Nouveau Care was downgraded from Good to Requires Improvement following a focused inspection that found breaches of Regulations 12 and 17 due to inadequate oversight of risk, medicines, staff competencies and governance. While staff were viewed as kind and recruitment was robust, late calls, weak audits, missing CQC notifications and poor MCA compliance placed people at increased risk of avoidable harm.
Concerns (14)
criticalCare planning: “Care plans and risk assessments were not completed in sufficient detail where a person had additional health needs or risks associated with their care.”
critical
Medication management
: “People were at risk of not receiving their medicines safely. Training and oversight of staff's medicine practices were not sufficiently robust.”
criticalStaff competency: “medicine competencies were not completed on a regular basis and not all staff had spot checks to observe them administering medicines”
criticalGovernance: “The provider had failed to ensure the service was always well planned and well led in the interests and safety of people using the service. This was a breach of regulation 17”
criticalLeadership: “The managing director and registered manager did not have sufficient oversight of the service.”
criticalSafeguarding: “some notifications had not been referred to CQC in a timely way”
moderateMissed or late visits: “calls were not delivered at agreed times and they were not always informed if staff were running late... time keeping was an issue with carers coming within a 2-hour window”
moderateStaff training: “Access to external training and role specific training was limited. There were no champions or train the trainers amongst the staff team.”
moderateIncident learning: “Learning from incidents was not sufficiently robust as there was limited analysis and understanding of why incidents occurred and how they could be reduced.”
moderateConsent / capacity: “The service was not working in line with the principles of MCA... mental capacity assessments were not in place as required.”
moderateSupervision / appraisal: “Staff spot checks were conducted by a senior member of staff when they were covering a care call with another carer. This meant there was not sufficient time or privacy”
moderateRecord keeping: “This instruction was not dated. Further down the care plan it stated they could sit in their own chair for up to 4 hours but gave no details of repositioning. This information was conflicting”
minorCommunication with families: “Some people said they had minimal contact with the office and not all remembered receiving a survey or review of their care.”
minorComplaints handling: “this information had not been collated and there was no mechanism in place to feedback to people using the service to tell them what improvements had been made”
Strengths
· Staff demonstrated a good understanding of types of abuse and what actions to take to protect people
· Recruitment processes were sufficiently robust including for staff recruited locally and from overseas
· Good infection control practices with PPE provided and used appropriately
· Carers were described by people and relatives as kind, gentle, and respectful of dignity
· Electronic systems used to record care and monitor scheduled visits
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
effective: Assessing people's needs and choicesRequires improvement
effective: Staff support induction, training, skills, and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks, and regulatory requirementsRequires improvement
well-led: Duty of candour and openness when things go wrongRequires improvement
well-led: Engaging and involving people, public and staff; promoting a positive person-centred cultureRequires improvement
well-led: Continuous learning and improving care; partnership workingRequires improvement