Nation Care Agency

Updated 15 September 2022

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors. Following the inspection two Experts by Experience carried out telephone interviews with people who were receiving support and relatives.

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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 5 July 2022 and ended on 14 July 2022. We visited the location’s office on 5 and 6 July 2022.

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 and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager, business and quality assurance manager, operations manager and two care coordinators. We reviewed six people’s care plans and the employment records for five care workers. We also looked at multiple medicines records and a range of records relating to the management of the service including audits. Following the inspection two Experts by Experience carried out telephone interviews with 10 people who were receiving support and seven relatives of people who had care visits.

Updated 15 September 2022

About the service

Nation Care Agency is a domiciliary care service providing personal care and support to people living in their own homes. The majority of people receiving support had their care funded by the local authority. At the time of the inspection the service provided support for approximately 85 adults, which included a majority of older people and a few younger adults. 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.

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

The provider had made some improvements to how care workers were deployed but care visits were not always carried out at the agreed time. The provider had introduced a new quality assurance system so a range of checks to monitor the quality of the service were carried out, but these were not always appropriate as they did not provide information where issues were identified so these could be addressed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not always ensure complaints were appropriately investigated to ensure preventative measures could be identified.

The provider had made improvements to the management of risks, but further actions were required to ensure risk management plans were always developed to provide care workers with guidance on mitigating the risks. We have made a recommendation in relation to the management of risk.

The provider had a procedure for the reporting of incidents, but investigations were not always carried out to identify lessons learned to reduce the risk of reoccurrence. We have made a recommendation in relation to the identification of lessons learned from investigations.

Care plans identified how people wanted their care provided, their communication support needs and their end of life care wishes. Medicines were managed appropriately to ensure people received their medicines safely. The provider had robust recruitment processes and care workers had completed the training identified as mandatory by the provider. Care workers had completed infection control training and had access to personal protective equipment.

People receiving support, relatives and care workers all felt the service was well run. The provider worked in partnership with other organisations. People and relatives told us they felt safe when care was being provided.

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 inadequate (published 22 January 2022) and there were breaches of regulation. We issued warning notices in relation to safe care and treatment, good governance and staffing requiring the provider to be compliant with the regulations by 28 February 2022. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had made some improvements but still remained in breach of regulations.

This service has been in Special Measures since 22 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nation Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to need for consent, good governance, receiving and acting on complaints and staff 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.