This focused inspection of Nomase Care Ltd - Chadwell Heath found that the provider had made sufficient improvements in Safe and Well-Led (both now rated Good) to exit Special Measures, having addressed previous breaches of Regulations 12 and 17. The overall rating remains Requires Improvement as uninspected key questions (Effective, Caring, Responsive) retain prior ratings.
Strengths
· Robust risk assessments in place covering health conditions, falls, mobility and skin integrity following previous breach of Regulation 12
· Medicines administered safely with staff trained and competency-assessed; previous MAR concern resolved
· Digital call monitoring system in place to verify staff attendance and duration; no missed calls reported
· Comprehensive pre-employment checks including DBS, identity verification and references
· Quality assurance audits covering care plans, risk assessments, medicines and staff files, with spot checks on staff performance
safe:Requires improvementresponsive:Insufficient evidence to ratewell-led:Inadequate
Nomase Care Ltd - Chadwell Heath remains in special measures following a focused inspection, with ongoing breaches of Regulation 12 (safe care and treatment) due to absent risk assessments for people with serious health conditions, and Regulation 17 (good governance) due to ineffective audit systems that failed to identify or remediate these shortfalls. Some improvements were noted in timekeeping, care planning and infection control, but the Inadequate well-led rating reflects persistent, widespread governance failures.
Concerns (5)
criticalCare planning: “Risk assessments continued not to be completed in relation to people's health conditions such as people at risk of stroke, heart disorder, respiratory failure and diabetes.”
criticalGovernance: “These audits did not identify the shortfalls we found at the inspection.”
moderateMedication management: “For one person in March 23, staff did not sign the Medicine Administration Chart (MAR) for the whole month.”
moderateRecord keeping: “The audit findings did not record the action that had been taken to ensure risks of reoccurrence was minimised such as if staff required further training on medicines.”
moderateIncident learning: “Failure to take robust action when identifying shortfall during audits meant there was a risk it may happen again.”
Strengths
· Robust systems were in place to ensure staff attended care calls on time, with significant improvement in timekeeping since last inspection.
· Pre-employment checks were robust to ensure staff were suitable to support people safely.
· Care plans were person-centred and included people's preferences, background and support needs.
· Staff had been trained in safeguarding adults and infection control with access to PPE.
· Systems were in place to obtain feedback from people and relatives for continuous improvement.
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood
Nomase Care Ltd - Chadwell Heath was rated Inadequate overall following a December 2022 inspection, remaining in Special Measures after failing to improve on four continuing regulatory breaches (Regulations 9, 12, 17 and 18) identified at its previous inspection. Critical failures centred on unsafe medicines management, persistent late and missed visits, incomplete risk assessments and ineffective governance audits that failed to detect known shortfalls.
Concerns (8)
criticalMedication management: “MAR charts showed gaps on 6 peoples MAR charts with no information on why these medicines were not administered, which meant there was a risk these medicines were not given”
criticalMissed or late visits: “We have had carers arriving as late as 1pm. We are not informed of lateness.”
criticalCare planning: “We are waiting for an assessment to be able to devise a care plan and we have been waiting now 2 months. So, no care plan and we have to tell the carers what needs to be done.”
criticalGovernance: “Audits continued not to find shortfalls we found with medicines, care plans, risk assessments and staff time keeping.”
criticalStaffing levels: “Staff were not being given time to travel in between appointments, which meant that they would be late for calls.”
criticalRecord keeping: “The medicines risk assessment document often had different medicines listed when compared to the MAR chart such as the dosage and frequency on some risk assessments did not match”
moderatePerson-centred care: “Inconsistency with people's preferences with personal care had not been recorded...they may not receive personalised care.”
moderateCommunication with families: “There is little communication between the office and us. We are not contacted if carers are running late.”
Strengths
· Pre-employment checks including DBS, references and proof of identity had been carried out for all staff.
· Staff had completed essential training including safeguarding, infection control, manual handling and basic life support.
· Regular supervisions and yearly appraisals were completed and staff felt supported in their roles.
· Systems were in place to obtain consent and MCA assessments had been completed; regulation 11 breach resolved.
· Staff wore appropriate PPE and followed good infection control practices.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choicesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
Nomase Care Ltd - Chadwell Heath deteriorated from Good to Requires Improvement overall, with Safe rated Inadequate due to unsafe medicines management, incomplete risk assessments and persistent late or shortened visits. Inspectors identified breaches of Regulations 9, 11, 12, 17 and 18, with Warning Notices issued for governance and staffing.
Concerns (13)
criticalMissed or late visits: “No, the carers have never arrived on time or stayed the allotted time of half an hour. Carers have only stayed a maximum of 12 minutes for an hour visit.”
criticalStaffing levels: “The registered provider was not deploying sufficient numbers of staff to ensure people received support in a timely manner. Regulation 18(1).”
criticalMedication management: “Medicines were not managed safely in some areas... we did not see any PRN protocols or guidance in place to guide staff on how and when to administer these medicines”
criticalMedication management: “they crush all medicines together and place in the person's tea. Professional advice had not been sought from the pharmacist to check if it is safe to give all the medicines together”
criticalCare planning: “Pre-admission assessments and care plans were not robust to ensure people's preferences with support and care were captured.”
criticalCare planning: “Risk assessments had not been completed for people at risk of falls... robust risk assessments had not been completed to minimise people from falling.”
criticalConsent / capacity: “MCA assessment had not been completed to determine if the person had capacity to ensure decisions were made in their best interests and as least restrictive as possible.”
criticalGovernance: “The registered provider was not robustly assessing, monitoring, improving the quality and safety of the service users and mitigating the risks to ensure people were safe at all times.”
moderatePerson-centred care: “Care plans had not been completed for people with dementia to include their level of dementia and how support can be personalised to ensure they received person-centred care.”
moderateCommunication with families: “The carers do not speak English and I cannot understand them, so they just point at me to move my arm, leg, body etc when washing and dressing me.”
moderateIncident learning: “robust systems were not in place to analyse incidents and accidents to learn from lessons and minimise the risk of re-occurrence.”
moderateComplaints handling: “complaints had not been analysed to identify potential trends and to ensure improvements can be made to the service and minimise risk of reoccurrence.”
moderateRecord keeping: “there was number of blank entries as staff had not logged into calls, which meant the service would not have oversight if staff attended calls on time.”
Strengths
· Pre-employment checks including criminal record checks, references and proof of identity had been carried out
· Staff had completed essential training (safeguarding, infection control, manual handling, basic life support) and felt supported
· Regular supervisions had been carried out with staff
· People were supported to eat and drink and to access healthcare services; care records included GP contact details
· Staff wore PPE and followed good infection control practices
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law