Archived: 1st Class Nursing Agency

Updated 8 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

The inspection took place on the 03 January 2018, and was completed by one adult social care inspector. Prior to the inspection we gathered the available information from Care Quality Commission (CQC) systems to help plan the inspection. This included the detail of any notifications received, any safeguarding alerts made to the Local Authority, any complaints or whistle-blowing information received and the detail of the Provider Information Return (PIR) received from the provider. The PIR is submitted to the CQC by the provider and includes details of the provider’s perspective on meeting the requirements of the regulations.

The service provides care and support for 16 people. We spoke with three people who received a domiciliary service, four relatives, and five members of staff including the acting manager and service provider. During the inspection we reviewed four people’s care plans, four staff files, quality audits, team meeting notes, medication records and other associated documents.

Updated 8 June 2018

This announced inspection took place on 03 January 2018. The provider was given 24 hours’ notice of the visit because the agency provides support and personal care to people living in their own homes and we wanted to make sure that the provider and manager was available.

1st Class Nursing Agency is a domiciliary care agency that supports people in the Kirkby and Ormskirk area to remain independent in the comfort of their own home with the support of care services. The agency has its main office in Burnley, but has a manager located in Kirkby, who liaises with people who use the service, and the agency staff.

At the last inspection on 02 December 2016, the service was given an overall rating of Requires Improvement. The Safe domain was rated as Inadequate. The Effective, Responsive and Well-Led domains were rated as Requires Improvement, and the Caring domain was rated as Good. At this inspection we found that the agency had met the previous breaches in the Regulations. However, we did identify areas were the agency was in breach of further Regulations, and areas were minor improvements could be made to formalise the systems in place. This would ensure that the records relating to staff competencies and good governance was as robust as they could be. The overall rating for the service is now Good.

The agency did not have a registered manager in place at the time of this inspection. This was a breach of Regulation 5 Registration Regulations 2009 (Schedule 1) Registered manager condition.

The location from which the regulated activities were being provided was not registered with the Commission at the time of the inspection. This was a breach of Section 10 Health and Social Care Act -Carrying on a regulated activity without being registered.

The legal obligations placed on the agency were understood by the service provider and manager. In June 2017, the agency closed its registered location in Ormskirk, and moved the operation of the service to its registered office in Burnley. The service provider applied to the CQC for their Ormskirk office to be removed from registration, and for their Burnley office to be added. However, the accompanying Registered Manager application was withdrawn by the applicant, and as a result, the Burnley office application was not progressed. In Dec 2017, the service provider submitted a further application to the CQC to add a location (the Burnley office), and this was accompanied by a Registered Manager application.

At the previous inspection in 2016, we found that the service did not have robust policies and procedures around the safe recruitment of staff or medicines management. We also found that the service did not have a robust quality auditing system in place. There were no audits for care files and medication administration records. These shortfalls in systems, processes and quality assurance, amounted to a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance.

At this inspection, we found that although quality assurance arrangements had improved, further work was needed to bring about further improvements. Some of the quality assurance records were disorganised and held on two different computer systems, and the medicines audit tool lacked detail regarding the competency of staff. We recommended that developments are made to the governance systems and that the service provider formalise and organise their audit and recording systems.

We recommended that a formal process be introduced relating to ensure medicines are only administered by designated and appropriately trained staff who have had their competency thoroughly assessed.

At this inspection, we found that the service was now compliant with the Mental Capacity Act (MCA) code of conduct, and that consent was always sought before care was provided, and when decisions were made on behalf of or about individuals, and then this was appropriately documented. This meant that people’s rights were being protected.

We also found that people’s care, treatment and support was set out in a written plan that had been devised by the agency following their own assessment of need, and that this plan described what staff needed to do to make sure personalised care was provided.

Everyone we spoke with told us they felt safe receiving care and support and that staff were kind, caring and professional. We were informed that people felt comfortable in the presence of the care staff that assisted them.

Staff we spoke with had a good understanding of the services safeguarding policy and knew how to recognise and report potential safeguarding issues.

People were supported to take their medicines safely and processes were in place to order, store and record people’s medicines. No-one we spoke with raised issues about how their medicines were managed.

The people we spoke with were happy with the consistency, timeliness and ability of the care staff that assisted them. Staffing levels were judged to be appropriate for the assessed needs of the people using the service.

Staff received an effective induction prior to them working alone with people. Staff then went on to receive training, supervision and support to enable them to carry out their role effectively.

People told us their privacy and dignity were respected and promoted by the care staff and that staff treated them well. People were involved in decisions about their day to day life and that people’s involvement was in line with their wishes.

People and relatives we spoke with told us they knew how to raise issues or make a complaint and that communication with the service was good. Care plans were seen to be person centred and reflective of peoples care and support needs. People were given choices in how they wished their support to be carried out and with daily living tasks such as what time they got up, went to bed or received assistance.

People we spoke with told us that they felt the service was well run and managed well. There was a range of auditing and monitoring in place to ensure a good overview of the service was maintained.