Nurtured Care NE

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always kept as safe as they could be and improvements to safety were not always made in as timely manner as possible. Care visits were too often cut short, delayed or otherwise at the incorrect time. This presented additional risks in terms of people’s wellbeing and receipt of person-centred care. People were respected and their freedoms protected in line with legislation. When people raised concerns about safety, they were listened to and the registered manager, and other staff, took action. Staff protected people from the immediate risks they faced. The registered manager ensured there were enough skilled people to meet people's needs and preferences, although these preferences had not always been met due to the poor oversight of the electronic call monitoring system over the previous months.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt listened to and able to raise concerns and some fed back that they had noted improvements where they had suggested them. People and families were involved in discussions when staffing or other matters needed to change.

Staff were able to quickly and easily notify leaders of incidents, and these were acted on promptly. Staff felt issues they raised would be dealt with appropriately. Risks were not ignored and were dealt with willingly. There was a culture of reporting incidents, but the culture of learning from these incidents, and deeply analysing what a range of incidents might mean, needed further improvement.

The provider had systems in place to review and act on incidents. There were ways of regularly recording and reviewing incidents. Some opportunities to improve safety through learning from the themes and trends of incidents had not always been taken. The provider reflected on this and was responsive to feedback about using the recording of incidents and accidents to more deeply explore what they might mean for the service more generally.

The majority of people felt their care needs were met by staff. Some felt the delays and inconsistent call times did leave them frustrated at times, and less able to plan around their care provision. Some risk management by the provider could have been more proactive, for instance in relation to environmental risk assessments and the risks of self-neglect.

The registered manager and other leaders understood the importance of the continuity of care and they did try to ensure people receive care from familiar staff. This at times was not well managed in conjunction with the need to ensure people’s needs were met, for instance staff arriving for evening calls in the late afternoon and then not returning until the next morning. People were at times at heightened risk of neglect due to the provider’s processes.

We received positive feedback from partners about how the service had supported people on discharge from hospital. One external social care professional said, “They have communicated well with myself via email and telephone regarding any requests that I made.”

The people we spoke with raised no significant concerns in this area. They felt staff would act if there was an imminent concern regarding their safety or risks posed. They told us they were aware of out of hours arrangements in the event of an emergency. People said, “I feel safe enough,” and, “She is perfectly safe with them, even with some of the frustrations.” There had been however, as mentioned above, numerous instances where people were at additional risk due to shortfalls in reporting both on the provider’s systems and to external agencies.

Staff received regular safeguarding training. They were aware of their responsibilities and reported changes to people’s presentation regularly to senior leaders. Staff confirmed their safeguarding responsibilities were discussed at meetings and on spot checks. This had not always been the case, but the provider had responded to feedback from external partners. There had been some patterns of call planning and delivery that had not ensured safeguarding was paramount. For instance, there had been numerous instances where staff received no response from a person on arrival, but this was not appropriately flagged. Likewise, when people had refused support, this had not always been documented appropriately, meaning potential risks could be missed.

Safeguarding processes and policies were in place and the staff we spoke with knew how to follow them. The safeguarding policy needed further review. For instance, it described the historic Independent Safeguarding Authority rather than the Disclosure and Barring Service. It made one reference to self-neglect but had no further information on how the provider/staff would approach this area of risk. It stated that DBS checks were completed annually when in fact they were every three years.

The majority of people and their relatives told us they were involved in risk planning and could contact the service if their needs changed. Some people however fed back that staff were not always fully aware of the specific risks they faced, and they had to remind staff.

Care plans and risk assessments were reviewed regularly and office staff updated risk assessments. This had not always happened promptly and the provider was working to an action plan to improve the quality of documentation (including risk assessments). At the time of inspection we identified a small number of risk assessments that needed further work to ensure they were up to date and person centred. The provider had recently been prompted by partners to include/improve urinary catheter risk assessments.

People did not raise any concerns about how staff supported them to remain safe in their home environment. They gave examples of staff completing agreed tasks and tidying after themselves.

The provider had engaged well with the fire service to facilitate fire officer visits to people who used the service, with a view to increasing their awareness of fire safety, and also ensuring homes were not subject to unnecessary risks. Whilst this aspect of environmental safety was a positive, the provider did not have completed general environmental risk assessments in place for all people who used the service – they planned to have all these in place wthin a month.

Policies and procedures were in place to help reduce the risks people faced through environmental hazards. As above, some of these needed to be updated with current and more detailed information.

A significant majority of people raised similar areas of concern: staff did not always arrive on time, did not always stay the planned duration and there was a lack of communication from the office if there were delays. Call time data we reviewed supported these responses. This meant some people could not feel assured they would receive the help they needed, when they needed it. One relative said, “The care staff are polite but always rushed.” Another said, “The carer never stays the allotted time” and another, “They do not let me know if they are going to be late.”

Staffing levels were planned to meet people’s needs but there were significant shortfalls in the duration and timings of care calls provided. These had been highlighted over a period of months prior to the inspection visit but there had been little effective action taken to improve and sustain these areas at the time of inspection. This meant there had not always been staff in place at the agreed time and place to deliver safe care. The registered manager had put in place additional measures in the days and weeks before our inspection visit, and after prompting by external partners, but these were not fully effective.

The provider had auditing and governance systems in place but they had not been effective, over a period of months, in identifying and rectifying the issues identified above. This meant there had not always been staff in place at the agreed time and place to deliver safe care. The registered manager did not have a good working knowledge of the electronic call monitoring system in place and it was not being utilised as effectively as it could be.

People and their relatives raised no concerns regarding infection control. They confirmed staff always used personal protective equipment (PPE) appropriately.

The registered manager ensured there were ample supplies of appropriate PPE and related equipment available for staff. Staff supported people to maintain clean environments. Where a specific concern was raised about this topic, the registered manager responded positively and the person told us the issue never happened again.

People raised no concerns about the support they received to administer medicines, other than where this was in relation to calls being delayed. One person said, “They do all my medicines and there has never been a mistake.”

Staff were conscious of the need to ensure timed medicines were given on time. This had been an issue at the previous CQC inspection and there were still some areas to improve to ensure that all people who relied on timed medicines, or medicines that needed a specific gap in between doses, were receiving these at the appropriate times.

Following the previous CQC inspection last year the provider sought help from North East and North Cumbria Clinical Networks (NECS) and made improvements to their medicines administration recording and practices. They were therefore no longer in breach of regulation 12 in relation to medicines.