We carried out a review of the data available to us about Right Nurse Care Services on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Right Nurse Care Services, you can give feedback on this service.
Right Nurse Care Services is a domiciliary care agency. The service provides personal care to people living in their own homes. At the time of our inspection there were 5 people using the service. Services are provided throughout Cornwall to people of all ages who have a range of complex needs, including people with a learning disability and autism.
Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided. There were three people who were receiving personal care at the time of this inspection.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture.
Right support:
Staff helped to maximise people’s choice, control and independence. People were able to choose how and where they spent their time, and staff supported people to make decisions if required. There were an adequate number of skilled staff to enable people to safely engage in activities of their choice. People were supported to achieve good outcomes.
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. Staff and the registered manager regularly communicated with people’s relatives. Where restrictions had been required, to keep a person safe, these had been appropriately reported to the appropriate authorities for authorisation.
Right care:
Staff were knowledgeable and cared for the people they supported. They were enthusiastic and able to tell us about people’s recent activities and achievements. Staff knew how to protect people from all forms of abuse and discrimination.
Right culture:
Healthcare professionals were positive about the quality of the support provided to people, the impact upon their well-being and their quality of life. Families were regularly communicated with and updated about their loved ones.
The registered manager was also the provider. They had experienced challenges in being able to recruit staff of the required calibre to meet the complex needs of the people they supported. Staff were recruited safely and told us they felt well supported by the registered manager. Staff and people were able to obtain assistance day or night from a member of the on-call senior management team.
There were effective recording systems in place. All daily records and handover information, for the next shift, were recorded on email and sent via the registered manager to help ensure good communication and that all staff were aware of any changes that may have occurred.
Care plans contained adequate information regarding the person’s needs. The service was working with a consultant to improve the setting of specific goals and outcomes for some people.
There were robust audit and quality assurance systems in place. Staff managed some people’s money. There was a clear system in use where staff accounted for any money spent on behalf of a person.
Medicines were managed safely. All medicines were blister packed by a pharmacist. Staff ensured people always received their medicines as prescribed.
The service had received many compliments regarding the service provided to people.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection:
The last rating for the service was good (published 5 October 2018). At this inspection the services rating has remained good.
Why we inspected
This inspection was prompted by a review of the information we held about this service. As a result we undertook a focused inspection to review the key questions of Safe and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Right Nurse Care Services on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Right Nurse Care Services provides personal care to people living in their own homes in the community. Services are provided across Cornwall to adults of all ages who have a range of complex needs, including physical disabilities, learning disabilities, mental health needs and dementia. At the time of our inspection the service was delivering 475.5 hours per week for eight people. These services were funded either privately, through Cornwall Council or NHS funding.
People were unable to us about their experiences of using the service due to their complex health needs. However, people’s families told us they were happy with the care their relative received and believed it was a safe reliable service. Comments included, “The service is very reliable and I am confident that the team can deal with any unforeseen circumstances” and “Very happy with the service provided.”
People were treated respectfully and staff asked how they wanted their care and support to be provided. Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. People who needed help taking their medicines were appropriately supported by staff.
Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.
People were supported by dedicated staff teams who were employed and trained to work specifically with each person using the service. There were suitable arrangements in place to cover for staff absences, this included office staff covering shifts and a group of care staff who had been trained to work in multiple teams. Relatives told us, “The team are very ‘stable’ and dad is very familiar with them all” and “Generally speaking there is a consistent team caring for my sister, some of whom have been doing it for years.”
The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.
The service had robust recruitment practices, which meant staff were employed suitable to work with vulnerable people. Training records showed staff had been provided with all the necessary training which had been refreshed regularly. Staff told us they found the training to be beneficial to their role. Staff said they were encouraged to attend training to develop their skills, and their career.
Staff told us they enjoyed their work and received regular supervision, appraisals and training. Staff were complimentary about the management team and how they were supported to carry out their work. The management team were also clearly committed to providing a good service for people.
There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. Relatives told us they knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.
Right Nurse Care Services is a domiciliary care provider based in Cornwall providing personal care and support to people in their own homes. On the day of the inspection nine people were receiving a service. Right Nurse Care Services support people who have complex needs and support packages ranged from four hours a day to twenty-four hour support. People using the service had varied health care needs including physical disabilities, learning disabilities, mental health needs and dementia.
The service had a registered manager in place. 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.
Relatives told us they felt the care and support provided by Right Nurse Care was safe. Comments included; “I’ve no qualms about that [the person’s safety]” and, “She is totally safe with them.” An external healthcare professional told us; “I would certainly consider them safe.”
Staff had received training in safeguarding adults and children and were aware of the service’s safeguarding and whistleblowing policies. Information on how to raise a concern was available on notice boards in the office and on-line. The organisation’s safeguarding policy contained the most up to date information for local reporting procedures.
Care plans contained associated risk assessments for a range of areas. Where people had been identified as being at any increased risk more detailed assessments were put in place to address the area of concern. The registered manager continually re-assessed people’s circumstances to help ensure that people were kept safe while maintaining their access to full and meaningful lives.
There were sufficient numbers of staff available to keep people safe. The service recruited staff to match the needs of people using the service and new care packages were only accepted if suitable staff were available and when current packages were clearly established. There was a robust recruitment process in place to help ensure staff had the appropriate skills and knowledge required to meet people’s needs.
People received care from staff who knew them well, and had the knowledge and skills to meet their needs. Staff normally only worked with two or three people at any one time. This meant they were able to get to know people and their support needs well. Staff told us; “You can get to know people really well and give continuity of care. It’s what people want.”
Staff were supported by a robust system of induction, training, supervision and appraisal. Team meetings were held regularly to allow staff to raise any areas of concern. Staff and management emphasised the importance of creating and maintaining clear and open lines of communication.
The registered manager had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Staff spoke of the importance of ensuring people were supported to make decisions and their right to do this even if staff considered the decisions to be unwise.
Relatives were highly complementary about staff and the support they received from Right Nurse Care Services. Comments included; “It’s been an absolute saviour, brilliant!”
People’s relationships with friends and family were recognised and respected. When people did not have family to support them efforts were made to ensure they received independent support from a local advocacy group.
Care plans were individualised and described people’s needs across all areas of their lives. They were reviewed and updated regularly and accurately reflected people’s current needs. Staff told us they were kept aware of people’s changing needs at all times and there were effective and appropriate systems in place for sharing information with staff.
There was a satisfactory complaints policy in place. No complaints had been received at the time of the inspection.
Staff and relatives told us they considered the agency to be a well led service. The registered manager knew people well and had a good understanding of what was happening on a day to day basis.
People's privacy, dignity and independence were respected and care was planned and delivered in a way that was intended to ensure people's safety and welfare.
People's health, safety and welfare was protected when more than one provider was involved in their care because the provider worked in co-operation with others.
The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.
People's privacy, dignity and independence were respected.
People experienced care, treatment and support that met their needs and protected their rights.
People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
People were safe from the risk of infection because appropriate guidance had been followed.
People were cared for by, suitably qualified, skilled and experienced staff.
People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.