This inspection took place over two days commencing on 5 April 2018. The provider was given 24 hours’ notice of our visit. This was so people who used the service could be told of the inspection and asked if they would be happy to speak with us.Nash Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in Derby and Gloucestershire. At the time of our inspection there were 13 people using the service, which included people receiving end of life care. It provides a service to adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.
Following the last inspection on 17 March 2017 we asked the provider to take action to make improvements in the management of people’s medicine and in its staff recruitment practices. The provider submitted an action plan outlining their planned improvements and this action has been completed.
Nash Healthcare Limited had a 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.
The registered manager did not take part in the inspection as they were on leave.
The overall rating for the service awarded at the previous inspection which took place on 17 March 2017 was requires improvement at which time we identified two breaches of the regulations. This inspection has found improvements have been made and the overall rating for the service to be good.
The provider’s recruitment procedures ensured pre-employment checks were carried out on prospective employees to ascertain their suitability to work with people. We found there were sufficient staff employed to meet people’s needs, who had the appropriate training and support to delivery good quality care, which included tailored training to meet people’s health care needs.
Systems to provide and support people with their medicine safely had been introduced. Medication Administration Records (MAR’s) were for a majority of people provided by pharmacists, which meant staff were no longer having to write MAR’s, thus reducing the potential for error. We found people were supported by staff that had undergone appropriate training and had their competency assessed to manage people’s medication.
An electronic system had been introduced, since the previous inspection. The system supported the management team by monitoring and recording the time of arrival and departure of staff from people’s homes. This provided a clear audit trail as to whether staff were providing care and support based on the times as detailed within people’s care plans.
People told us they felt safe when they were supported by staff and trusted them. All staff had undertaken training in safeguarding to enable them to recognise signs and symptoms of abuse and knew how to report them. Potential risks to people were assessed and plans were put into place to minimise risk, which staff understood and followed.
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 rights were upheld and decisions about their care were sought as part of the assessment process to identify their needs. The management team had focused on improving the involvement of people using the service or family members in the assessment process and development and review of care plans.
People’s health and welfare was promoted as staff supported people with the preparation and cooking meals. Staff liaised and worked with health care professionals to promote people’s health, which included providing support to people receiving end of life care and the management of individual health needs.
People received care from staff that in many instances had developed positive relationships. This assisted people in maintaining their wish to remain at home at the end of their lives, whilst for others in meant they were supported to take part in everyday activities to promote their quality of life. People’s care and support was documented within their care plan and the service was flexible to enable it to react to people’s individual needs.
The outcome and action taken in responding to concerns was now documented, along with the initial comment, concern or complaint. People experienced improvements as a result of sharing their concerns. A number of thank you cards had been received from family members, expressing their gratitude of the care provided to their relatives.
Staff were complimentary about the support they received from the management team and told us they were valued. Staff spoke of the visions and values of the service and shared the management teams ethos of wishing to provide good quality care based on people’s individual needs.
People’s views were sought through questionnaires and individual comments within these were acted upon. However people did not receive an overall analysis and any planned actions that would be taken in response to people’s collective comments. The management team had introduced a number of audits to monitor how people’s care was recorded. Where shortfalls were noted these were addressed. Quality audits undertaken by commissioners identified the service had responded positively to action plans put in place to continually develop and improve the service. This evidenced positive partnership working between the management team and commissioners.