We carried out a review of the data available to us about Natgab Care 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 Natgab Care, you can give feedback on this service.
• Natgab Care is a domiciliary care agency for adults of all ages who may have dementia, mental health, physical disabilities, sensory impairments, a learning disability or an autistic spectrum disorder.
• The service was providing personal care to 15 people at the time of the inspection.
Rating at last inspection:
• Requires Improvement (Report published 15 March 2018). We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of safe care and treatment, recruitment, staffing, governance of the service and the requirement to notify CQC of significant events. At this inspection, we found that improvements had been made.
People’s experience of using this service:
• People told us they felt safe with the staff who knew how to meet their needs, in the way they preferred. One person told us, “Yes I do feel safe. If I ask for help, they listen.”
• People were at the centre of their care and support; care plans enabled people to maintain their independence.
• The registered manager had implemented new systems to record checks that had been completed on people's care records, daily logs and medication administration records.
• Systems were in place when recruiting new staff to assess that their experience and character was appropriate to the role.
• The registered manager monitored staff's ongoing working practice and training needs to help ensure they were competent and confident in their role.
• Staff had access to training which was appropriate to their role.
• Records relating to consent for care were completed accurately.
• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
• Staff knew what action to take to protect people from the risk of abuse and the registered manager notified CQC of significant events as required.
• Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of avoidable harm occurring.
• We found that complaints raised had been listened to and investigated by the registered manager.
• People who used the service, their relatives and staff told us the registered manager was approachable and helpful.
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
At our last inspection on 10 September 2015 the service was rated as ‘Good’ overall.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.
At the last inspection we made a recommendation that the service put in place a comprehensive system of audits and checks to ensure that it was well run and deficiencies were identified and promptly responded to. At this inspection we found there were not always effective systems or audits in place to check the quality of the service. We also found there were not always effective systems in place to prompt management actions in relation to reviewing care and prompting spot checks. We also found issues with recording so actions taken by staff were not always recorded on care records.
We found that medicines management was not always safe as the registered manager did not assess the competency of staff to support people with medicines and did not require staff to undertake refresher training in this area. There was not an effective system to check medicines records at the office reflected current medicines people were being supported with.
Risk assessments did not always provide detailed information to staff in supporting people as the service sometimes relied on documentation from health professionals to guide staff.
The provider could not always evidence safe recruitment practices prior to staff starting work with vulnerable people.
The registered manager organised comprehensive team meetings quarterly at which best practice was discussed. However, there was no requirement for care staff to attend or undertake refresher training courses or to have individual supervision. So the registered manager did not always check staff understanding in key areas. For example, we found not all staff understood fully their role in safeguarding adults.
People were supported to have maximum choice and control of their lives and staff understood the importance of consent, but they did not always understand best practice in decision making related to the Mental Capacity Act (2005).
Family members spoke highly of the care provided and staff supported people with complex medical conditions. Health and social care professionals told us the service worked effectively in partnership with them in meeting people’s ever changing health needs.
The provider had a complaints process in place which dealt with complaints appropriately and family members told us they felt confident in drawing attention to concerns they had with the registered manager.
We could see there were infection control practices in place to safeguard people and the registered manager shared learning with staff from issues that arose from incidents or safeguarding concerns.
We found the provider was in breach of five fundamental standards. These related to safe care and treatment, recruitment, staffing, governance of the service and the requirement to notify CQC of significant events.
We have made three recommendations in relation to the Mental Capacity Act (2005) and best practice in care and recording of mental capacity, evidencing personalised care on care records and ensuring they are up to date to reflect current care needs, and developing a more robust system to minimise missed visits.
You can see what action we told the provider to take at the back of the full version of the report.
We undertook this announced inspection on 10 September 2015. Natgab Care provides a range of domiciliary care services which include personal care, administration or prompting of medication, food preparation and housework. Some people who used the service have palliative care needs.
At our last inspection on 11 September 2014 the service was found to be meeting the regulations we looked at.
The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.
People who used the service and their relatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and people’s care needs had been attended to by care staff. Care staff developed positive relationships and they got on well with people who used the service.
People’s needs were carefully assessed. Risk assessments had been carried out and these contained guidance for staff on protecting people. Staff provided care as detailed in people’s care plans. When needed or agreed with people or their representatives, people’s healthcare needs were monitored. The arrangements for the prompting and administration of medicines were satisfactory. The service had an infection control policy and staff were aware of good hygiene practices.
