Regenerage

The registered manager was on duty throughout 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.

At the last inspection on 27 and 29 July 2016, we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection or on-going monitoring that demonstrated serious risks or concerns. However, at the previous inspection some recommendations were made within the key question of ‘safe’, which resulted in this domain only being rated as ‘requires improvement’. At this inspection we found the provider had addressed the previous recommendations and therefore, the key question of ‘safe’ is now rated as, ‘Good.’ This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People we spoke with told us they felt safe using the services of Central Lancashire nail cutting service. We did not identify any areas of risk during our inspection. Those who used the service were protected from abuse and records showed the staff team had received training in safeguarding vulnerable adults.

People who used the service were protected by the robust recruitment practices adopted by the home. This helped to ensure only suitable staff were appointed to work with the vulnerable people.

New employees were guided through a detailed induction programme. Staff were regularly monitored through supervision and appraisals and a broad range of training modules were provided.

People were supported to have maximum choice about the delivery of the service and staff supported them in the least restrictive way possible; the policies and systems of the service supported this practice.

People looked comfortable and relaxed in the presence of staff members. We observed a staff member supporting one person in a kind and caring manner, ensuring their privacy and dignity was consistently protected. Staff members displayed a friendly and compassionate attitude towards those who used the service. People we chatted with expressed their satisfaction about the service provided and relatives spoke highly of the staff team.

The needs of people had been thoroughly assessed before a service was arranged. The care files we saw were found to be detailed and person centred. We observed a staff member at work in the community and found she followed the agreed plans in day to day practice. This helped to ensure people received the nail care they needed.

Records showed feedback from people had been actively sought about the quality of service provided. This was underpinned by regular audits, in order to monitor the quality of service provided. We found that a system was in place for the management of complaints, although none had been received. People we spoke with felt the service was being well-managed.

Further information is in the detailed findings below.

The agency Central Lancashire Age Concern - Nail Cutting Service is managed from well-equipped offices located near to the centre of Preston. Foot nail clipping and some fingernail clipping services are provided in people's homes to support people who are unable to deal with these tasks themselves in order to help them stay active and independent.

The service is registered to provide personal care. The service is currently changing the registered manager in post. However, there remains a nominated individual and a new manager has been appointed. 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 we spoke with told us they felt safe and staff told us they knew how to report safeguarding concerns and felt confident in doing so.

Risk assessment documentation was present in each care record with regards to a person’s home. However, we found risk assessments for potential risks individuals may be exposed to were not always completed. The service did on occasion apply creams for people who they supported. It was not always clear if these were prescribed topical treatments or not.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. The service had procedures in place to reduce the risk of cross contamination and infection control.

Everyone we spoke with consented to the service. Referrals were made by health professionals or people self- referred to the service. People's consent was gained prior to the service being delivered at each visit. Consent forms were not always signed, however consent for the service was mostly informal and implied, in that people sat and had their nails cut.

We saw the service had a detailed induction programme in place for all new staff and staff were required to complete the induction prior to working unsupervised. We were told and saw evidence staff received clinical support from the podiatrist on a six weekly basis and their competency was assured at this time and formally every six months.

We asked people how they were treated by staff when they were in receipt of the service and everyone told us staff were respectful and polite.

When people first started using the service, the podiatrist undertook a comprehensive assessment. People who used the service had a paper treatment record which was taken to each appointment. This was updated with the service provided following the visit. There was very minimal information to inform staff about the person they were supporting.

A system for recording and managing complaints and informal concerns was in place. The provider offered support in signposting people to other local community services, as and when required.

We found all the staff members we spoke with reported a positive staff culture. Staff felt that they were listened to and supported by management. The provider had recently developed a quality improvement plan for the service and we were told the feedback from the inspection would form part of this plan going forward.

We found the management team receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We have made recommendations around risk assessments, the application of topical treatments, person centred care planning and quality assurance to improve the service.

Below is a summary of what we found. The summary is based on our observations during the inspection. We visited the main office to look at records. We then visited and spoke to people who used the service in their own homes and also by telephone. We also spoke with people's relatives and staff employed by the agency.

The service is registered to provide the regulated activities of Personal care to support people to remain active and live independently in the community.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found that people who used the service and their relatives had been fully involved in decisions made around their personal care. One person who used the service told us 'They asked me what I wanted and told me what they could provide. The girl that comes in is lovely, it's like having a friend round'.

People we spoke with who used the service told us they felt safe with the staff in their homes. Staff wore a uniform to identify themselves and reassure people. Staff we spoke with had a good understanding of infection control and preventative measures which helped to keep people safe.

A full assessment of peoples health needs was carried out before any service was provided. We saw that people were kept safe by regular reviews of their health condition.

Staff felt well supported by the manager and senior staff, and were confident in reporting any concerns.

Is the service effective?

Following an initial question and answer assessment the health and personal care needs of those who used the service had been thoroughly assessed by a qualified podiatrist (a person trained in the care and treatment of feet and foot diseases). People who used the service told us that the manager had spent some considerable time completing the initial assessment. One person told us: 'She went through all my medication and discussed my medical conditions'.

Relatives we spoke with confirmed with us that a full assessment of needs had taken place.

People who used the service told us that staff met people's needs in a friendly and relaxed manner and that they looked forward to the visits. We saw from records that future appointments were arranged in advance during the visit. People we spoke with told us that they always knew when the nail cutting staff were due.

We saw evidence that the service assisted people who used the service to access other forms of health care when required. We saw from records that regular contact had been maintained with other health and social care professionals in order to provide safe and effective care.

Is the service caring?

We visited and spoke with people who used the service. We also spoke with people by telephone. We asked about the care they received. All of the feedback given to us was positive. People told us staff who visited them were caring and they were happy.

Staff we spoke with told us that they loved their job and felt well supported.

We looked at care files for people who used the service and found that information was recorded in a person centred way. Risk assessments were in place and files contained sufficient information for staff to meet the needs of people who used the service. A reassessment of people's needs was carried out every 18 months.

Is the service responsive?

People's preferences in terms of visit times and punctuality had been recorded and care and support had been provided in accordance with people's wishes.

We saw that the company had taken note of people's comments and made changes to the service where required. For example due to people's comments they had introduced a finger nail cutting service as well.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The manager held regular staff meetings. Checks and audits were carried out by the manager and senior staff. Staff received regular one to one supervision.

The service had a quality assurance system. Records showed that identified problems and opportunities to change things for the better were addressed promptly. People who used the service told us who the service engaged with them to ask for feedback on the service provided.

People reported they were very happy with the service and staff had been polite and helpful.

People had been supported to maintain their independence and improvements were noted in people's 'confidence', 'mobility' and 'improved well being'. They commented 'Excellent service from a caring team. Not only does she do my feet but she leaves me feeling good about myself'.

Good risk assessments were carried out to ensure people were not placed at risk and were receiving the right level of support.

Appropriate checks were undertaken before staff began work and staff could only practice after they had been trained and assessed as competent in safe nail cutting.

Contractual arrangements meant staff were not allowed to accept gifts, or gain in any way financially from people using the service.

There were arrangements in place to monitor and assess the quality of the service provided and people were regularly consulted to give their views. There were clear lines of accountability for practice. This meant people were cared for by a well informed organised team.