KMX Nursing Agency

KMX Nursing Agency is a domiciliary care agency providing personal care to adults living with families or in their own homes in the community. 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. At the time of our inspection the service was supporting five people living with frailty and other health related conditions and younger people living with learning disability and/or Autistic spectrum conditions.

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

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.

People’s care plans and risk assessments were written in a person-centred way; however, the provider was using two different systems to record this information. Improvement was needed to streamline this to avoid the potential for confusion.

The quality assurance system was not formalised and improvements were needed in how the provider assessed, monitored and used their systems to drive improvements.

Staff were recruited safely and received training and supervision to support them in their role and identified any learning needs and opportunities for professional development.

Staff supported people to have enough to eat and drink and to make choices about what they ate and drank. People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance.

People and their relatives told us they were given every opportunity to be valued and equal partners in decisions around their care and support. This was reflected in the good quality care and support people received, from a committed and caring group of staff. One relative said, “they have attention to detail, nothing is too much trouble, they go above and beyond.”

People, relatives and staff told us that they were encouraged to give feedback about the care delivered and communication was good with the staff and registered managers.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People were supported in their own family home. Staff had the training, knowledge and skills to understand people’s specific needs. Care plans were person centred and detailed with an emphasis on how people’s communication was to be supported.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 requires improvement (published 19 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

Enforcement

Since the last inspection we recognised that the provider had failed to comply with the display ratings requirement. This was a breach of Regulation 20A of the Health and Social Care Act 2008. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for KMX Nursing Agency on our website at www.cqc.org.uk.

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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

KMX is a domiciliary care agency which provides support for adults in the community, who require assistance with personal care and re-enablement following hospital discharge, including people living with dementia. At the time of the inspection seven people used the service and were supported by four care staff a team leader and a registered manager.

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

People were not always protected from abuse and improper treatment because the provider did not have effective procedures in place to make sure people were safe. Processes were not in place at the time of the inspection to ensure medicines were administered safely by trained staff or that accidents and incidents were accurately recorded. We did not identify any negative impact for people from the lack of procedures and process.

The provider's arrangements for ensuring staff were appropriately trained were not sufficiently robust. The provider had, in most cases, relied upon verbal accounts from staff of training they had undertaken with previous employers without verifying the accuracy of this information.

Health and social care risk assessments were basic and lacked important detail. Support plans did not contain detailed and person-centred information and therefore these did not always accurately reflect the needs of those who used the service. The provider did not have a processes for assessing people’s capacity for specific decisions. We have made a recommendation for the provider about undertaking capacity assessments.

There was little oversight of the management of the service and effective audits were not taking place. Therefore, a robust system for assessing and monitoring the quality of service provided had not been established. We did not identify any negative impact for people from this lack of governance.

People's needs, and choices were assessed before a package of care was arranged and before a person returned from hospital. People told us they were involved in the planning of their care and personal preferences were respected.

People told us that they were supported by kind and caring staff. They told us they felt safe and we received positive comments about the service provided to them and about the staff team.

People's privacy and dignity was respected, and people's diverse needs were supported. 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.

Regular team meetings had been conducted and staff members felt able to approach the managers with any concerns, should they need to do so.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This was a planned inspection. This service was registered with us on 4 July 2018 and this is the first inspection.

Enforcement

We have identified breaches in relation to safeguarding people from abuse and a lack of safe care and treatment. Staff lacked knowledge and the service was not always well-led. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.