Archived: NSF Health

Updated 8 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the recruitment of staff, and the management of medicines. A decision was made for us to inspect and examine those risks.

Following our initial site visit, additional concerns were raised about the safety of people using the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Inspection team

Inspection site visit activity was completed by two inspectors. Two additional inspectors supported the inspection by contacting staff, people who used the service and their relatives by telephone.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats, and specialist housing.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed the information we held about the provider since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We also sought feedback from the local authority.

During the inspection

We spoke with seven people who used the service and three relatives about their experience of the care provided. We spoke with nine members of staff including the provider, registered manager and care workers.

We reviewed a range of records. This included five people’s care records and medication records. We looked at eight staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff training information and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 8 July 2021

About the service

NSF Health is a domiciliary care service providing care to people in their own homes. The service is provided to people who have a range of needs including a learning disability, mental health needs, physical disability and age-related frailty. At the time of the inspection, there were 37 people receiving support from NSF Health.

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

The management of medicines within the service was not always safe as shortfalls in medicines records did not support safe delivery of the service. We could not be assured people had always received their medicines. Staff practices in relation to medicines were not always in line with national guidance or the provider’s policy.

We could not be satisfied that governance systems used within the service were always effective. Shortfalls within the service were not always identified and appropriate action had not always been taken to address shortfalls. Where shortfalls had been identified, there was a lack of evidence as to what action had been taken to address the shortfalls. Subsequently, these shortfalls were still present at the time of the inspection.

The recording of people’s care delivery had not always been completed. We also found inconsistencies relating to call monitoring. This meant, management could not always identify whether people had received their care calls as agreed and what support people had received from staff. The people and relatives we spoke with provided mixed feedback relating to the punctuality of care staff.

The provider and registered manager had reviewed all incidents reported by staff and acted upon them to reduce risks to people. However, they had not always notified CQC of incidents they had a legal obligation to report to us.

People were protected from avoidable harm and the risk of abuse had been minimised. Staff had received safeguarding training and had a good understanding of the action they needed to take if they had any concerns.

The service took appropriate action to ensure the safe recruitment of staff. Infection prevention measures had been established within the service. Staff had a good understanding of these procedures and people confirmed staff were wearing personal protective equipment (PPE) when visiting people in their homes.

People and their relatives were positive about the caring nature and approach of staff. People told us they were supported by staff who were kind and caring.

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 had received training which was appropriate to their role. Staff told us they received regular support from management. Staff told us they could seek advice from the registered manager and senior carers.

The registered manager acted on concerns to ensure people received care which was safe and responsive to their needs. Any concerns or accidents were reported and acted on.

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 11 October 2019).

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the recruitment of staff, and the management of medicines. A decision was made for us to inspect and examine those risks.

Following our initial site visit, additional concerns were raised about the safety of people using the service so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this report.

We found multiple breaches of regulation. You can see what action we have asked the provider to take at the end of this full report.

Following our inspection, the provider has engaged with us and have given reassurances that people will receive safe care and treatment. The provider took immediate action to arrange additional training, staff support and are in the process of reviewing their quality assurance systems to ensure risks to people are minimised.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines, ensuring accurate and cotemporaneous records, maintaining good governance within the service and notifying CQC of incidents.

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 for 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.