Nouveau Care

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.

CQC only inspects the service being received by people provided with ‘personal care’ such as help with tasks related to personal hygiene and eating. We also take into account any wider social care provided.

There was a registered manager in post. 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.

There were enough staff to meet people’s needs and a robust recruitment policy in place. The staff were aware of safeguarding procedures. There were risk assessments in place with guidance on how to mitigate risks to people, in respect of falling, mobility and equipment.

People were supported with their medicines where required, however improvements were needed around the recording and care planning of ‘as required’ (PRN) medicines.

Staff had undertaken qualifications and training relevant to their role, however we have made a recommendation around further training when the service employs new staff. There was a comprehensive induction process in place.

Staff supported people to have a healthy balanced diet and to drink enough if this was needed. They were responsive to people’s changing needs, and assisted them to access healthcare when required.

The service worked with other organisations to meet people’s needs, including sharing information and gaining advice. They provided compassionate care, including to people towards the end of their lives. People were treated with dignity, and their privacy respected.

Relatives were involved in people’s care planning and delivery. People’s choices were respected and staff promoted people’s decision making and independence. They understood people’s mental capacity and sought consent before delivering care to people.

There was good leadership in place and the service sought feedback from people in order to improve. They had quality assurance systems in place and the registered manager was aware of their responsibilities.