Nayland Care Agency Limited, a domiciliary care service in Suffolk supporting 130 people, retained its Good rating across all five key questions at this remote inspection in September 2023. The service demonstrated robust safeguarding, safe staffing and medicines management, strong leadership culture, and high satisfaction among people and relatives, with only minor concerns around inconsistent staff engagement and late-visit communication.
Concerns (3)
minor
Person-centred care
: “some people told us this was not always the case. We received feedback that some individual staff did not engage with people nor always listen to what they said.”
minorMedication management: “a relative told us how tablets had been found in their family member's bedding, which had been reported to the office and they were assured this would be looked into.”
minorCommunication with families: “whilst some said they were told when their visit was running late, some said they were not.”
Strengths
· Robust safeguarding systems with clear reporting procedures, staff training, and documented lessons learned.
· Safe recruitment practices including DBS checks and elimination of agency staff through a sponsored overseas workforce.
· Effective medicines management with monitoring systems to identify discrepancies and competency-checked staff.
· Comprehensive induction including Care Certificate, shadowing, and ongoing refresher training covering dementia, learning disability and autism.
· Strong person-centred care culture underpinned by the 'Time to care' ethos with no missed visits recorded.
Quality-Statement breakdown (25)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
Nayland Care Agency Limited improved from its previous inadequate Safe rating but remained Requires Improvement overall, with ongoing issues around late and missed visits, incomplete record-keeping for staff recruitment, and governance systems not yet fully embedded. Effective and Caring were rated Good, reflecting progress in staff training, supervision, care planning, and person-centred practice.
Concerns (8)
criticalRecord keeping: “where care workers had a previous criminal conviction there were no risk assessments or records in place to show how the service had considered this”
moderateMissed or late visits: “one person said about their care workers being late, "What can you do? I'm used to them. I think it's because they are short staffed."”
moderateMissed or late visits: “morning visit ranged from 9am to 11.40am and the afternoon visits ranged from 4.05pm to 5.15pm”
moderateRecord keeping: “Of the 11 care records we reviewed only two had the specific times that visits were to be completed.”
moderateGovernance: “for the late visits there was no time on the planned visit time and how late they were. Without this information, the service cannot effectively assess late visits.”
moderateStaffing levels: “care workers did not always stay for the agreed length of time. They said that sometimes it could total up to two hours each week that they had cut short visits.”
moderateCommunication with families: “"Sometimes I get in a muddle and I need help quickly. I ring the office staff but they don't help me and don't pass my messages to the carers."”
minorPerson-centred care: “a person told us that at weekends they did not always get their preferred gender of care workers and they had raised this with the office, but this was not addressed”
Strengths
· People told us that their care workers treated them with kindness and respect, with positive relationships and continuity of regular care workers.
· Medicines management systems had been reviewed and updated, with competency observations and updated training for care workers.
· Care plans had been reviewed and updated to be person centred, including detailed risk assessments and guidance for care workers.
· Improvements made in care worker training, including dementia awareness, moving and handling, MCA, and safeguarding.
· One-to-one supervision meetings introduced and recorded, supporting care workers to meet people's needs effectively.
Nayland Care Agency Limited was rated Requires Improvement overall (with Safe rated Inadequate) following an inspection in November–December 2016, with regulatory breaches identified across Regulations 9, 12, 17, and 18. Key failures included missed and late care visits, unsafe medicines management, inconsistent safeguarding training, inadequate staff supervision, and a quality assurance system insufficiently robust to identify and address service shortfalls.
Concerns (13)
criticalSafeguarding: “The training records of care workers were not up to date therefore we could not be assured that all staff had received up to date safeguarding training.”
criticalMissed or late visits: “One day they did not turn up until 1.40pm should be after 7am and before 8.45am...this concerned them because the person had to have medicines in the morning.”
criticalMedication management: “Training records did not demonstrate that all staff had received up to date training in the safe administration of medicines or that those that had received training had had their competency regularly checked.”
moderateStaffing levels: “I can be half way through one round then get a phone call to say there has been a change to the rota so not enough staff.”
moderateStaff training: “Of the 57 care workers listed 25 had training in diabetes and 42 had received training in dementia.”
moderateSupervision / appraisal: “Of seven care worker personnel files reviewed only one had received a one to one supervision meeting in 2016.”
