Rosie Nightingale Homecare

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to protect people from the risk of harm or abuse. Safeguarding policies and procedures were robust and had been followed when required. Staff could identify safeguarding concerns and knew how to raise them appropriately.

Risk assessments had identified the individual risks people needed support to manage and plans had been developed to minimise the potential for harm. Environmental risk assessments ensured staff were aware of potential hazards at each property they visited.

Staff had been recruited safely with all necessary checks being completed prior to them starting to work with people. Staffing was sufficient to support people safely. No one told us they felt rushed.

Medicines were managed safely. Staff had received training in medicines. Regular spot checks and audits ensured records were accurate.

People were protected from the risk of infection. Staff were trained in infection control and had access to appropriate equipment, including gloves and aprons which had been supplied by the service.

The service learned from their experience and improved their practice in response to incidents. One example had been developing a more effective system for recording variable dose medicines such as warfarin.

People's needs had been assessed prior to their package of care starting. Care plans had been developed to meet people's needs which reflected good practice guidance.

Staff had received appropriate training and had the necessary skills and knowledge to provide care and support effectively. Some staff had completed further qualifications, including NVQ 2 and 3.

People received support to maintain their nutrition. The service had introduced cooking skills in their recruitment processes to ensure staff could provide meal support as preferred by the service users.

The service worked cooperatively with other organisations and services to ensure people received a coordinated level of care and support.

The service had supported people to access health services in a timely way. They had also promoted health and wellbeing by addressing broader issues such as isolation, communication needs and emotional wellbeing.

People signed their care plans to indicate they had consented to them. Staff were aware of the importance of gaining consent before providing care and support. The service was working within the principles of the Mental Capacity Act (2005) and had considered people's capacity in relation to specific decisions about their care and support.

People told us staff were caring and kind and went the extra mile for them. Relatives praised the commitment and dedication of the staff and service.

People's rights were included in the service user guide which was kept in the care record in people's homes. These rights included statements in relation to dignity, respect and equality.

The service had made efforts to understand people's communication needs and preferences. There had been several examples of individual communication strategies being developed to maximise individuals choice and control.

People's views on the care they received were sought through an annual survey and also informally throughout the year.

People continued to receive care which was personalised and responsive to their needs. Care plans were person centred and reflected the person's choices, background and preferences.

There was a complaints policy which had been followed when required. People were aware of how to raise any concerns and reported being responded to quickly.

People had been supported at the end of their life to have as comfortable and pain free death as possible. Though the service did not provide this type of support routinely this had increased recently. The service worked with people, their families and community based health professionals to ensure a coordinated compassionate service.

The service had a clear set of values and commitment to providing high quality care. Statements about this had been included in the service user guide. Staff were aware of the values and culture of the service and felt committed to achieving these goals.

The people who used the service and staff all praised the registered manager and said they found them to be clear about standards and to be approachable and supportive.

The service had effective governance and auditing systems to ensure care had been provided as detailed in the care plans and professional standards had been maintained. Any gaps identified by audits had been addressed.

The service had regular quality assurance meetings with the local authority who told us they experienced a good level of cooperation from the service who they reported worked very closely with them.

Effective communication systems had been developed using technology to ensure the team were up to date with any changes in policy and practice. Staff also used a secure social media app to communicate with each other throughout their shifts.

An annual staff survey invited staff to comment on what was going well and what could be improved. The registered manager had responded to some of the improvements suggested but had not always informed staff they had done this.

The service works with partner organisations and stakeholders and have shared their skills and knowledge.

Rosie Nightingale Home Care is a domiciliary care service, registered to provide personal care within people’s homes. The office is situated in Bolton. Services are provided across Bolton via private arrangements or through local authority and clinical commissioning group (CCG) contracts.

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.

People we spoke with told us they felt safe using the service. The service had appropriate systems and procedures in place to protect people who used the service from abuse. The service had a safeguarding policy and associated procedures which were up to date. Staff we spoke with were able to tell us about the different forms of potential abuse.

The service had a whistleblowing policy in place and this told staff what action to take if they had any concerns.

Care and support records of people who used the service were very comprehensive, well organised and easy to follow. We saw that the service communicated regularly with peoples’ relatives who did not live nearby or who lived in another country.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. We looked at the medicines administration record (MAR) charts for people when we visited them in their own homes and found that these had all been completed correctly, were up to date and stored securely. All staff administering medication had received training.

There was an appropriate and up to date medicines administration policy in use which included information on medicines to be taken ‘as required’ (PRN).There was an up to date accident and incident policy and procedure in place and details of any accidents and incidents were recorded appropriately, including any remedial action required to reduce the risk of any future potential harm. There was an up to date business continuity plan in use.

People who used the service told us they felt that staff had the right skills and training to do their job. There were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service. There was a comprehensive process of staff induction in place which was used to audit the progress of new staff relative to the induction process.

We found that all staff had completed training in the Mental Capacity Act in general as part of the process of induction. At the time of the inspection no person using the service was subject to any restrictive practices.

We reviewed the service’s training matrix and staff training certificates, which showed staff had completed training in a range of areas, including dementia, safeguarding, first aid, medicines, infection control and health and safety.

Staff received supervision and appraisal from their manager and the service which kept a record of all staff supervisions that had previously taken place.

The service used an electronic staff scheduling and planning tool called ‘People Planner’. This system enabled real-time live updates to be sent to care staff members which reduced the potential for missed or late visits.

We looked at the way the service managed consent for any care and support provided and found that before any care and support was given the service obtained consent from the person who used the service or their representative.

We found that each person who used the service had a comprehensive health assessment which was easily accessible within their individual care and support plan.

People who used the service and their relatives told us that staff were kind and treated them with dignity and respect. We found the service aimed to embed equality and human rights through well-developed person-centred care planning. The views and opinions of people were actively sought.

The service did not provide end of life care directly but supported other relevant professionals such as district nurses and Macmillan Nurses

The service had a Customer Services Guide which was given to each person who used the service, in addition to a Statement of Purpose.

Regular reviews of care needs were undertaken by the service and a schedule of reviews had been drawn up for 2016.

People who used the service and their relatives told us that they felt confident in talking to the manager directly and had regular discussions with management. The service had a complaints policy and procedure and we saw that they followed this consistently.

Staff told us they felt they were able to put their views across to the management, and felt they were listened to. The staff we spoke with told us they enjoyed working at the service and said they felt valued.

The service undertook audits to monitor the quality of service delivery. There was a schedule of field observations for 2015 which was fully completed and dates for checks due in 2016 had been scheduled.

We found the service had policies and procedures in place, which covered all aspects of service delivery including safeguarding, medication, whistleblowing, recruitment, complaints, equality and diversity, moving and handling and infection control. These policies were all up to date.