Connect Nursing

Connect Nursing is a domiciliary care service providing support to people within their own homes who have complex health needs, which include people who had suffered a stroke and spinal cord injury. At the time of our inspection 13 people were using the service. Staff provide support with personal care to people living in their own houses and flats in the community.

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

People told us they felt safe and their relatives observed staff keep their family member safe while receiving care.

Risk was assessed and regularly reviewed to ensure people were not at risk of potential harm.

Staff knew the different types of abuse people may face and how to report and escalate if they wanted to whistleblow.

Staff were recruited safely following policy and procedures and there were enough staff to provide care to people on time.

People were protected from the risks of acquiring an infection as staff wore appropriate protective equipment and clothing and disposed of it safely.

Staff training was effective and in-depth. People and their relatives told us staff showed they had the skills to care for complex health needs. Staff were regularly supported by the management team and other nursing staff who provided training. People were confident knowing that staff received specialist training and competency checks before supporting their health needs.

An assessment of need involved people, their relatives and appropriate health professionals.

Consent to care was requested before care could begin and people were supported to make their own decisions. Where this support was provided, people were given enough to eat and drink.

Care was given by kind and patient staff who respected people’s diversity. People’s privacy, dignity and confidentiality was respected. People were encouraged to make choices and decisions about their care.

Care was planned with the person at the centre and staff respected their preferences. Staff were able to get to know people and understand how people liked to have care provided.

People and their relatives knew how to raise a complaint and were reassured and satisfied once they had received an outcome from their complaint.

The service had a clear management structure where people knew who they could contact if they had any queries about care. Staff enjoyed working with the service and felt empowered to give people the best care as they were developing skills in complex 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 and update

The last rating for this service was good (published 3 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager at the service at the time of our inspection. 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.

We last inspected the service in September 2017, where we carried out a responsive inspection that only covered our findings in relation to one outcome; safe. At that inspection, we found one breach of our regulations because the provider did not always deploy a sufficient number of staff to make sure that they could meet people's care and treatment needs. At this inspection, we found that this had been rectified and a sufficient number of staff had been employed. At our last comprehensive inspection in December 2016, we found a breach of our regulations because the service was not working within the principles of the Mental Capacity Act and we found that there was a lack of understanding in this area. At this inspection, we found that this had been remedied. Care workers and management demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people's care plans.

The service was safe and people were protected from harm. Care workers were knowledgeable about safeguarding adults from abuse and what to do if they had any concerns and how to report them. Safeguarding training was given to all staff.

Risk assessments were thorough and personalised. Care workers knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and care workers demonstrated they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely and audited on a weekly basis.

Newly recruited care workers received an induction. Training was provided on a regular basis and updated when relevant, and included specialised training to support people with specific needs.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and these were provided in line with their preferences.

People were supported to have access to healthcare services and receive on-going support. Referrals to healthcare professionals were made appropriately and a multi-disciplinary approach was adopted to support people.

Positive relationships were formed between care workers and the people who used the service and staff demonstrated how they knew the people they cared for well. People who used the service and their relatives told us care workers were caring and treated them with respect.

Care plans were detailed and contained relevant information about people who used the service and their needs such as their preferences and communication needs.

Concerns and complaints were listened to and records confirmed this. Complaints were dealt with promptly.

Staff felt supported by the registered manager and the culture of the service was open, with regular communication between teams.

Quality assurance practices were robust and taking place regularly.

The inspection was a focused inspection and was prompted by notification of an incident, which occurred whilst care workers were supporting a person outside of the service. The information shared with CQC about the incident indicated potential concerns about the management of risks in relation to the safety of people who used the service and people in the community. This inspection examined those risks.

This report only covers our findings in relation to one outcome; safe. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Connect Nursing on our website at www.cqc.org.uk. At the last inspection the service was rated 'Good' overall. This inspection only considered whether the service was safe and therefore the overall rating was not reviewed.

Connect Nursing is a domiciliary care service providing support to people with complex health needs which includes people who have suffered a stroke and spinal cord injury. At the time of our inspection 20 people were using the service.

Risk assessments were in place for people who used the service and were reviewed every month. They included assessments by health professionals and were readily available for care workers to access.

People who used the service and their relatives expressed that they felt safe with their care workers and safe using the service.

Accidents and incidents were reported and investigated in a timely manner and records were kept of all investigations and findings.

Care workers told us they knew what to do in an emergency situation and felt confident in acting accordingly.

Care workers had access to protective equipment such as gloves and told us they were able to order equipment or come into the office to collect it.

Medicines were managed in a safe way and records were completed and audits were carried out to ensure that medicines were correctly administered and documented.

Relatives of people who used the service told us that carers were not always reliable and reported episodes of lateness and missed calls and as a result we found the provider to be in breach of the regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of the full version of this report.

Connect Nursing is a domiciliary care service providing support to people with complex health needs which included people who had suffered a stroke and spinal cord injury. At the time of our inspection 24 people were using the service.

The service 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.

People felt safe at the service with staff and were protected from abuse as staff knew the different types and how to report it for investigation.

Risk was identified at the service and risk assessments were in place to reduce the likelihood of harm towards people. This included assessing the environment for hazards and the equipment needed to ensure suitability.

Records confirmed staff were recruited safely at the service and staff rota’s confirmed that there were enough staff to support people in their homes.

Where medicines were given they were handled safely and staff explained how they gave medicines to people in accordance with the policy.

People were supported by staff who had received an appropriate induction, training, supervision and a yearly appraisal. People’s preferences were met and people were asked for their consent in care. However staff understanding of the mental capacity act where people lacked capacity was not always understood. People who lacked capacity did not have an assessment and where best interest meetings were needed they had not been held.

People were cared for by kind compassionate staff who respected their wishes, privacy and dignity. Staff took the time to get to know people so they understood their personal histories.

Care plans were personalised and people and their relatives were involved in the planning of care. Staff were vigilant to changes and would report back to the office if they noticed people’s needs changed.

People and staff spoke positively about the management of the service. Staff felt they were treated with respect and could easily approach management. The service performed a number of audits to monitor the quality of the service, however some audits did not document what had been checked.

We found one breach of the regulations.

One member of staff said "I check on people every hour as per the policy where I am working, if someone needs closer monitoring I will check on them more frequently."

Care was coordinated by the service and they worked well with other health professionals to ensure they obtained a clear understanding of people's needs. The service aimed to have the same person visit people so that people and their relatives knew who the key contact was.

Staff had completed medication training and the service carried out medication audits to check staff were following the policy and administering medication safely.

The staff we spoke to said they felt supported, however we did not see evidence of regular formal supervision by the service.

The service had a complaints policy and information on how to make a complaint that was available for people. The service responded to complaints and investigated them fully where they were required to respond to a professional regulator.

The manager told us people or their relatives always sign assessments. The assessments we looked at were all signed by the people who use the service or their relative.

One person we spoke with said "The staff are courteous most of the time and know what I like and don't like.'

The manager and staff gave us clear definitions of the types of abuse people who use the service were at risk of and what they would do if they suspected abuse. This was in line with what was written in their policy.

There were effective recruitment and selection processes in place. This included checking peoples work history, face to face interviews and identifying any training needs.

We saw copies of completed stakeholder questionnaires which are sent out annually. Comments included staff are "well trained" and "if we have a concern about the service we phone the manager and they address it."