Nursing Direct Ltd received an overall Good rating across all five key questions at its August 2023 inspection, maintaining the rating held since 2018. Two minor areas for improvement were identified: inconsistent office communications when staff were running late, and supervision sessions that were infrequent and insufficiently detailed with no annual appraisals in place, though the provider had already begun implementing a remedial supervision matrix.
Concerns (2)
moderateSupervision / appraisal: “We checked supervision records, which indicated discussions in these meetings was very brief and the sessions were not regular. We noted staff did not receive annual appraisals.”
minorCommunication with families: “Some people using the service and their relatives said communications from the office when staff were late for their calls, could be improved.”
Strengths
· Robust safeguarding policies and procedures with staff demonstrating good knowledge of abuse recognition and reporting processes.
· Effective recruitment and selection processes including DBS checks and pre-employment references.
· Medicines administered safely with annual competency checks, audits and appropriate staff training.
· Person-centred care plans personalised to individual needs, reviewed regularly with people and their relatives.
· Consistent staffing providing continuity and strong relationships between staff and people using the service.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 and access healthcare servicesGood
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 controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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 candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Continuous learning and improving careGood
Nursing Direct Ltd received an overall Good rating across all five key questions at its first CQC inspection in June 2018, demonstrating strong person-centred, clinically specialist homecare. The sole area of concern was insufficient Mental Capacity Act assessment processes for four people, though the provider took immediate remedial action upon being notified during the inspection.
Concerns (4)
moderateConsent / capacity: “The provider did not have robust systems to provide care in line with the MCA at the time of our inspection...the provider had not carried out MCA assessments and ensured decisions were made in people's 'best interests'”
moderateGovernance: “The quality assurance processes in place had not identified the issues we found relating to the MCA.”
minorRecord keeping: “For some people the provider had 'repositioning charts' in place...For other people staff recorded repositioning within daily care notes. This meant it was more difficult for the provider to audit.”
minorStaffing levels: “when their usual staff went on leave or were sick people and relatives told us they were often not provided with replacement staff who knew them well.”
Strengths
· Individualised 'competency observation frameworks' ensured all staff were trained to meet each person's specific and complex needs before lone working.
· People were involved in staff recruitment, including 'meet and greet' sessions before care commenced.
· Medicines managed safely with monthly audits, specialist administration training and robust competency assessments.
· Staff treated people with kindness, dignity and respect; several staff were 'dignity champions'.
· Cultural and ethnic needs catered for, including matching staff by language, cultural background, and shared interests.