Night and Day Care

Night and Day Care is a domiciliary care service providing personal care and support to people living in their own homes. All the people receiving support were funding their own care. At the time of the inspection the service provided support for 6 adults and older people. 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

The provider did not always ensure risk management plans had been developed for identified risks to provide staff members with guidance on how to manage the risk. Medicines were not always managed appropriately to ensure people received their medicines safely. When incidents and accidents or safeguarding concerns occurred the provider did not identify any lessons which could be learned to reduce the risk of reoccurrence of the issue.

The provider did not ensure staff members had completed the training they had identified as mandatory. The provider did not have a robust quality assurance process to enable them to identify areas where improvement was required.

People’s care plans were not written in a person-centred manner which identified the person’s wishes as to how they wanted their care provided. The records of the care provided during each visit which staff members completed, were task focused and did not reflect the experience of the person who received support. People’s wishes in relation to how they wanted their care provided towards the end of their life were not identified.

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.

The provider had a safe recruitment process. Staff had access to personal protective equipment (PPE) and relatives confirmed they wore it when providing care. Relatives were happy with the care their family members received. Staff felt supported by the provider. Staff members provided support in a kind and caring way whilst ensuring people’s dignity and privacy was respected.

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 9 November 2017).

Why we inspected

We inspected this service due to the length of time since the previous inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full 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 Night and Day Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care and treatment, good governance and staffing at this inspection.

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.

The last comprehensive inspection of the service was on 04 November 2015 when we rated the service as Good for each of the five questions we ask.

Night and Day Care provides care and support to people living in their own homes. At the time of this inspection, 15 people were using the service.

The provider’s Nominated Individual is 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.

People told us they felt safe with their care workers. The provider had systems to keep people safe and care workers followed these. They followed effective recruitment procedures to make sure care workers were suitable to work with people using the service and there were sufficient numbers of care workers to provide the care and support people needed.

Where people needed support with their medicines, care workers provided this safely.

The provider worked within the principles of the Mental Capacity Act 2005 (MCA) to make sure that, as far as possible, people made decisions about the care and support they received.

People using the service were cared for by staff who had been appropriately trained and supported.

Care workers gave people the support they needed with their nutritional needs and the provider supported people using the service to meet their health care needs.

People using the service told us they liked their regular care workers and described them as kind, caring and professional. People told us they were supported to do things for themselves when they were able.

The provider recorded people's religious, cultural and communication needs and their care workers were able to tell us about these.

The provider had a complaints policy and procedure in place. People using the service told us they knew how to complain to the provider but they told us this had never been necessary. People using the service were also able to provide feedback on the care they received.

People told us their care workers usually arrived on time, stayed the correct amount of time and completed all of the tasks that were included in their care plan.

The registered manager was professionally qualified. People using the service and care workers told us the manager was approachable and supportive. The provider had systems to monitor the quality of the service that people received and to make improvements. There was an open culture at the service. People using the service, their relatives and care workers told us they felt able to approach the management team and felt valued by them. The provider actively engaged with our inspection and they provided the information we needed to make our judgements.

The last inspection of the service was in August 2013 when we found the provider was compliant with all of the outcomes we checked.

Night and Day Care provides care and support to people living in their own homes. When we inspected, the service was supporting 36, mainly older, people.

There is a registered manager for the service. 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 provider assessed risks to people using the service and took action to mitigate these. The provider carried out checks before care workers started to work with people using the service. When people needed support with their medicines, care workers provided this safely.

Care workers received the training they needed to work with people using the service. The registered manager was aware of their responsibilities under the Act and ensured all care workers completed appropriate training. People’s care records included assessments of their healthcare needs and details of how care workers would ensure they met these.

People using the service and their relatives commented very positively about the care they received and told us their care workers were kind, respectful and caring. Care workers treated people with dignity and respect.

People using the service told us they received care and support that was personalised to their needs. People using the service and their relatives told us they did not have any complaints about the care and support they received.

People using the service, their relatives and staff working for the service were very complimentary about the manager and the service. The provider kept information about people using the service confidential. The provider had systems to assess and monitor the quality of the service.

We looked at the care plans for 4 people using the service. We saw the care plans detailed people's health, social and personal care needs and the support their care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse. A relative told us 'I know my [relative] is safe with her carers, it takes a lot of worry off me.'

We looked at the training and supervision records for 4 care workers and saw that staff received regular supervision and training that was regularly updated. One care worker told us 'I only started recently but I've done a lot of training.' This meant that care staff had the support and training they needed to look after people.

There were procedures in place to monitor the quality of services provided. The provider carried out regular audits and people using the service were asked for their views on the care and support they received.

People's comments included 'they are excellent, we're most satisfied,' 'my carer is first class, always helpful' and 'the carers are always punctual or they ring if there's a problem and they're held up.'

The care needs of people using the service were well assessed and clearly recorded in their care plans. Risk assessments were completed to make sure that people were cared for safely. The agency has thorough recruitment policies and procedures to make sure that all required pre-employment checks are carried out. This meant that people using the service were cared for and supported by suitable staff.

Care staff told us that they felt well supported by the provider and they were able to access the training they needed to do their job. Care workers' comments included 'every week I go to a course, for example I've done effective communication, mental capacity and safeguarding,' 'I feel fully supported by the company' and 'I like working here, 'we get lots of feedback.'