Archived: Nightingale Homecare and Community Support Services Ltd

Updated 14 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13, 14 & 19 January 2015 and was announced. The provider was given 48 hours’ notice because the location provided a domiciliary care service. On the 13 and 14 January we went to the agency’s office and looked at care plans, staff files audits and other records. On the 14 and 19 January we visited and talked to people in their own homes.

Two inspectors and an expert-by-experience, with a background of older people and domiciliary care, completed the inspection. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection visit we reviewed the information we held about the service, including the Provider Information Return (PIR) which the provider completed before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we received since the last inspection, including notifications. A notification is information about important events, which the provider is required to tell us about by law.

During the inspection we visited nine people in their own homes. We spoke with the provider, the managing director, the quality assurance manager, the staff who plan and deliver training, a co-ordinator who organised the work for the staff and one member of staff.

We reviewed people’s records and a variety of documents. These included six people’s care plans and risk assessments, three staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys.

After the inspection the expert by experience contacted 12 people by telephone. We also contacted four members of staff by telephone to gain their views and feedback on the service.

We received feedback from two professionals who had recent contact with the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Updated 14 April 2015

The inspection visit took place at the agency’s domiciliary care office on 13 and 14 January 2015. On the 14 January and 19 January we visited people who used the agency in their own homes.

Nightingale Homecare and Community Support Services Ltd are registered to provide personal care to people, living in their own homes in the community. The support hours varied from one to four calls a day, with some people requiring two members of staff at each call. Calls can be from 15 minutes to however long is needed. The agency’s office in based in the middle of Ramsgate town centre and the agency offer support and care to people in Ramsgate, Broadstairs, Margate and the surrounding area. They provide care and support to a wide range of people including, older people and people living with dementia and mental health needs. They also provide support and care for people with learning disabilities, sensory impairment and younger adults.

Concerns had recently been identified by the Care Quality Commission (CQC) about the overall management of the three agencies run by the provider. Since the last inspection of March 2014 the service had expanded rapidly and now offered care and support for about 300 people in the local area. The agency had not managed the rapid increase in the number of people and this had resulted in serious concerns being raised.

At the time of the inspection the agency did not have 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 and associated Regulations about how the service is run.

People gave differing views about the service they received. Some people were happy, some were not. Our own observations and the records did not reflect the positive comments some people had made.

People told us they did not feel safe when some staff were supporting them with their care. There was very limited information and guidance in care plans to inform staff how to care and support people in a way that kept them as safe as possible and keep any risks to a minimum. There was no guidance for staff in care plans about how to move them safely or how to provide people with the individual personalised care and support that they needed. People said that when they had their regular staff that knew them well they received the care and support that they needed, however, when different staff came they ‘did not know what they were doing’ especially when they were moving them or attending to their personal care.

People said that most staff were caring and treated them with dignity and respect and the staff were kind and polite. However, some people said that staff did not listen to them and did not give the care and support in the way they preferred. People were not always involved in the assessment and the planning of their care. The amount of detail in the care plans was limited and the information recorded in the daily notes was not always reflected in the care plans. People told us that their care plans had not been reviewed and senior staff from the agency had not visited them so any relevant changes to their care were not made. They said that every time new or different staff arrived they had to go through everything with them as there was nothing written down.

Staff said the communication between the staff who delivered the care and the office staff who organised the care was not good. People and staff were supported by an out of hours on call system. Staff told us that this was not always responsive and any queries raised were not sorted out. They did not feel supported by staff in the office. They said that they were not listened to. People said that when they called the office, especially at weekends, no-one answered the phone and if they left a message it was not responded to. They said that often messages did not get passed on. There was not enough staff employed to give people the care and support that they needed at the times they wanted it and in a way that they preferred. There were high levels of missed calls to people and staff were often late to calls.

On the whole staff had made appropriate referrals and worked jointly with health care professionals, such as community nurses, to ensure that people received the support they needed. However, there were occasions when staff had not taken the appropriate action to contact health care professionals when people needed support with their health care.

People told us that the staff often did not arrive on time and they sometimes felt rushed when they did arrive. On the whole they said that staff stayed the duration of their call. People also said that they did not receive care from a consistent team of staff. They said they often didn’t know who was coming and they were not informed by staff in the office when staff were going to be late.

New staff had induction training which included shadowing experienced staff, until they were competent to work on their own. However other staff who had worked at the service for over a year had not received the up to date training to make sure they had the competencies, skills and knowledge to do their jobs effectively and safely. Some staff had not received up to date training in how to keep people safe. During the inspection we found that staff had not raised safeguarding concerns when they should have done. Most staff demonstrated an understanding of what constituted abuse and how to report any concerns. Staff had not received regular supervisions and support where they could discuss their training and development needs. Staff competencies were not checked to make sure they were competent and safe when caring for people.

Staff were not up to date with current guidance to support people to make decisions and consent to care and support. Staff had not received training on the Mental Capacity Act 2005. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

People's medicines were not always handled and managed as safely as they could be. There was no guidance for staff to tell them how to give people their medicines safely and in a way that they preferred and that suited them best. Some medicine records were not clear and were not accurate. There was a lack of detailed guidance for medicine needed on a 'when needed' basis.

People and their representatives told us that they did complain when they had any concerns but felt that they were not always listened to and nothing was done to resolve their concerns. When some complaints had been made the management team had not identified them as complaints and had not taken any action to resolve them.

The systems in place to monitor the safety and quality of the service were not effective and were not improving the service. When shortfalls and concerns had been highlighted no action had been taken to make improvements. Staff were unaware of the values and vision of the service and were not involved in the development of the service.

People were supported with their nutritional needs. People told us that they chose what they wanted to eat. Staff prepared meals or supported people to cook.

A system of recruitment checks was in place to ensure that the staff employed to support people were fit to do so. Staff received appropriate safety checks before working with people to ensure they were suitable.

At the previous inspection on the 5 March 2014 there were no concerns.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.