Rosie Nightingale Homecare

Updated 23 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15, 16 and 18 October 2018 and was announced. We gave the service 48 hours notice because it is small and the manager is often out of the office supporting staff or providing care and we needed to be sure they would be in to assist us with the inspection.

Inspection site visit activity started on 15 October 2018 and ended on 18 October 2018 . We visited the office location on 15 and 16 October to see the manager and office staff; and to review care records and policies and procedures. We conducted two home visits on 16 October 2018 and made phone calls to service users, their relatives and staff on 16 and 18 October.

The inspection was completed by one adult social care inspector from the Care Quality Commission (CQC).

Prior to the inspection we reviewed all the information we held about the service in the form of notifications, previous inspection reports, expected/unexpected deaths and safeguarding incidents. We contacted Bolton quality assurance team to establish if they had any information to share with us.

We met with the registered manager and the training coordinator. We completed two home visits with people who received a service and spoke with another service user and two relatives. We interviewed three members of staff.

Records looked at included four care plans, four medicine administration records (MAR), four staff personnel files, training records for the whole staff team and the services policies and procedures. This helped inform our inspection judgements.

Updated 23 November 2018

Rosie Nightingale Homecare provides care to 49 people living in their own homes, including; older people, people living with dementia and people with physical disabilities. The service is based in the Harwood, Horwich and Westhoughton areas of Bolton with a head office in Bolton.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to protect people from the risk of harm or abuse. Safeguarding policies and procedures were robust and had been followed when required. Staff could identify safeguarding concerns and knew how to raise them appropriately.

Risk assessments had identified the individual risks people needed support to manage and plans had been developed to minimise the potential for harm. Environmental risk assessments ensured staff were aware of potential hazards at each property they visited.

Staff had been recruited safely with all necessary checks being completed prior to them starting to work with people. Staffing was sufficient to support people safely. No one told us they felt rushed.

Medicines were managed safely. Staff had received training in medicines. Regular spot checks and audits ensured records were accurate.

People were protected from the risk of infection. Staff were trained in infection control and had access to appropriate equipment, including gloves and aprons which had been supplied by the service.

The service learned from their experience and improved their practice in response to incidents. One example had been developing a more effective system for recording variable dose medicines such as warfarin.

People's needs had been assessed prior to their package of care starting. Care plans had been developed to meet people's needs which reflected good practice guidance.

Staff had received appropriate training and had the necessary skills and knowledge to provide care and support effectively. Some staff had completed further qualifications, including NVQ 2 and 3.

People received support to maintain their nutrition. The service had introduced cooking skills in their recruitment processes to ensure staff could provide meal support as preferred by the service users.

The service worked cooperatively with other organisations and services to ensure people received a coordinated level of care and support.

The service had supported people to access health services in a timely way. They had also promoted health and wellbeing by addressing broader issues such as isolation, communication needs and emotional wellbeing.

People signed their care plans to indicate they had consented to them. Staff were aware of the importance of gaining consent before providing care and support. The service was working within the principles of the Mental Capacity Act (2005) and had considered people's capacity in relation to specific decisions about their care and support.

People told us staff were caring and kind and went the extra mile for them. Relatives praised the commitment and dedication of the staff and service.

People's rights were included in the service user guide which was kept in the care record in people's homes. These rights included statements in relation to dignity, respect and equality.

The service had made efforts to understand people's communication needs and preferences. There had been several examples of individual communication strategies being developed to maximise individuals choice and control.

People's views on the care they received were sought through an annual survey and also informally throughout the year.

People continued to receive care which was personalised and responsive to their needs. Care plans were person centred and reflected the person's choices, background and preferences.

There was a complaints policy which had been followed when required. People were aware of how to raise any concerns and reported being responded to quickly.

People had been supported at the end of their life to have as comfortable and pain free death as possible. Though the service did not provide this type of support routinely this had increased recently. The service worked with people, their families and community based health professionals to ensure a coordinated compassionate service.

The service had a clear set of values and commitment to providing high quality care. Statements about this had been included in the service user guide. Staff were aware of the values and culture of the service and felt committed to achieving these goals.

The people who used the service and staff all praised the registered manager and said they found them to be clear about standards and to be approachable and supportive.

The service had effective governance and auditing systems to ensure care had been provided as detailed in the care plans and professional standards had been maintained. Any gaps identified by audits had been addressed.

The service had regular quality assurance meetings with the local authority who told us they experienced a good level of cooperation from the service who they reported worked very closely with them.

Effective communication systems had been developed using technology to ensure the team were up to date with any changes in policy and practice. Staff also used a secure social media app to communicate with each other throughout their shifts.

An annual staff survey invited staff to comment on what was going well and what could be improved. The registered manager had responded to some of the improvements suggested but had not always informed staff they had done this.

The service works with partner organisations and stakeholders and have shared their skills and knowledge.