Nightowls Home Care

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

The provider, who is also the registered manager was passionate about providing a good service to people, and often stepped in to provide support where this was needed, however this impacted on their ability to oversee the quality and safety of the service. Audits carried out by the registered manager had failed to identify shortfalls in the recruitment processes. Staff often worked alone when entering people’s homes, therefore robust recruitment checks were needed to ensure people were protected from unsuitable staff.

People confirmed they received a consistent reliable service from caring staff. Staff maintained regular visits which enabled them to develop relationships with the people they supported and their families.

Staff had a good understanding of safeguarding processes to keep people safe and how to report concerns. Staff were aware of people’s needs and supported them to manage risks to their safety whilst supporting them to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests.

People told us they received their medicines when they needed them. We were assured the service met good infection prevention and control guidelines.

People’s needs had been assessed before using the service. Care plans contained comprehensive information about people’s routines and guidance on how to meet their specific needs. However, further work was needed to ensure people’s views about end of life care, including their individual religious and cultural values and beliefs, were known, respected and acted on.

We have made a recommendation about end of life care arrangements

The service had received several compliments thanking staff for the care and support provided to people at the end of their life.

Staff confirmed they had received training that gave them the knowledge and skills to carry out their roles. ‘Spot checks’ were carried out by senior staff to monitor staff practice and ensure they were working safely. People told us where they needed support with their meals this was being managed well. People were supported to access healthcare where needed. Staff worked well with other professionals to ensure people’s healthcare needs were met

Staff treated people with dignity, respect and kindness. Staff understood their responsibilities to respect people’s right to privacy, confidentiality and to promote their independence. Staff had a good understanding of people's protected characteristics and were respectful of these.

Staff told us Nightowls Home Care was a good company to work for and there was a positive culture in the service. Staff intuitively were providing care in line with the values of the company but were not clear what the service’s vision, values and goals were.

Staff understood and were aware of their responsibilities to raise concerns and report incidents and near misses. Systems were in place to respond to and investigate complaints. Where things had gone wrong, the registered manager was open and transparent with people, and their relatives and used their feedback to improve the service.

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 4 July 2019) where we identified a breach of regulation and made recommendations for the service to improve. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been sustained and the provider was still in breach of the regulation.

The previous inspection in May 2019 found people's medicines were not always managed safely, individual risks had not always been identified or recorded to provide guidance to staff, staff had not received moving and handling training and arrangements to monitor the quality of the service needed to improve. At this inspection we found improvements had been made to ensure people received their medicines safely, individual risks had been assessed and staff had been trained to assist people to safely transfer. However, the systems to assess and monitor the quality and safety of the service had failed to identify shortfalls in the recruitment processes, which placed people at risk of harm. Unsafe recruitment practices had previously been identified at our inspection in April 2018. The inspection in May 2019 found improvements had been made, however at this inspection we found this improvement had not been sustained which means this service has been rated requires improvement for the last three consecutive inspections.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nightowls Home care is a domiciliary care agency which provides personal care to older people living in their own homes within Colchester and Mersea Island.

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

People’s medicines were not always managed safely. People were cared for by staff who had a good understanding of how to keep them safe, however not all individual risks had been identified or recorded to provide guidance to staff. Staff were recruited safely, there were enough staff to meet people’s individual needs and care visits were carried out as required. Systems required further development to ensure that any issues were recorded, learning was identified, and action taken to make improvements.

Staff had received some training to support people effectively, however practical moving and handling and training to meet people’s specific health needs had not been provided. People’s nutritional needs were met, and people’s health was well managed. Staff had links with health professionals which promoted positive outcomes for people. People were actively encouraged to make day to day decisions.

People were cared for by staff who maintained their privacy and dignity. Staff knew people well were kind and compassionate. Positive relationships had been formed between staff and people using the service and people were encouraged to maintain their independence.

People, relatives and staff were positive about the registered manager and how the service was managed. Some concerns raised at the previous inspection had not been addressed. The oversight and governance of the service required review to ensure that any issues were identified and rectified to ensure the service continuously improved.

We have made a recommendation about medicines management, training and the implementation of the Accessible Information Standard.

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 May 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made or sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the second time.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Nightowls Home Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for older adults living within Colchester and Mersea Island. The domiciliary care agency office is situated in Marks Tey and based within the registered provider’s home.

This inspection was undertaken on the 20, 26 and 27 April 2018. At the time of the inspection 33 people were receiving a domiciliary care service from Nightowls Home Care.

The registered provider was also the registered manager. 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.

Staff recruitment practices required significant strengthening as not all records had been sought. Newly employed staff had not received a comprehensive induction and improvements were required to ensure all staff attained up-to-date refresher training and received practical manual handling training.

Effective and robust governance arrangements were not in place to assess and monitor the quality of the service. Quality assurance systems did not identify the issues we found during our inspection to help drive and make all of the necessary improvements required to achieve compliance with the fundamental standards and the registered provider’s own policies and procedures. The fundamental standards are the standards which care provided by the domiciliary care service must not fall below.

Although there was no impact to suggest that people’s care and support needs were not being met, not all risks to people’s health, welfare and safety had been identified and improvements were required to guide staff in the steps they should take to mitigate risks to ensure people’s safety and wellbeing.

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these measures. The service was appropriately staffed to meet the needs of people using the service. The management of medicines ensured people’s safety and wellbeing.

Suitable arrangements were in place for staff to receive regular formal supervision. People’s nutritional and hydration needs were met. People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance. The service worked together with other organisations to ensure people received coordinated care and support. People were supported to have choice and control of their lives.

People using the service and those acting on their behalf were very complimentary regarding the service provided. People were treated with care, kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished to be cared for and supported. There was a positive culture within the service that was person-centred, open and inclusive.

Support plans were in place to reflect how people would like to receive their care and support, and covered all aspects of a person's individual circumstances. Information about how to make a complaint was available and people’s representatives told us they were confident to raise issues or concerns.

We have made recommendations about the management of risk and robust inductions for newly appointed staff being in place.

You can see what action we told the provider to take at the back of the full version of the report.