Nursing Direct Ltd - DCA Office

About the service:

Nursing Direct Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats. People had a wide range of complex nursing needs including people living with moderate to complex learning disability needs. At the time of the inspection it provided a service for 76 people. The Care Quality Commission (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.

People's experience of using this service and what we found:

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

Right support

People were supported to have maximum choice and control over 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.

Some people using the service and their relatives said communications from the office when staff were late for their calls, could be improved. Other people said communications were good and they said they were informed if staff were going to be late.

Relatives told us they felt they and their family members were safe and were protected from the risk of abuse. The service had appropriate safeguarding procedures. Staff told us they received regular training and they knew how to safeguard people from abuse and the processes that should be followed where concerns arose.

Assessments of people’s needs and any risks were carried out and formed part of the care plan. Relatives told us these care plans were reviewed appropriately and drawn up together with themselves. Risk management strategies were in place as part of the assessment and support planning process. This meant risks to people and to staff were minimised and people’s care was appropriately delivered to meet their needs.

There were robust recruitment practices in place that meant new staff were safely recruited. There were sufficient staff levels to meet people's needs.

Appropriate policies and procedures were in place to ensure people received their medicines safely. Comprehensive training was available for staff on the safe administration of medicines. This together with appropriate supervision and monitoring meant when required people received their medicines, it was administered safely and staff had clear guidance to follow.

Right care

The provider had ensured that appropriate training and supervision was available for staff. This included understanding and how to manage best practice for infection control and the use of PPE.

There were systems in place to ensure that accidents, incidents and risks were appropriately recorded. Analysis of the information meant any trends could be identified and actions put in place to reduce the likelihood of events re-occurring in the future.

People and their relatives told us they were supported by a regular team of staff who knew them well and were able to identify their likes and dislikes. They were supported to eat and drink according to their dietary requirements taking into consideration their preferences.

Right culture

People told us they received good quality care from kind and caring staff. They said in most cases their care was delivered by regular staff and this provided the consistency and continuity they needed. They told us they were treated with dignity and respect. They told us staff had the right skills to deliver appropriate care and support.

People were confident that any concerns would be addressed appropriately and resolved by the registered manager. They told us the registered manager welcomed feedback.

People told us they thought the service was well led and that they were very happy with the support they received.

There were effective systems in place to monitor the quality of the service provided to people which ensured good governance. The service had systems in place to notify the appropriate authorities where concerns were identified. The culture of the service was positive, open and person centred.

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 good (published July 2018).

Why we inspected:

We undertook this inspection to assess that the service is applying the principles of right support, right care and right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for this service has remained good based on the findings of this inspection.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was our first inspection of this service since registration with us on 6 March 2017.

Nursing Direct is a domiciliary care agency that provides personal care and nursing care to people living in their own homes. People had a wide range of complex nursing needs. The agency provided care to people across a large area which included Peterborough, Sussex and London. There were 23 people receiving services from Nursing Direct at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always carry out assessments in line with the Mental Capacity Act 2005 when there was reason to suspect people lacked capacity. This meant there was a risk people may receive care inappropriately. However we were not concerned this was the case with people using the service at the time of our inspection. The provider took immediate action when we raised our concerns in carrying out MCA assessments and arranged ‘best interests’ meetings where they had assessed people lacked capacity.

Staff training was developed and delivered around people’s individual needs. The provider developed a staff training package for each person in relation to their needs. The provider assessed each staff member was competent in all aspects of care before they were able to lone work with them. Training was also tailored to the individual needs of staff and nurses were provided with training in specialist clinical skills to enable them to meet people’s needs.

The provider managed people’s medicines safely. Staff received training in medicines management, including in specialist techniques people required to administer and monitor their medicines.

The provider had suitable recruitment systems to check staff were safe to work with people. There were enough staff to support people safely. People were involved in the recruitment of staff. People met with staff selected to support them before their care began to check they wanted to receive care from them.

The provider assessed risks relating to people’s care and put robust risk management plans in place to guide staff. Care plans informed staff about people’s individual needs, and the best ways for staff to care for them.

People felt safe with the staff who supported them. Staff understood how to respond if they suspected anyone was being abused and received training from the provider to refresh their knowledge.

Staff were supported through a programme of supervision, appraisal and mandatory training to help them understand their role and the best ways to care for people. Care workers were also encouraged to complete diplomas in health and social care to further their knowledge.

People received the necessary support from staff in relation to eating and drinking including support with any specialist equipment. The provider also catered to people’s ethnic and cultural needs. People were supported with their day to day healthcare needs.

Staff treated people with kindness, dignity and respect and respected their privacy. Staff developed good relationships with people and understood their needs and preferences. People were involved in their care and were supported to maintain their independence.

The provider had systems in place to investigate and respond to concerns and complaints appropriately.

The provider had systems in place to assess, monitor and improve the service. The provider also gathered feedback from people and staff and used this as part of improving the service.