Nation Care Agency

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.

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 170 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 did not ensure the management of risks was effective as risk management plans for identified risks were not always developed to provide care workers with guidance on mitigating the risks. Medicines were not always managed appropriately to ensure people received their medicines safely. The provider did not always deploy care workers appropriately to ensure care visits were carried out at the planned time and for the length of the allocated time.

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 could not demonstrate care workers had completed training they had identified as mandatory in line with their policy.

Care plans were not written in a person-centred manner which identified the person’s wishes in relation to how they wanted their care provided. The daily records of care provided during each visit, which were completed by care workers, were task focused and did not reflect the experiences of the person receiving support. People’s wishes in relation to how they wanted their care provided towards the end of their life were not identified and addressed. People’s communication support needs were also not always identified so appropriate plans were put in place to meet these needs.

The provider had a quality assurance system and carried out a number of checks to monitor the quality of the service, but these were not robust enough to identify where there were issues and improvements were required, so these could be addressed.

Care workers had access to the personal protective equipment they required when providing support such as gloves and face masks. The provider had a safe recruitment process in place. Care plans identified if people required support to prepare and/or eat meals. People were supported in making decisions about their care. Care workers felt they were supported and that the service was well-led. The provider worked in partnership with the local authority.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good published (26 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received from the local authority about care visits not being carried out as planned, visits being cut short, staffing levels, training and the provider’s quality assurance procedures. A decision was made for us to inspect and examine those risks.

We initially undertook a focused inspection to follow up on the concerns raised by the local authority. We inspected and found wide ranging concerns, so we widened the scope of the inspection to look at all the key questions.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections 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

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 discharge our regulatory enforcement functions required 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 person centred care, need for consent, safe care and treatment, receiving and acting on complaints, good governance and staffing.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nation Care Agency 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 people including those living with the experience of dementia, those with mental health needs, with a sensory impairment, with drug/alcohol dependencies, younger adults and people with a physical disability and/or learning disabilities. The service offers support to people who require help with day to day care including personal care, meal preparation, cleaning services and companionship. When we inspected, the service was supporting 84 people with their personal care needs.

The service is required to have a registered manager and there was one 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.

The quality assurance processes in place were being used and work was ongoing to ensure these were used robustly so shortfalls were always identified and promptly addressed.

People and relatives felt staff maintained people’s safety when providing them with care and support.

Policies and procedures for safeguarding people were in place and the care workers and office staff knew how to report any suspicions of abuse including reporting to the local authority safeguarding team.

Individual and environmental risks were assessed and identified so action could be taken to minimise any risks.

The provider completed recruitment checks to help ensure prospective care workers were suitable to work with people. There were enough staff employed and deployed to meet people’s needs and systems were in place to provide people with consistent care workers wherever possible.

Staff who supported people with their medicines had received relevant training and knew how to do so safely. Staff and relatives confirmed that infection control procedures were followed to protect people from infection risks.

People were assessed to identify their needs and wishes and care plans drawn up to meet these. Staff received training to provide them with the knowledge and skills to care effectively for people’s individual needs.

Staff prepared simple meals and knew to report any concerns around people’s nutritional intake so this could be escalated to healthcare professionals, where required. Staff described the procedures they would follow if someone was unwell to include summoning healthcare professionals and the emergency services if required.

The registered manager understood their responsibility to act within the requirements of the Mental Capacity Act 2005 and to provide care and support in people’s best interests.

People and relatives said the staff were kind and caring and understood people’s needs and wishes. They confirmed that staff were respectful towards people using the service. Staff encouraged people to maintain as much independence as they could and respected their right to choose the care and support they wanted to receive.

Personalised care records reflected the care and support people wanted to receive. This included information about people’s lives and interests and any religious and cultural needs, so staff could respect these.

People and relatives said they would feel confident to raise any concerns and knew how to contact the office to raise any issues.

There were processes for obtaining people’s views about the service including surveys, reviews and spot checks.

People and relatives were confident to contact the service if they needed to discuss any aspects of the care provision. Staff said the provider was supportive and approachable and they could discuss any issues and knew they would receive a response.

The provider worked with health and social care professionals and understood the importance of collaborating with them to improve the care people received.

At this inspection we checked the auditing being carried out for MARs and daily logs and saw this was taking place and the majority of issues had been followed up and improvements made. This meant that the provider was now meeting legal requirements.

This report only covers our findings in relation to these topics. 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.

Nation Care Agency provides a domiciliary care service for adults with a range of needs. The service offers support to people who require help with day to day routines including personal care, meal preparation, light housework, shopping and companionship. At the time of our inspection there were 85 people receiving personal care.

The service is required to have a registered manager and there was one 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made in the auditing and monitoring of documentation including MARs and daily records and action taken to address shortfalls identified.

The last inspection took place on 23 January 2014 and the service was compliant with the regulations we checked.

Nation Care Agency provides a domiciliary care service for adults with a range of needs. The service offers support to people who require help with day to day routines including personal care, meal preparation, light housework, shopping and companionship. At the time of our inspection there were 84 people receiving personal care.

The service is required to have a registered manager and there was one 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some aspects of the service were not monitored effectively so shortfalls were not being identified and addressed in a timely way.

Risks were assessed and action plans put in place to minimise them. Staff knew when to summon the emergency services if someone was unwell.

Procedures were in place and being followed by staff to safeguard people against the risk of abuse.

Staff recruitment procedures were in place and being followed. There were enough staff to meet the needs of people using the service.

Staff understood medicines management procedures and provided the support people required to take their medicines safely.

Infection control procedures were in place and being followed to minimise any risks to people and staff.

Staff received training and supervision so they had the knowledge and skills to provide the care and support each person required.

Staff understood and respected people’s rights to make choices about their care and knew to act in their best interests.

People were supported to maintain their nutritional intake. Staff recognised changes in people’s healthcare needs and knew the processes to follow to ensure input from healthcare professionals was sought in a timely way.

People told us staff treated them with dignity and respect and maintained their privacy. Staff took the time they needed to give people the care and support they required.

Care records reflected people’s individual needs and wishes and staff understood these and cared for them in a person-centred way. People’s care and support was planned and reviewed when any changes were identified so people’s needs continued to be met.

Procedures for raising complaints were in place and people and relatives said they would be confident to raise any concerns so they could be addressed.

People and relatives could contact the service easily when necessary and care staff said the registered manager and senior staff were supportive and approachable.

The registered manager accessed good practice guidance to enhance the service provision and keep up to date with the care sector.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Most of the people using the service told us they were happy with the care and support they received. Their comments included 'they are very well trained and really know what they're doing' and 'they give me the help I need, they are very good.' However, one person did comment 'it didn't start well but it has got better. The carer was often late but the last couple of weeks have been OK. The carer is excellent with my [relative], it was just the punctuality.'

We looked at the care plans for four people using the service. We saw people's care plans detailed their health, social and personal care needs and the support care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse.

We looked at the recruitment records for four care workers and saw the provider carried out pre-employment checks to make sure new staff were suitable to work with people using the service.

There were procedures in place to monitor the quality of services provided. The provider carried out regular audits and people using the service were asked for their views on the care and support they received.