Archived: Twenty Four Seven Nursing - Domicilliary Care Agency

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes the records we looked at and what people who used the service and the staff told us.

Is the service safe?

At the time of our visit there were approximately 60 people who used the service. We spoke with four people and one relative. They all told us they felt safe when staff visited them.

We found there were relevant recruitment procedures in place to ensure appropriate checks were undertaken before staff began work.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents and complaints. This reduces the risks to people and helps the service to continually improve.

Is the service effective?

Staff were able to provide us with detailed information about people's care and treatment needs. Such as what people liked and disliked, potential risks to their health and wellbeing and what their specific care needs were for each visit. This showed staff understood the people they were caring for.

People told us they received the care and support they required at the times they needed it. One person said 'staff ask me what I want and help me in the way I want'. Another person said 'if staff are running late they will give me a ring to let me know, but they are usually always on time'.

We saw the service had made improvements to the procedures in place to ensure staff were appropriately trained and supported. This showed us people were being cared for by staff with the appropriate skills and who were supported to deliver care and treatment safely and to an appropriate standard.

Despite the positive comments people made and the ability of staff to demonstrate to us that they knew people and how best to support them, we found evidence that people were not always protected from the risks of unsafe or inappropriate care and treatment as the provider did not maintain accurate records in relation to the care and treatment provided to people. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to records.

Is the service caring?

People told us they were pleased with the standard of care they received. One person said 'I really cannot fault the care I have received. With the staff's support I am now on the road to recovery, they have helped me get my life and independence back.' Our discussions with people and the records we looked at told us that individual wishes for care and support were taken into account and respected.

Since our last visit there had been a change to the management team at the service. During our discussions with them it was clear that they were committed to driving improvements in the standards of care people received.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

Is the service responsive?

People told us they knew how to make a complaint if they were unhappy. One person said that they had made a complaint and were satisfied with the outcome. From our review of records and from speaking with people we saw that people who used the service were asked for their views about their care and treatment and they were acted on.

The daily care notes were returned to the office each month for review to ensure issues or changes had been identified and appropriate action had been taken for people, such as making referrals to health professionals. The staff we spoke with told us they would immediately commence a care review and alert the management team if they noticed a change in people's needs.

Is the service well-led?

Although some processes were still being implemented, which meant we were unable to test their efficiency during this visit, the provider had taken steps to ensure they assessed and monitored the quality of service people received. The management team recognised there was some way to go to ensure the revised processes were fully embedded across the service. However, they said both they and the staff team were fully committed to ensure improvements continued.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

We found the provider was taking reasonable steps to promote good infection control practice and in-field audits had recently been undertaken to monitor compliance with the infection control policy.

We found short falls in terms of staff support particularly in relation to appraisals and personal development plans. We also found team meetings to be relatively infrequent and there did not seem to be many examples of where staff had got together as a group to provide peer support. We found mixed standards in terms of quality assurance but the relatively new head of homecare had started to introduce new processes. There were some shortfalls, especially in terms of audit, and the processes in place had missed the shortfalls in some standards that we found during the inspection.

We found there were safeguarding processes in place that ensured abuse could be identified and correctly reported. We also found the complaints process was clearly set out and complaints had been managed appropriately.

People who used the service told us they were satisfied with the support they had received, had no complaints about the care and felt staff were 'very polite'.