Naswell Care Ltd improved from Inadequate to Requires Improvement following a focused follow-up inspection, with Safe now rated Good and previous regulatory breaches remedied. However, governance systems, health action plan documentation, and incident record analysis require further development before the service can be considered consistently effective and well-led.
Concerns (5)
moderate
Governance
: “parts of the quality monitoring systems needed to be further developed to cover all areas of the service. For example, the provider's recruitment audits had not identified that health questionnaires had not been completed by all staff.”
moderateRecord keeping: “the records of their analysis of incident records had not been consistently maintained.”
moderateCare planning: “details of people's routine appointments, any recommendations and next review dates were not always clearly documented. The manager acknowledged that further development was needed in this area.”
moderateIncident learning: “Incident reports relating to the monitoring of people's behaviours and health such as patterns in people's seizures or emotions were reviewed and known by the managers. However, the records of their analysis of incident records had not been consistently maintained.”
moderateLeadership: “At the time of our inspection there was no registered manager in post, however a new manager had been employed and supported this inspection.”
Strengths
· Risk management plans were completed, monitored, and kept under review; staff were aware of how to support people with their risks such as seizures and specialised diets.
· People received their medicines as prescribed; staff completed medicines administration training and competency assessments.
· Safe recruitment practices were in place and disciplinary action was taken to address poor staff practices or conduct.
· A comprehensive incident reporting system was in place with actions recorded and changes made to care plans to reduce risk of repeat incidents.
· Staff worked closely with other professionals including social workers, GPs and occupational therapists to maintain people's well-being.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
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; supporting people to live healthier livesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
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 candour; continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood
Naswell Care Ltd, a supported living service in Gloucester supporting four people with learning disabilities and autism, was rated Inadequate overall following a focused inspection in October 2022, with breaches of Regulations 9, 11, 12, and 17 and warning notices issued for person-centred care and governance failures. Key failings included incomplete risk assessments and medication records, absence of mental capacity assessments, non-personalised care planning, inadequate staff training for complex behavioural needs, and ineffective governance systems across the service.
Concerns (12)
criticalMedication management: “The management and administration of people's routine prescription, 'as required' medicines and medicines prescribed mid cycle such as antibiotics were not complete and accurately recorded.”
criticalCare planning: “People's care plans did not always provide staff with personalised information such as their preferences, wishes and aspirations.”
criticalConsent / capacity: “The assessment of people's mental capacity to make specific decisions about their care and any associated unwise or best interest decisions on their behalf had not been completed.”
criticalGovernance: “The provider had failed to ensure effective governance systems were being used to drive improvements. This was a breach of regulation 17 (Good governance).”
criticalPerson-centred care: “People did not always receive care and treatment which was based on evidence based assessments...put people at risk of not receiving personalised care.”
criticalStaff competency: “The registered manager was unable to demonstrate how they had ensured themselves that agency staff who supported people had been suitably vetted and had the skills they required.”
moderateStaff training: “Staff told us the training they had received to support people with heightened emotions or distress was not adequate to support people with complex behavioural needs.”
moderateRecord keeping: “Without accurate and concise record keeping by staff, the team leaders and registered manager may miss opportunities to review people's needs and seek appropriate support.”
moderateLeadership: “The roles and responsibilities of the management team were not clear which had resulted in conflicting decisions on how the service should be managed.”
moderateInfection control: “Staff did not always wear PPE in accordance with current government guidance. This put people at risk of the spread of infection.”
moderateIncident learning: “The provider could not be assured that timely actions had been taken to prevent further reoccurrence as there was limited evidence that the outcomes and actions taken as a result of investigations had been completed.”
minorCommunication with families: “Others commented that communication from the service could improve, especially when they had raised concerns about the quality of care.”
Strengths
· Safe recruitment practices were in place including telephone screening interviews to verify care experience and employment histories.
· Staff were provided with safeguarding training and understood procedures to report concerns and escalate issues.
· The registered manager engaged frequently with people and relatives, enabling them to act on feedback.
· A system of managing and monitoring people's daily expenditures was in place and monitored by the registered manager.
· People were referred to specialist health care professionals such as Occupational Therapists and Speech and Language Therapists when health needs changed.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Staff support: induction, training, skills and experience