Nightingale Homecare Norfolk (Norwich)

Nightingale Homecare provides personal care for people in their own homes. This was a first comprehensive ratings inspection of this service. 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.

When we inspected, 127 people were using the service, 90 of whom were receiving the regulated activity of personal care.

There was a registered manager in post. 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.

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

Recruitment procedures were not always robust. There were unexplored gaps in employment history and the provider had not always taken suitable action taken to follow up additional references. There were unexplored inconsistencies in some applications.

Medicines were not always recorded and administrated safely; allergies not always recorded consistently across Medicines Administration Records (MARs) and care plans, and there was not always up to date information in care plans to reflect what medicines were prescribed.

Management checks did not always identify shortfalls in the care records, recruitment files and medicines administration.

Some risks to people’s health were not fully planned for, for example, related to conditions such as diabetes or multiple sclerosis (MS) or a significant risk of chest infection. Care plans did not always contain comprehensive guidance for all staff to follow as to how they should reduce the associated risks.

We have made a recommendation about care planning.

Despite the above areas highlighted for improvement these risks had not led to harm of people or staff, but needed to be further mitigated. Where we had specific concerns about people’s health needs, the provider took prompt action to mitigate the risks.

There were enough trained staff to meet people’s needs and they had good knowledge of safeguarding. People felt safe when staff supported them.

Staff used Personal Protective Equipment (PPE) as required by current guidelines and followed good infection control practices.

Staff had a good knowledge of consent and issues regarding mental capacity. 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 were caring, compassionate and kind. People felt listened to and involved in their care, from planning to delivery. People received care that respected their privacy, dignity and independence.

People received care that was assessed and planned for, and responsive to their individual needs and preferences, by consistent staff. Changes were made to people’s care as needed, and people were involved in their care.

People, relatives and staff were positive about the management in place, and complaints and concerns were investigated and resolved.

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)

This service was registered with us on 10/10/2018 and this is the first inspection.

The last rating for the service at the previous registered location was Good, published on 03 December 2019.

We have found evidence that the provider needs to make improvements, and three breaches of regulations. Please see the safe and well-led sections of this full report.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service. A decision was made for us to inspect and examine those risks.

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 monitor the service 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 safe care, safe recruitment and governance at this inspection.

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.