Nouveau Care

Updated 30 September 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

2 inspectors carried out this inspection and an Expert by Experience. An Expert by Experience who is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

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 a short period notice of the inspection because we needed people’s consent to talk to them prior to the inspection visit.

Inspection activity started on 17 August 2023 and ended on 24 August 2023. We visited the location’s office on 17 August 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 used information gathered as part of monitoring activity that took place on 12 May 2023 to help plan the inspection and inform our judgement. We also acted on information received from the local authority. We used all this information to plan our inspection.

During the inspection

We looked at 5 people’s electronic records. We looked at staff training and recruitment. We spoke to 3 staff on site, the registered manager, and the managing director. We looked at other records relating to the oversight and management of the service. The Expert by Experience spoke to 11 relatives and people using the service. Following the inspection, we continued to ask for clarification and additional evidence.

Updated 30 September 2023

About the service

Nouveau Care is a domiciliary care agency which provides the regulated activity of personal care to people in their own homes. At the time of our inspection there were 19 people using the service. 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.

People did not always receive care in line with their expectations as they said calls were not delivered at agreed times and they were not always informed if staff were running late. Most people and relatives were happy with the service but said time keeping was an issue with carers coming within a 2-hour window. Some people said they had minimal contact with the office and not all remembered receiving a survey or review of their care.

Care plans and risk assessments were not completed in sufficient detail where a person had additional health needs or risks associated with their care. This meant staff might not have enough information to provide safe care.

The managing director and registered manager did not have sufficient oversight of the service. They told us that staff were required to send an alert through the electronic recording system if there was a change in a person’s need or identified risk. This by itself was not a reliable way to monitor the safe delivery of care. Reviews of care plans took place, but these were usually triggered by a change in need rather than regular scheduled reviews.

Staff spot checks were conducted by a senior member of staff when they were covering a care call with another carer. This meant there was not sufficient time or privacy to talk to the person about the care they received or the staff member about their understanding of the care being provided.

Auditing of medicines and staff competencies to administer medicines was not sufficiently robust and left people exposed to the risk of harm.

The registered manager had failed to submit all notifications and safeguarding concerns to CQC as required by regulation. This meant they had not understood their regulatory responsibility and had failed to ensure there was sufficient oversight of incidents and safeguarding concerns. Following the last local inspection, the provider completed an plan to identify and monitor required improvements but during a follow up visit only some improvement had been made.

There was a lack of analysis of accidents, incidents, and safeguarding concerns to consider what actions were in place or what actions could be put in place to reduce further incidents occurring. This increased the risk of avoidable harm to people.

Policies were accessible but were not regularly reviewed to ensure they were up to date and included all the required information.

The manager and the managing director were happy to take on feedback and share information.

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. Mental capacity assessments were completed but did not clearly show how people participated in decisions made and when they should be reviewed. This meant the principles of the MCA were not being correctly followed to adequately safeguard people.

Electronic systems were used to record people’s care and to monitor risk and ensure scheduled visits took place. Care staff respected people’s privacy and followed good infection control principles. Rotas were issued so people knew which carer was visiting and feedback about carers was positive.

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 good, published 14 December 2017.

Why we inspected.

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to the lack of notifications and other aspects of the day-to-day management of the service. This was a focused inspection and we looked at Safe, Effective and Well led. 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.

We have found evidence that the provider needs to make improvements in Safe Effective and Well led. Please see the relevant key questions of this report.

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

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

Enforcement and Recommendations

We have identified breaches of regulation in relation to the assessment of risk, staff competencies and medicines and also in relation to the management and oversight of the service.

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

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.