People’s preferences were recorded and arrangements were in place to ensure that these were responded to. Staff were knowledgeable regarding the individual care needs and preferences of people. There was documented evidence of reviews of care carried out although some people said their care had not yet been reviewed.
Staff had been recruited with care and provided with training to enable them to care effectively for people. Staff had the necessary support and supervision from their managers. They knew how to recognise and report any concerns or allegations of abuse. There were enough staff to meetpeople's needs.
The service had a complaints procedure. Complaints had been recorded and promptly responded to. There were some arrangements for quality assurance. Audits and checks had been carried out by senior staff and the registered manager. However, these audits and checks were not sufficiently comprehensive as we did not see evidence of audits and checks on areas such as staff recruitment records, accidents and complaints.
We saw a record of compliments received and these indicated that relatives and people concerned were satisfied with the quality of care provided.
At this inspection we were satisfied that the service had suitable arrangements in place to ensure that people were protected from the risks of unsafe or inappropriate care and treatment because appropriate records and information related to the care of people were well maintained.
Care records of people contained essential details of assessments. These assessments included information such as skin condition, mental state and the care needs of people. The care records contained care plans signed by people or their representatives to indicate their agreement. Reviews of care were documented.
The training records of staff contained information regarding induction, safeguarding and moving and handling training. Spot checks carried out on staff had been recorded. This ensured that staff were carrying out their duties as agreed in the care plans of people.
The service was newly registered and had only a few people who used the service. We spoke with one person who used the service and three relatives of people who used the service by phone. We also spoke with the registered manager, the care co-ordinator, an administration staff and three care staff regarding the care provided to people who used the service.
Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us and what we found in the records we looked at.
If you want to see evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
People who used the service and three relatives informed us that they had been treated with respect and dignity. They were satisfied with the care provided by staff and expressed no concerns regarding the services provided.
People had been assessed to ensure that their needs were noted. Care records contained risk assessments which provided guidance to staff on action to take to keep people safe.
Safeguarding procedures were in place and the manager and her staff were aware of action to take in response to safeguarding incidents or allegations.
Is the service effective?
Feedback from a person who used the service and relatives indicated that the service was effective and able to meet the needs of people. The preferences of people regarding their care and how it should be delivered were documented and staff we spoke with were aware of these. Care plans were up to date and people and relatives we spoke with stated that staff did what was agreed in their care plans. Staff were knowledgeable regarding how to care for people with specific healthcare problems. This was confirmed in feedback we received from people and their relatives.
Is the service caring?
People and relatives informed us that staff were caring. They described staff as 'wonderful', 'caring' and 'brilliant'. One relative told us that staff understood people's religious and cultural needs.
The care records contained details of personal care to be provided and the specific dietary needs of people. The care co-ordinator was able to give us examples of what they did to meet people's special preferences such as allocating particular carers who had an understanding of the cultural needs of a person and if a person got on well with a particular carer and requested them, the agency would arrange for the carer(s) to attend to them. The care co-ordinator stated that she would regularly contact people and their relatives to check if they were well cared for. She stated that this was routine when the person who used the service was new to the agency.
Is the service responsive?
One relative informed us that staff were responsive and provided the care that was needed and in accordance with what was agreed in the care plan. Other relatives and a person who used the service stated that the care provided was good and they were happy with the services provided. No complaints or concerns were expressed by them.
The care co-ordinator stated that where a relative or person who used the service had requested visit times to be changed, the agency would be flexible and try to meet that need.
Is the service well-led?
The registered manager was knowledgeable regarding her role and responsibilities. There were arrangements for monitoring the quality of care provided. A satisfaction survey had been carried out. The results indicated that people who used the service and their representatives were satisfied with the care provided. Monitoring visits and phone calls had been made to people who used the service and their relatives to ensure that people were well cared for. Staff informed us that communication with their manager and senior staff was good. The care co-ordinator stated that she would regularly contact care staff to check if they were coping with their work.
We however, noted that appropriate records and information related to the care of people and the management of the service were not always comprehensive or well maintained. Some assessments were not sufficiently comprehensive. Record of care reviews and telephone conversations with people who used the service were not always documented. Some staff recruitment records did not contain all the required documentation and training records were not sufficiently informative.