Top Carers Nursing and Domiciliary Care Agency improved from Requires Improvement to Good across all five key questions, having addressed previous breaches in safe care and treatment and good governance. The service demonstrated robust medicines management, comprehensive care planning, strong staff training and supervision, and effective governance systems.
Strengths
· Risks to people were comprehensively assessed with clear guidance for staff, and medicines management was audited regularly by the registered manager.
· Staff received two days of medicines training plus specialist training, with competency assessments carried out by a senior nurse.
· Robust recruitment checks were in place including DBS, identification, health conditions, work history and performance.
· Sufficient staffing levels with good timekeeping; staff were not rushed and had meaningful time with each person.
· Structured supervision schedule implemented with well-recorded sessions; staff found supervisions supportive.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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: End of life care and supportGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving care; Managers and staff being clear about their roles and governanceGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
Top Carers Nursing and Domiciliary Care Agency was rated Requires Improvement overall at its June 2021 inspection, down from Good in 2015, with breaches of Regulations 12 and 17 identified across medicines management, unrecorded supervision, incomplete care plans, and ineffective governance audits. Caring was the sole domain rated Good, reflecting consistently positive feedback from relatives about staff compassion, consistency and dignity.
Concerns (9)
criticalMedication management: “The provider had not always assessed risks relating to medicines management comprehensively, in line with national guidance.”
criticalMedication management: “competency assessments, but these were not recorded so we could not check whether they were appropriate.”
criticalMedication management: “The provider was unable to show us any recent medicines records during the inspection which indicated they had not audited them.”
criticalSupervision / appraisal: “staff did not receive structured supervision or appraisal and the registered manager told us they stopped recording supervision over a year ago.”
criticalGovernance: “The provider's audits to check people received a good standard of care were lacking because they had not identified and resolved the concerns we found.”
criticalRecord keeping: “Records of risk assessments and care plans, staff supervision and appraisal, medicines records, daily logs and staff recruitment in particular were insufficient.”
moderateCare planning: “for one person the provider was unable to evidence they had assessed their needs as there were no pre-assessment records nor care plans to guide staff.”
moderateStaff competency: “the provider did not always carry out sufficient checks of previous work history and performance. We checked two staff files and found the provider had obtained only one reference for each.”
minorInfection control: “The management team told us they carried out checks of infection control practices to ensure staff followed current guidance, but these were not recorded.”
Strengths
· Staff were caring and considerate, developing good relationships with people; relatives described staff as 'almost part of the family'.
· People received consistency of care from staff who knew them well, with good timekeeping and no missed visits reported.
· Staff received annual training across a wide range of topics including dementia, health and safety, nutrition, epilepsy and specialist medical needs.
· The provider matched staff to people's specific needs, including sourcing staff who spoke particular languages.
· A suitable complaints procedure was in place and relatives had confidence complaints would be investigated properly.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and support
Top Carers Nursing Agency received a Good rating across all five key questions at its March 2015 inspection, with six people using the service at the time. The service demonstrated strong safeguarding practices, effective staff training and supervision, person-centred care delivery, and robust quality monitoring systems.
Strengths
· People consistently reported feeling safe, with relatives expressing confidence in staff protecting their loved ones from harm.
· Staff arrived on time and stayed for the allotted period, with sufficient staffing levels maintained and continuity of care ensured.
· Robust recruitment process including DBS checks, identity verification, right-to-work checks, and professional references.
· Comprehensive induction including three weeks of structured training, shadowing, and competency checks before independent working.
· Weekly supervision, performance reviews, and unannounced spot checks by the field supervisor to monitor care quality.
Good
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 preferencesRequires improvement
responsive: End of life care and supportGood
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving care; Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood