received personalised care at all times, and this was reviewed to ensure care was continuing to meet their needs. People were involved in planning their care with their relative. People’s communication needs were clearly stated to support staff have effective communication in a format that best suited them.
People and their relatives knew how to complain and how to give positive feedback to the service.
Quality assurance systems were now embedded and effective to monitor the service people received.
The registered manager and other managers were committed to improving the service and continuously learning to ensure they had the skills to provide people with high quality care.
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.
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 requires improvement (published 21 February 2019).
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.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. Nwando Domiciliary Care is owned and managed by Mrs. Ifeoma Nwando Akubue. Hence, there is no requirement for a separate registered manager. We have referred to her as the provider.
Not everyone using Nwando Domiciliary Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection, the service was providing personal care to 21 people.
The service was last inspected on 6 August 2018, where we found the provider to be in breach of the regulations in relation to safe care and treatment, safeguarding, staffing, fit and proper persons employed, good governance, and notifications of incidents. We also made three recommendations in relation to the Mental Capacity Act 2005, personalised care plans and end of life care. The service was rated Inadequate and was therefore in ‘special measures’. We served the provider with Warning Notices where we specified actions that the provider was required to take by a set date. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least Good.
At the inspection on 16 January 2019, we found the provider had made some improvements and were no longer in ‘special measures’. We found that the provider had followed their action plan, based on our Warning Notices, which was to be completed by the 16 November 2018, and we found that the provider had addressed the breach of the regulations in relation to safe care and treatment, safeguarding, staffing, fit and proper persons, good governance and notification of incidents. However, we found the service was still in the process of implementing effective systems and processes to assess, monitor and improve the quality and safety of the service and hence, the service was rated Requires Improvement. This is the third time the service has been rated Requires Improvement or Inadequate.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. Nwando Domiciliary Care is owned and managed by Mrs. Ifeoma Nwando Akubue. Hence, there is no requirement for a separate registered manager. We have referred to her as the provider.
Not everyone using Nwando Domiciliary Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection, the service was providing personal care to 21 people.
People told us they felt safe with staff and that staff mostly arrived on time. The provider was in the process of reviewing and updating people’s risk assessments to ensure all risks to people were assessed and mitigated. People’s medicines needs were met by appropriately trained staff. However, not all staff had their medicines competency assessed every year as required by the National Institute for Health and Care Excellence. Staff were knowledgeable about risks to people and how to provide safe care. The provider had systems and processes in place to safeguard people against abuse. The provider followed safe recruitment practices to ensure sufficient and suitable staff were employed to meet people’s needs safely. Staff followed appropriate infection control practices to prevent the spread of infection.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People’s needs were assessed and met by staff who were trained appropriately. People told us staff met their healthcare needs. All new staff had received induction training and shadowed existing staff before they started working on their own. All staff were provided with refresher training that enabled them to provide effective care. Most staff received regular supervision and an annual appraisal. Where requested, people were supported with their dietary needs and to access healthcare services.
People and relatives told us staff were caring and helpful, and treated them with dignity and respect. The provider ensured continuity of care by ensuring people were supported by the same team of staff. Staff were knowledgeable of and met people’s cultural and spiritual needs, and these were recorded in their care plans. People were involved in the care planning process and made decisions regarding their care and support as far as possible. Staff supported people to remain as independent as they could be.
People’s care plans were personalised, detailed how they liked to be supported, and were regularly reviewed. People, and their relatives where necessary, were involved in their care reviews. Staff told us they found care plans useful and were promptly informed of any changes to people’s needs. The provider had systems in place and trained staff on how to support people on end of life and palliative care. People and relatives knew how to make a complaint and they told us their complaints were addressed in a timely manner.
Staff were trained in equality and diversity, and told us they supported people without any discrimination. The provider encouraged lesbian, gay, bisexual, transgender people to use the service.
People and relatives told us they were happy with the service and spoke positively about the provider. Staff told us they felt well supported. People, relatives and staff's feedback was sought to continuously improve the service.
The provider had reviewed and updated their monitoring and auditing systems and processes to enable them to evaluate the safety and quality of the service. As they had recently been introduced we could not fully assess their efficiency.
The provider worked with the local authority and healthcare professionals to improve the quality of the service.
We carried out an unannounced comprehensive inspection of this service in July 2017. The Care Quality Commission (CQC) recently received anonymous concerns in relation to hiring illegal staffing, missed visits, providing personal care to children which the service is not registered for, and governance.
As a result of these recent, anonymous concerns we undertook this responsive comprehensive inspection. At our last inspection, this service was rated 'good' overall with Well-led being rated as 'requires improvement'. At this inspection, Effective and Responsive had been rated as 'requires improvement' and Safe and Well-led as 'inadequate'. The overall rating for this service has changed to 'requires improvement'.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to 58 people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the provider.
The provider did not follow appropriate procedures to safeguard people against avoidable harm and abuse. The provider did not raise a safeguarding alert with the local authority in relation to a person at risk of neglect, psychological and financial abuse from their relative. The provider failed to notify us about three safeguarding concerns without delay. The provider did not always identify, assess and mitigate risks to people in a timely manner. There were gaps in staff recruitment checks and we could not be assured if they were safe to work with vulnerable people. The provider lacked systems to ensure the safe management of medicines.
