Archived: Prestige Nursing Swindon

This focused inspection was carried out to assess whether the provider had taken the necessary actions to meet the three requirement notices we had issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the requirement notices have been sustained, and to provide an overall quality rating for the service.

This report covers our findings in relation to the requirement notices we issued and we have not changed the ratings since the inspection in October 2015. The overall rating for this service is 'Requires improvement'. You can read the report from our last comprehensive inspection by selecting 'all reports' links for Prestige Nursing Swindon on our website at www.cqc.org.uk.

At this inspection we found the provider had taken some action to address the issues highlighted in the requirement notices but further improvements still needed to be made. The manager had developed an action plan to address the requirement notices in the inspection report where they were found to be in breach of regulations.

At our last inspection we found that medicines were not being managed safely or recorded appropriately. At this inspection we saw staff had received medicine update training. The manager had created a new medicine administration record to make the process clearer for staff and there were clear procedures in place for dealing with any medicine errors. We saw one person’s medicine administration record (MAR) did have some missed signatures and did not record the date accurately.

Previously at our last inspection staffing levels had been inconsistent resulting in some missed visits for people. During this inspection people and staff told us they had seen improvements. The manager had significantly reduced the high sickness levels by ensuring staff were aware of the formal process to take when calling in sick and was holding the back to work interviews when staff returned.

Our last inspection showed that staff had not been receiving regular supervision to appropriately support their role. At this inspection we saw that supervisions were now consistent and a performance development plan was going to be put in place alongside observational supervisions for staff.

Health care assessments and monitoring charts were still not being appropriately completed or followed correctly to meet people’s needs effectively. This was a breach of the Regulations.

At our last inspection care plans had not contained up to date information, required for staff to be able to care for people consistently. People had not been receiving regular reviews of their care needs. At this inspection we saw that some progress had been made in relation to providing guidance for staff on specific health needs but more improvements were needed. We saw that people were now having their care needs reviewed and families were being involved in these reviews.

The service did not have a registered manager in place. The branch manager has been responsible for the day to day running of the service and had put in an application to register with us but this was rejected for incorrect completion. Not having a registered manager at this location is a breach of the providers conditions of registration and further action will be taken if this is not addressed.

At our last inspection the manager did not have effective systems in place to monitor the quality of the service. At this inspection we looked at the manager’s online compliance system and saw audits of the service were being completed. The service had also received support from its internal quality compliance team.

We saw at this inspection the ratings from our last inspection were not clearly displayed at the service location. This is a breach of the Regulations and we have told the provider to take action in line with this regulation.

As part of this inspection we spoke with three people who use the service and the relatives of two people who use the service. We spoke with the registered manager, a representative of the provider and seven staff. We also reviewed records which included four care plans, daily care records, staff training records and other records relating to the management of the service.

Below is a summary of what we found. The summary describes what people and the staff told us, what we observed and the records we looked at.

Is the service safe?

People told us they would approach the agency or care staff if they were worried about their safety or worried about the services provided and felt they would be listened to.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was able to describe the circumstances when an application should be made and knew how to submit one.

People's care plans detailed how the person wanted their needs to be met. Risk assessments identified risks associated with personal and specific health related issues, and recorded guidance for staff to minimise those risks.

Staff knew how to report any concerns they had about the care and welfare of people and to protect people from abuse. Staff we spoke with confirmed they were given enough time on each call to complete the care needed to a good standard. They felt they were provided with training that enabled them to do their job safely and efficiently.

Is the service effective?

People we spoke with told us staff always turned up when they should and stayed the correct length of time. Comments from people we spoke with included: 'They always arrive on time and always make a point in saying, is there anything else I can do' and 'they always keep to the nearest time possible'. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service caring?

People we spoke with felt the staff always respected their privacy and dignity. One person said: "I feel safe with them and they treat me well'.

People experienced care and support that was planned and delivered in a way that was intended to ensure people's safety and welfare. People were complimentary about the care staff and felt they had the skills needed when providing care and support.

Is the service responsive?

Although the people we spoke with had not made a complaint, all knew what to do and who to talk to if they had any concerns. All felt their concerns would be listened to and acted upon. One comment was: 'I can't fault any of them they are all excellent'.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people receive. People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on. Comments from people about the service included: "I had used another agency before but I like this one' and 'They are kind and caring'.

Staff had received training and support and their training needs were identified to promote continual development.

People who used the services told us they felt safe, cared for and listened to by staff. Comments included, 'Staff are very patient", "I find that all the staff are always very helpful and polite', 'I do have a care plan and it has been reviewed', staff are always on time, they let me know if they are running late'.

We found staff were knowledgeable of people's support and personal care needs, but had not received the training and support they needed to update their skills and knowledge. Staff told us they felt supported by the management team even though formal meetings to discuss their development needs had not taken place.

Staff knew of the procedures to follow to protect people who used the services should they suspect or witness abuse. We found that people who used the services and their representatives were listened to and that complaints were taken seriously by the agency and investigated to a satisfactory resolve.

People we spoke to told us that they had received the right information from the agency at the start of the care package. Staff we spoke to said that they found the risk assessments helpful in delivering the right care. Staff also told us that they had training about medication and they were able to tell us the differences between the levels of support. One told us that 'the training had changed the culture of the agency and made it much safer to work in'.