moderateCare planning: “Not all had been assessed by the service and the care plans in place remained from their previous care provider.”
moderateGovernance: “The provider's quality assurance systems were not robust enough to identify shortfalls in the service and to take actions to address them.”
moderateIncident learning: “There was a log maintained about where missed calls had happened. However, not all of these included actions taken to reduce the risks of these happening in the future.”
moderateRecord keeping: “Safeguarding records were currently kept on the service's e mail systems and were not analysed and did not give a clear audit trail of actions taken.”
moderatePerson-centred care: “The care records did not include people's preferences regarding the gender of the care workers who visited them in their own homes.”
moderateCommunication with families: “Communication could be better as it is very poor when there are no phone calls to say sorry they are late.”
minorCultural competency: “We had received comments from people about the difficulties they faced when they were supported by people who did not use English as their first language.”
Strengths
· People had positive and caring relationships with care workers and were treated with respect and kindness.
· Robust recruitment procedures were in place, including checks that care workers were of good character before working in the service.
· A complaints procedure was in place and complaints were investigated and responded to in a timely manner.
· People were supported to maintain good health and access healthcare services, with care workers taking appropriate action when concerned about wellbeing.
· Where people required assistance with dietary needs, systems were in place to provide safe support.
Quality-Statement breakdown (17)
safe: Safeguarding systems and trainingInadequate
safe: Visit scheduling and staff deploymentInadequate
safe: Medicines management and administrationInadequate
safe: Recruitment proceduresGood
effective: Staff training and competencyRequires improvement
effective: Staff supervision and appraisalRequires improvement
effective: Health and dietary supportGood
effective: Consent and Mental Capacity Act complianceRequires improvement
Nayland Care Agency Limited improved from Requires Improvement to Good overall at this July 2018 inspection, with all five key questions rated Good following sustained improvements in visit monitoring, governance, staff training and complaints handling. Residual concerns around occasional late visits without notification, isolated infection control lapses and historic complaints-handling failures were acknowledged and actively being addressed by the managing director.
Concerns (5)
moderateMissed or late visits: “One person's relative said this was a problem, because their family member was waiting for support with their personal care and when their care workers did not arrive on time, this affected them.”
moderateMedication management: “There were times when the visits between the two were not always coordinated which resulted in them not being able to take their pain medicines, because their visits were too close together.”
moderateComplaints handling: “The managing director had identified that there had been some complaints which had not previously been addressed appropriately.”
minorInfection control: “We were told in a concern received about the service that the care workers had not used gloves or aprons when they were supporting a person with their personal care needs.”
minorPerson-centred care: “One person's relative said that their family member's usual care workers knew about their needs, but when they had newer care workers, 'They do not appear to be aware of what they are doing.'”
Strengths
· Significant reduction in missed and late visits following introduction of new monitoring system (43 late visits in January 2018 reduced to 7 in June 2018; 17 missed visits in February reduced to 2 in June 2018).
· People reported feeling safe and expressed high levels of satisfaction with the kindness and professionalism of care workers.
· Strong staff training programme including induction, Care Certificate assessment, dementia training, and responsive bespoke training such as grief management.
· Effective governance improvements including monthly quality audits across all five key questions and introduction of computerised visit planning system.
· Care workers received regular supervision, appraisal and direct observations, with records showing identified needs (e.g. English language support) were acted upon.
Quality-Statement breakdown (20)
safe: Missed and late visitsGood
safe: Medicines managementGood
safe: SafeguardingGood
safe: Infection controlGood
safe: Staffing and recruitmentGood
safe: Incident learningGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
Mental Capacity Act compliance
caring: Relationships, respect and dignityGood
caring: Person-centred preferences including gender of care workersRequires improvement
caring: Cultural and language needsRequires improvement
responsive: Assessment and care planningRequires improvement
responsive: Complaints handlingGood
responsive: Care reviews and involvement in decisionsRequires improvement
well-led: Quality assurance and governance systemsRequires improvement
well-led: Incident monitoring and learningRequires improvement
well-led: Staff culture and communicationRequires improvement
effective:
Good
effective: Nutrition and hydration supportGood
effective: Access to healthcare professionalsGood
caring: Dignity, privacy and respectGood
caring: Person-centred relationshipsGood
caring: Independence promotionGood
responsive: Care planning and person-centred careGood