Norvic Healthcare Anglia

Norvic Healthcare Anglia is a domiciliary care service providing personal care to people living in their homes. At the time of the inspection they were supporting 80 people, 70 of whom were receiving the regulated activity of personal care.

People’s experience of using this service and what we found

People who used the service usually had the same regular staff who cared for them. They spoke highly of the care received and the experience levels of the staff. A number of the carers had gone 'over and above' their role for example with taking people to the doctors and ensuring they had enough food during difficult times, such as bad weather.

People were informed if their visits were going to be late and there were enough staff to ensure care visits took place and for the allotted time duration.

People knew who the manager was and who to speak to if they had any concerns. People and relatives told us, they felt they would be listened to and actions taken to resolve their issues

We have made a recommendation about reviewing systems to identify when medication has not been given and reasons, taking appropriate action.

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 requires improvement (published 26 July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvement had been made, but the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 20 June 2019.

We undertook this focused inspection on 13 July 2021 to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Norvic Healthcare Anglia 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 monitor the service.

We have identified a breach in relation to regulatory notifications to CQC, at this inspection.

Follow up

We will ask the provider to complete an action plan, to confirm when and how they will make improvements. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

living in their own homes. At the time of the inspection they were supporting 22 people.

People’s experience of using this service and what we found

The service did not always effectively assess and manage risks to people when receiving care and support. Staff knew people well and were aware of how there care and support should be provided. People told staff arrived on time and stayed the required amount of time. Staff had been appropriately trained and told us they felt supported by the registered manager. They were aware of safeguarding procedures and actions to take should they suspect abuse. Where people required support with their meals or medicines this was provided effectively.

Each person had an individual care plan which set out the care and support they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care and support from staff that were caring and knew them well.

There was not always effective quality assurance processes in place to ensure care plans were up to date and consistent. The service had an open and positive culture. People and staff were encouraged to visit the offices which fostered good relationships.

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 requires improvement (published 27 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although some improvements had been made these were not sufficient and the provider was still in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the quality assurance processes at this inspection.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Following the last inspection on 10 November 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Well-led to at least good.

This service is a domiciliary care agency. It provides personal care to 29 people living in their own houses and flats in the community. It provides a service to older adults and people who are living with a learning disability.

There was 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 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection on 10 November 2016 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for good governance and notification of other incidents under the Care Quality Commission (Registration) Regulations 2009. At this inspection we found the provider had taken action to ensure they were compliant with the Registration regulations. We found that whilst some improvements had been made with the governance of the service, there were still concerns about the assessment and monitoring of the safety and quality of the service. The provider was still in breach of this regulation.

The quality assurance system that was in place was not effective at identifying areas for improvement within the service. This was because there was a lack of any in depth examination of the service. Satisfaction surveys were sent to people but the responses were not collated to gain an overall picture of the service.

There was clear and visible leadership in place and staff felt supported by the registered manager. The registered manager was able to be contacted by people and their relatives and made time to listen to people.

Regular staff meetings took place and there was frequent communication in the form of newsletters, phone calls and texts between the provider, management team and the staff.

Working relationship had been fostered and maintained with other services such as local hospitals and the local authority to ensure continuity of care for people.

People’s medicines were not always managed in the safest way possible. There were no protocols in place for ‘as required’ medicines and staff did not have a good understanding of this type of medicine.

Staff had received training in the safe management of medicines and documentation relating to people’s medicines was completed fully.

Individual risks to people had been identified but there was little information to guide staff about how to mitigate them. Risk assessments for people’s homes had been completed to help ensure the safety of people using the service and the staff visiting them.

There were enough staff to safely meet people’s care needs and staff arrived to people’s houses on time. Staff had received training in safeguarding and knew how to report any concerns of abuse. There were safe recruitment practices in place and the necessary background checks had been carried out before staff started working in the service.

Accidents and incidents were recorded and these were looked at regularly to identify any patterns or trends.

Processes were in place to prevent and control infection. Staff had received training in infection control and food hygiene and knew their responsibilities in relation to these areas.

People’s care and support needs were not always holistically assessed. Whilst there was information in people’s care plans relating to their physical health, there was little detail about any mental health needs that people may require support with.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and whether the service is working within the principles of the MCA and report on what we find. We found that not everyone had an MCA assessment and decisions made for people in their best interests were not always documented. Staff we spoke with had a good understanding of the MCA and knew how to offer people choices.

Staff received training relevant to their role and they were supported to access additional training that would benefit them in their role. Staff were further supported through regular supervisions and appraisals.

People who required support with their meals were supported to maintain a healthy nutritional intake. Relevant healthcare professionals were contacted where there were concerns about a person’s health or wellbeing.

Staff were caring and took time to listen to people and involve them in making choices about their care. People were treated in a respectful way and their right to privacy was maintained.

People’s independence was promoted and people were encouraged to do as much for themselves as possible.

Care records were updated regularly and people and their relatives were involved in this process. Care plans were updated to reflect people’s current needs.

There was a complaints procedure in place and people felt happy to raise a complaint if needed and knew who they would direct their concerns to if needed.

This inspection took place on 10 November 2016 and was announced. Norvic Healthcare Anglia is a domiciliary care agency providing personal care to people living in their own homes. At the time of our visit, 37 people were using the service.

There was a registered manager in place, who had been the registered manager since October 2010. 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 provider had a system to monitor the quality of the service, although this did not always identify where care and staffing records were missing information.

Notifications to provide information about important events, which the provider is required to send us by law, had not been completed.

You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to safeguard people from the risk of abuse and how to report concerns to the relevant agencies. Individual risks to people’s safety had been assessed by staff and actions had been taken to reduce or remove these risks.

People felt safe using the agency and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs. Most recruitment checks for new staff members were obtained before new staff members started work, although information about previous employment and gaps in employment histories were not always checked.

Medicines records were not always completed to show people received their medicines as prescribed. Staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA). The service was meeting the requirements of the MCA. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, clearer information was needed to guide staff.

Staff supported people to eat and drink. Staff members helped people to access the advice of health professionals in the community if this was required.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted their care to be provided. Staff responded well to people’s needs and support was available for staff. Care plans contained a varied level of detail in the information to support people with their needs, which did not always provide enough guidance to staff. Staff members knew how to care for people when this information was not recorded but there was a risk that new staff would not have this knowledge.

Most people knew how to make a complaint and these were responded to appropriately by staff. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

We found detailed care notes that described what care and support was required, how the person's needs were met and how the support provided was carried out as safely as possible.

We received complimentary comments about the service such as how this was 'the best agency ever'. We were told how supportive the service was and how well trained staff were. A relative told us that they were transferring all the care needs to this agency as they were, 'the best'.

We saw evidence of how staff were supported with training, supervision and appraisals. This ensured staff were skilled and able to carry out the work required safely and suitably.

The manager told us the method of monitoring the quality of the service through questionnaires had been on hold since October 2012. However the one person receiving the care and support was visited and spoken with regularly to ensure the service was what was expected. This was confirmed by their relative.

Following this May inspection an action report was sent to us showing what the manager had done to address the concerns. Staff, from the 1 August had a process in place that offered them regular supervisions, an annual appraisal and suitable e-learning for their own training and development.