This was a routine comprehensive inspection, and was our first inspection of the service under its current registration. We gave the service two days’ notice of the site visit, as the registered manager needed to obtain people’s consent to us making home visits. We also needed to be sure the registered manager and other staff we needed to speak with would be available. We visited the office on 3, 4 and 9 May 2018, and visited someone at home on 9 May 2018.This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger disabled adults, and to children and young people.
Not everyone using Newcross Healthcare Solutions Limited (Bournemouth) receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’: help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection, the service was providing personal care to 11 people.
The service had a registered manager, who had worked for the service for several years, under its current and previous registrations. 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.
There were good links with health and social care services. These enabled people to stay at home rather than being admitted to a nursing home, or to be discharged from hospital sooner than they would otherwise have been.
The service’s lead nurses had current expertise in their specialist areas.
People were treated with kindness and compassion, and their privacy and dignity was respected. Staff got to know people well and had a good understanding of the care and support they needed.
People were supported to express their views and be involved in decisions about their care. Their views were taken seriously. There was ongoing discussion between people, their relatives and the service to make sure people’s care was centred on their needs and preferences.
Assessments and care plans flagged any sensory loss or communication needs.
Where the service was responsible, staff supported people to follow their interests, access the community, and develop and maintain relationships with people who mattered to them.
Consent to care and treatment was sought in line with legislation and guidance, including the Mental Capacity Act 2005 where this applied.
Risks to people were assessed and managed with the least possible restriction.
Medicines were managed safely.
People were protected through the prevention and control of infection.
People were supported to eat and drink enough to maintain a balanced diet. Where people had food and drink through tubes inserted into their abdomen, staff managed this competently, following clear directions in people’s care plans.
Staff worked sensitively with people, their families, staff and health and social care professionals, to plan for end of life care.
There were sufficient care staff with the skills and experience to provide the care people needed. Only staff with the correct skills and competencies worked with people who had particular needs, such as tracheostomy care.
Staff morale was good. Staff had a clear understanding of their roles and responsibilities, and those of their colleagues. They were treated fairly and with respect, experiencing no discrimination in relation to protected characteristics such as sex, race, disability and sexual orientation.
The registered manager worked closely with the office team and maintained an overview of the atmosphere and culture in the service.
Staff said they found the registered manager approachable and that they were well supported.
They had the training, supervision and appraisal they needed to deliver effective care and support.
Staff understood their responsibilities in relation to safeguarding people and knew what they should do if they had concerns about abuse or neglect.
Lessons were learned and improvements made when things went wrong.
There was a system for receiving complaints and ensuring these were addressed promptly and thoroughly. We have made a recommendation regarding clarification within the provider’s complaints policy, of CQC and other agencies’ roles for managing complaints.
There were rigorous pre-employment checks before new staff were allowed to start work, in line with the provider’s recruitment procedures. However, the provider’s application form asked for an employment history covering only the last 10 years, rather than a full employment history. We have made a recommendation about revising the application form so it meets the regulations.
People’s personal information was treated confidentially. The provider had been accredited for meeting internationally recognised standards in relation to data security and protection.
Systems operated to maintain and improve the quality of the service. These included gathering people’s views of the service through ongoing discussions, and meetings for staff to provide updates and hear their views. There were regular spot checks and audits within the service and by the provider’s clinical governance team. We have made a recommendation regarding how audits feed into an action plan to drive improvements.