Background to this inspection
Updated
3 December 2019
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.
Inspection team
The inspection was carried out by one inspector, an assistant inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 3 working days’ notice of the inspection. This was because we needed to make arrangements to speak with people who use the service.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with 17 people who used the service and 18 relatives about their experience of the care provided. We spoke with eleven members of staff including the director, the nominated individual, the registered manager, care co-ordinator, a senior care worker, five care workers and the member of staff responsible for HR and training.
We reviewed a range of records. This included four people’s care records and three people’s medication records. We looked at two staff files in relation to recruitment practices. 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 training data and quality assurance records.
Updated
3 December 2019
About the service
Nightingale Homecare Norfolk (Brooke) is a domiciliary care service. They provide personal
care and support to people living in their own homes. 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 providing a regulated activity to 45 people.
People’s experience of using this service and what we found
People’s end of life care needs were not routinely assessed. We have made a recommendation that the provider review how it meets people’s end of life care needs.
People were protected from the risk of harm. Risks to people were assessed and staff took action to help mitigate identified risks. People were supported staff who had been recruited safely. People received support from fairly regular and consistent staff. The provider had recently implemented new systems which would help them to provide more regular and consistent visits for people. People’s medicines were managed safely and people received these as prescribed. People were supported by staff who had a good understanding of proper hygiene and infection control. Incidents that occurred in the service were reviewed. Appropriate actions to mitigate the likelihood of a repeat incident were taken.
Holistic assessments of people’s needs were carried out. People were supported by competent and trained staff. Where people required support with their meals this was done appropriately and staff supported people to eat the food they liked. People’s health care needs were assessed and staff supported people in this area where required. 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 were supported by kind and caring staff, who often gave up their own free time and resources to help enhance the quality of people’s lives. People’s independence was respected and supported. There were meaningful opportunities for people to discuss and make decision about the support provided.
People received person centred care which met their individual needs and preferences. People’s preferences and wishes in relation to the service provided were accommodated where possible. People had care plans in place which provided guidance and information for staff, although in some areas would have benefited from more person centred detail. People’s communication needs were assessed and supported. Staff understood the importance of social inclusion and supported people with social needs, this included facilitating the sharing of information with relatives when appropriate. People and relatives felt able to discuss any concerns about the service with staff. Staff took responsive action in response to any issues raised.
People and relatives felt some aspects of the service required further work. This was in relation to communication from the office and consistency of calls. The provider and registered manager were committed to seeking feedback from people using the service so they could make changes which would result in improved outcomes for the people using it. The provider had recently implemented changes to help improve communication and consistency of calls. There was good oversight of the service delivery by both the provider and registered manager. The provider had recognised the service could be strengthened by the development of a more formal governance system, plans were in place to address this. Staff felt happy and supported working in the service.
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 (report published 19 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.