N-Able Support Services, a small Liverpool domiciliary care agency, was rated Good overall at its November 2016 inspection, with improvements confirmed since a substandard 2014 inspection. The sole Requires Improvement rating in Well-Led reflected incomplete quality monitoring records and gaps in medication administration records and care plan detail, though the provider took immediate corrective action during the inspection.
Concerns (5)
moderate
Record keeping
: “items of medication which was prescribed for the person to be taken 'when required' had not been entered onto their MAR sheet”
moderateMedication management: “items of medication for one person had been handwritten onto the persons MAR but had not been signed by two members of staff to ensure the accuracy of the information”
moderateGovernance: “checks to monitor the quality of the service however a record detailing what checks had been carried out and the outcome of them was not always maintained”
minorCare planning: “tick boxes were used to indicate a particular area of need, however there was little information describing how the need was to be met”
minorPerson-centred care: “there was no formal process in place to capture people's feedback”
Strengths
· Staff had completed safeguarding training and were confident about recognising and reporting abuse
· People received care from the same consistent staff who knew them well and had built positive relationships
· Staff were kind, caring and treated people with dignity, respect and patience
· People's healthcare needs were understood and staff liaised appropriately with health professionals
· Staff felt well supported by the registered provider through weekly meetings and regular one-to-one contact
Quality-Statement breakdown (15)
safe: Medicines managementGood
safe: Safeguarding people from abuseGood
safe: Safe recruitmentGood
safe: Staffing levelsGood
safe: Infection prevention and controlGood
effective: Staff training and competencyGood
effective: Staff supervision and supportGood
effective: Nutrition and hydrationGood
effective: Mental Capacity Act complianceGood
caring: Treating people with dignity and respectGood
caring: Person-centred approach and independenceGood
responsive: Care planning and needs assessmentGood
responsive: Complaints handlingGood
well-led: Record keeping and quality monitoringRequires improvement
N-Able Support Services is a small domiciliary care agency rated Good overall, providing high-quality, person-centred care to one individual, with staff demonstrating strong relationships, safeguarding knowledge and consistent support. The Well-Led domain requires improvement due to repeated failure to maintain accessible contact details with CQC and insufficiently detailed records of quality assurance visits and staff training.
Concerns (4)
moderateGovernance: “We tried to contact the provider to advise of the start date of our inspection on several occasions over a period of five weeks and were unable to make contact on the majority of these occasions.”
minorRecord keeping: “At times these were brief and did not reflect the service being provided. We discussed with the provider the benefits of keeping more comprehensive records.”
minorRecord keeping: “Records of visits to people by senior staff were very brief. We discussed with the provider the benefits of maintaining a more comprehensive record.”
minorStaff training: “Not all of the training staff had undertaken was clearly recorded, we discussed with the provider the benefits of recording all training and awareness sessions staff undertook.”
Strengths
· People were protected from abuse and harm; staff had good safeguarding knowledge and implemented it on a person-centred basis.
· Sufficient experienced staff were always available; safe recruitment practices were followed.
· Staff built strong, warm relationships with people supported, treating them with dignity and respect.
· Person received individualised support aligned with their preferences, choices and interests.
· Clear complaints procedure in place; no complaints received in the past year.
Quality-Statement breakdown (20)
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: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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 meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Planning and promoting person-centred, high-quality care and openness; duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersRequires improvement