People were not always supported by staff who were appropriately trained, competent and skilled. Staff were not provided with regular supervision to do their job effectively. People’s care records were not always as per the requirements of Mental Capacity Act 2005 (MCA). Not all people’s care plans were person centred. The provider did not discuss people’s end of life care wishes and did not train staff in end of life care. People told us different staff supported them and there was a lack of continuity of care.
The provider lacked robust and effective systems and processes to ensure the quality and safety of service. Not all people were asked for their feedback and the provider did not analyse and evaluate the feedback that was received. There were gaps in internal audits and the provider did not fully implement the agreed improvement action plan that was developed following the local authority monitoring visit.
People told us they felt safe with staff and were generally happy with staff timekeeping. Staff knew safeguarding and whistleblowing procedures and how to escalate concerns and abuse. Staff were provided with appropriate personal protective equipment to prevent spread of infection.
People told us their individual needs were met and they were happy with nutrition and hydration support. Staff gave people choices and encouraged them to make decisions.
People told us they were supported by staff who were caring, friendly, and treated them with dignity and respect. People’s cultural and religious needs were recorded and met by staff.
People and their relatives were encouraged to raise concerns and were happy with the complaints process. There were accurate records of complaints and written correspondence to complainants.
Staff and their relatives told us they were happy with the service and found the management approachable. Staff told us they felt supported and enjoyed working with the provider.
We found six breaches of regulations during the inspection. These were in relation to the safe care and treatment, safeguarding, staffing, fit and proper persons employed, good governance, and notifications of incidents. We have made three recommendations in relation to MCA, personalised care plans and end of life care.
You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to 20 people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the provider.
At the inspection on 25 July 2017, we found that the provider had made sufficient improvements and were no longer in breach of legal requirements.
People using the service and their relatives were happy with the care provided and found staff reliable and trustworthy. They were happy with staff punctuality and had never experienced missed visits. Staff understood people’s individual needs. People told us their needs were met by staff and they felt safe with them. Staff treated people with dignity and respect. Care plans were personalised and regularly reviewed, they recorded people’s needs, likes and dislikes. Staff were provided with instructions on how to support people to meet their needs and preferences.
Staff demonstrated a good understanding of safeguarding procedures and knew how to report abuse and poor care. The provider carried out safe recruitment procedures and staff were vetted appropriately before providing care. Risk assessments were detailed and provided sufficient information and instructions to staff on the safe management of identified risks. However, the service did not always maintain health specific risk assessments.
Staff received regular supervision and induction and mandatory training to do their jobs effectively. However, not all staff were provided specialist skills training and were not competency assessed for medicines administration. Staff sought people’s consent before providing care and gave them choices. People’s nutrition and hydration needs when requested were met. Staff maintained daily care records but did not always detail care visit times and a clear account of how people were supported. The service worked with health and care professionals in improving people’s physical health.
The provider regularly sought feedback from people but did not always keep records of this. The service visited people’s homes to observe staff whilst supporting people with their care needs to ensure they were supported as per their care plans but these were not carried out regularly. The service had systems and processes to assess, monitor and improve the quality and safety of the care delivery however, did not always identify gaps in the record keeping.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 17 and 23 January 2017 to check that they had followed their plan and to confirm that they now met legal requirements.
This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Nwando Domiciliary Care’ on our website at www.cqc.org.uk’.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to three people. Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager. We have referred to her as the registered person.
At our focused inspection on the 17 and 23 January 2017, we found that the provider had followed their plan which they had told us would be completed by the 16 August 2016 and overall, we found that the provider had addressed the breaches of these regulations.
People’s risk assessments were reviewed. They detailed risks to people and how to safely manage them. Appropriate action had been taken to induct staff in their roles and appropriate security and references checks were carried out to confirm staff’s suitability to work with vulnerable people. New systems had been introduced in relation to staff training and supervision, and staff told us they found training and support provided helpful. Regular staff meetings were taking place.
Staff showed understanding of the Mental Capacity Act 2005 (MCA) and the implications of this legislation and how they sought consent from the people before supporting them.
The care plans were reviewed and were personalised and captured people’s needs, likes and dislikes. The daily care records were in place but were not consistent and did not always include information on nutrition and hydration intake.
There were records of spot checks, care plans and staff personnel files audits. People using the service and their relatives were asked for formal feedback. The service was in the process of seeking formal feedback from staff and professionals.
Nwando Domiciliary Care is a domiciliary care service that provides personal care to people with learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment and older people in their own homes. At the time of this inspection the service was providing personal care to three people.
Nwando Domiciliary Care is owned and managed by Ifeoma Nwando Akubue. There is no requirement for a separate registered manager.
At the time of the inspection, the service did not maintain care plans and risk assessments. Following the inspection, the service provided us with care plans and risk assessments for people using the service. However, risk assessments were incomplete and care plans not personalised.
People using the service and their relatives told us they found staff caring and friendly. People’s relatives told us that staff listened to them and their health and care needs were met. They told us their family members were treated with respect and staff engaged with them in a friendly and considerate manner.
There were safeguarding policies and procedures in place. Staff were able to demonstrate their role in raising concerns.
Staff files lacked records of reference checks. There were no records of staff supervision and staff told us they did not receive one-to-one formal supervision. There were no records of staff induction training and the service did not offer any training to their staff.
The service did not have effective systems and process to assess, monitor and improve the quality and safety of service.
We found that the registered provider was not meeting legal requirements and there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.