We carried out our on-site assessment on 9 October 2024, off site assessment activity started on 9 September 2024 and ended on 21 October 2024. There were areas for significant improvement in Safe and Well-led, particularly with regard to the planning of care calls and governance. The service performed well against some of the statements we looked at. The registered manager and leadership team have been responsive to our feedback and continued to work with external partners to improve systems and safety. The service has previously been in breach of regulations 12 (safe care and treatment), 17 (good governance). The service was no longer in breach of regulation 12 but remained in breach of regulation 17 and was now in breach of regulation 9 (person-centred care). The provider used an electronic care records system, which was also used to plan and record call times. A sizable proportion of these call times had been significantly below the agreed duration for a number of months. There was a significant minority of people we spoke with who felt staff were either rushed, did not stay for the allotted time, and/or did not arrive on time. The provider gave assurances about their future monitoring and acting on shorter calls, late calls and otherwise poorly planned or actioned calls. Staff were committed to their role and knew people’s needs well. Governance still needed to improve. We found instances of risk assessments that needed improvement, which could have been identified and acted on with more effective auditing and governance arrangements in place.
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Nurtured Care NE was rated Requires Improvement overall following a May 2023 inspection of this 260-person domiciliary care agency, with breaches identified in medicines management, risk assessment, and quality assurance (Regulations 12 and 17). While staffing levels, safeguarding, infection control, and partnership working were found to be adequate, significant concerns remained around unsafe medicines administration timings, incomplete risk assessments, and ineffective governance systems.
Concerns (7)
criticalMedication management: “Some people were routinely receiving doses of medicines too close together. This meant people were at risk of harm from a medicines overdose.”
criticalCare planning: “Two people required a hoist to move to and from bed. There was no risk assessment in place for this. This meant people were at risk of being moved incorrectly.”
criticalGovernance: “The failure to have robust quality assurance processes in place is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014”
moderateMedication management: “Records for 'as and when required' medicines were lacking detail. This meant people were at risk of not receiving their 'when required' medicines appropriately.”
moderateIncident learning: “It was not always clear what action was taken following an incident to help ensure similar issues did not occur again.”
moderatePerson-centred care: “People's equality characteristics were included in some care plans but not all. There was limited person-centred information in care plans.”
minorRecord keeping: “Some records did not include the dates of previous employment for staff. We could not be assured that references were obtained from the most recent employers.”
Strengths
· People were safe from the risk of abuse; safeguarding incidents were recorded, reported and investigated appropriately.
· There were enough employed staff to keep people safe, with training including specialist areas such as catheter care.
· Staff worked effectively with other healthcare professionals and people were referred to specialist services in a timely manner.
· Infection control measures were in place; staff wore PPE and management carried out spot checks.
· People and relatives gave largely positive feedback about care staff, describing them as 'like part of the family'.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
safe:Insufficient evidence to rateeffective:Insufficient evidence to rateresponsive:Insufficient evidence to rate
This targeted inspection of Nurtured Care NE was triggered by concerns about medicines management, staffing levels, staff training and unmet care needs, but found no evidence of harm or regulatory breach in any of these areas. Safe, Effective and Responsive were inspected but not rated as only specific parts of each key question were assessed; Caring and Well-led were not inspected.
Concerns (1)
minorCommunication with families: “some were unhappy they were not told which carers would be visiting each week”
Strengths
· Sufficient staffing levels to safely support people during planned visits
· Medicines managed safely with regular checks by the registered manager and office team
· Staff received training in medicine administration with competency assessments
· New staff received an in-depth induction and ongoing training and support
· Staff received regular supervisions and could seek support at any time