Archived: Prestige Nursing - Basingstoke

The inspection was conducted by an inspector who gathered evidence against the outcomes inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

People's needs were assessed by trained staff and care and treatment was planned and delivered in line with their individual care plan. Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this. We found that staff received appropriate training in relation to various complex needs from health professionals, which had ensured that people's needs were met safely.

The provider had procedures in place to ensure the safe management of medicines. Staff we spoke with were clearly aware of the level of their own responsibility within the provider's system. One care worker told us, 'I am only trained to prompt people and know I cannot do anything else unless I receive further training.' Another care worker told us, 'The coordinator knows who requires extra support and only sends people with the right level of training.'

There were systems in place which made sure that the provider and staff learned from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve. For example we saw that alterations had been made to a person's bathroom to transform it into a shower and wet room to ensure that identified risks had been reduced to a minimum.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives. People told us that they felt safe and trusted the staff.

The Care Quality Commission (CQC) monitors the operation of the DoLS which applies to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lacked mental capacity to make decisions were not deprived of their liberty, other than in accordance with the law. The manager told us they had not needed to apply for DoLS for any of the people who used the service, but they were aware of the process to follow.

The registered manager told us that staff had received Mental Capacity Act training during their induction. We found that care staff understood the main principles regarding mental capacity. A member of the care staff told us, 'I can't quote the act but I know the important thing is to assume everyone has capacity unless it has been assessed otherwise.'

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us that they had been involved in every aspect of their care planning and had signed their needs and risk assessments to show their consent. We looked at people's care records and found that they had been reviewed during the previous four months or more frequently if required. We saw that one person had complex needs, including a progressive condition, which was subject to constant review by the care coordinator.

People said that their care plans were up to date and reflected their current needs, which was confirmed by the records we reviewed. This meant that the provider had ensured that people's changing needs had been identified and met.

We found that the provider had an effective system to support workers through regular supervisions, appraisals and assessments of care practice. Staff we spoke with told us that they felt valued by the management team, who were approachable and willing to listen to their views.

We found that staff were knowledgeable of people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had received a recognised induction covering core subjects including safeguarding, infection control, management of medicines, food hygiene and moving and positioning. We reviewed the service training matrix and certificates within staff files to confirm that training was up to date.

Is the service caring?

We observed care practices where people were supported in a caring professional manner, with genuine warmth and compassion. Staff treated people with respect and spoke with them as they provided their care. We saw that people trusted the staff who provided their care and were comfortable in their presence. We noted that staff were unhurried and did not rush people with their care. People and their relatives provided positive feedback on the care they received. One person told us 'The staff are so caring and you can tell they are genuinely concerned about me.' Another commented 'they are more than just carers to me and I know they have what they call boundaries or whatever but they are like my family.'

Is the service responsive

We found that the service provided support to people with complex needs which were subject to constant change. We noted that people's needs had been continually reviewed and where staff required further training this had been planned in advance or where anticipated arranged immediately.

The provider took account of complaints and comments to identify trends and improve the service. We found that there had been one complaint since the last inspection, which had been resolved to the person's satisfaction. One person told us, 'I just tell the care coordinator if I have a niggle because I know she will sort it out and let me know what's happening over a cup of tea'

Is the service well-led?

The provider had a quality assurance system, and records showed that identified problems and opportunities to improve care and service delivery had been addressed promptly. People who used the service, their relatives and other professionals completed an annual satisfaction survey. This was supplemented by quarterly quality assurance telephone calls and visits made by the field care supervisor. Staff told us they were clear about their roles and had a good understanding of the values of the service. This helped to ensure that people received a good quality service at all times.

We found that staff were knowledgeable of people's specific health and personal care needs and had received training to update their skills and knowledge. There were procedures to protect people from abuse and to minimise the risk of unsuitable staff being employed.

We looked at people's care plans and supporting documents and found that there was a risk that people's needs were not being fully met. This was because the detail of records within people's care plans and risk assessments had not reflected the care and support that their assessed needs had identified. The provider had identified that improvements were needed. However, the provider had not taken appropriate action to ensure the requirements' they had set, had been followed through to make sure people's needs were being fully met.