About the service:

Nationwide Care Services Limited (Derby) provides personal care and support to people in their own homes in Derby and the surrounding areas. At the time of this inspection 102 people received personal care from the service.

Our last inspection report for this service was published on 05 December 2017 and the rating was ‘Requires Improvement’ with no breaches.

This was a scheduled inspection based on the service’s previous rating.

What life is like for people using this service:

People felt safe using the service. Care workers knew where people were at risk and what to do to keep them safe. Improvement had been made to care plans and risk assessments and the service’s staff recruitment procedure.

Improvements had been made to the way people’s mental capacity was assessed and the service was working within the principles of the Mental Capacity Act (MCA).

People’s cultural needs were identified during their assessments and care plans put in place to show how these were to be met.

Care workers were well-trained and competent. They treated people kindness, respect and compassion.

People were encouraged to make decision about their care and support and had access to their care plans.

People received personalised care that was responsive to their needs. They said care workers were mostly on time and stayed for the duration of their calls.

People knew what to do if they had a complaint about the service and staff listened to them and made improvement where necessary.

The office has been re-designed to create a welcoming and informative place for people, relatives and care workers to visit. A display celebrating equality and diversity emphasised staff member’s commitment to providing an equal and non-judgemental service to all.

There was a new registered manager in post who people and staff said was helpful and supportive.

People were involved in how the service was run and their views sought at review meetings and through regular quality assurance questionnaires.

The service’s audit system covered all aspects of people’s care and support and people were involved in through review meetings and quality assurance questionnaires.

For more information please see the Detailed Findings below.

This inspection took place on 24 October 2017 and was announced.

We carried out an announced inspection of this service on 4, 5, 6 and 7 April 2017. Five breaches of legal requirements were found and we rated the service as 'Inadequate'. This was because the provider had failed to: submit statutory notifications when required; identify, receive, record, handle and respond to complaints effectively; ensure suitable staff were employed; provide people with safe care; and operate effective systems to assess, monitor and improve the service, and mitigate risks to the health, safety and welfare of the people using it.

Following this inspection we also took action to restrict new admissions to the service. We also issued a requirement for the provider to send us monthly reports on the progress they had made towards improving the service.

In response the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we found that action had been taken and the breaches had been met. As a result we have lifted our requirement to restrict new admissions to the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Nationwide Care Services Ltd provides personal care and support to people in their own homes in Derby and the surrounding areas. At the time of this inspection 50 people received personal care from the service.

The service did not have a registered manager. A registered manager a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager told us they were in the process of applying to CQC to be the next registered manager.

We found significant improvements to the service. Medicines were managed safely and people told us they received them at the right times. Staff were trained to administer medicines safely and medicines records were audited to ensure they were of an acceptable standard.

Care plans and risk assessments had been re-written and improved so that risks to people were safely managed and they were protected from harm. Care plans were personalised and included an explanation of what people wanted to achieve with the support of their care workers People told us they were involved in making decisions about their care and had access to their care plans.

The provider’s recruitment procedure, which helped to ensure the staff employed were safe to work with the people using the service, had been followed. An improvement was needed to the staff risk assessment procedure to ensure it was fit for purpose.

The provider’s complaints procedure had been followed and people who raised concerns had been listened to and told of the outcome of their complaints and what was being done to improve the service in response. Most people said they were satisfied with how staff responded to complaints.

Most people said they were happy with the staff who supported them and said they provided safe care. Staff knew how to protect people from harm. They were well-trained and had completed a range of courses designed to give them the skills and knowledge they needed for their work. Some improvements were needed in the way the Mental Capacity Act was implemented at the service.

The service promoted equality and diversity and management followed the provider’s policy on delivering a culturally appropriate service. The staff team was m

This inspection took place between 4 and 7 of March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk to staff and review records. Phone calls to people were completed on 4 March 2017 and we visited the premises on 4 and 5 March. We made phone calls to staff between 5 and 7 March 2017.

The service provides personal care and support to people who live in their homes in and around the Derby area. At the time of this inspection 61 people received support from the agency, 48 of whom received support with their personal care needs.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered persons could not demonstrate medicines were managed safely and administered as prescribed.

The registered persons could not demonstrate people received care that was safe and consistent as care plans and risk assessments were not always in place. Monitoring of people’s health was not always completed in line with the provider’s own guidance.

The registered persons could not demonstrate all the required pre-employment checks had been completed on staff employed at the service.

Staff received training, however staff did not always follow good practice guidance in relation to medicines and their knowledge of other areas relevant to peoples’ care was not always in place.

Not all staff understood local safeguarding procedures and potential safeguarding incidents had not always been recognised and referred to the local safeguarding authority.

Not all staff were confident the support they received from their managers had been effective at resolving concerns or improving services.

Most, but not all people and their family members thought staff were caring; some staff practice did not always support the care and welfare of people.

Care was provided in ways to respect people’s privacy and promote their dignity. People were involved and felt listened to when their care was discussed. People’s care was reviewed with them, however this did not always lead to their care plans and risk assessments being updated when their care needs changed.

Complaints were not well managed or always investigated appropriately. Concerns and complaints were not used to improve the service. Not everyone felt confident to raise concerns.

Systems and processes designed to assess, monitor, improve and reduce risks in the quality and safety of services were either not in place, or where they were in place they were not effective. Actions taken to improve services had not always resulted in improvements. Staff were not always confident support from their managers would lead to improvements. Not everyone felt the service was led with an open style of leadership.

Policies and procedures did not always ensure quality services for people.

The registered persons could not demonstrate accidents and incidents were always recorded as appropriate and that any subsequent investigation and actions to reduce future risks had been taken.

Other healthcare professionals had not always been informed of changes to people’s needs in a timely manner.

The provider had a policy in place on the Mental Capacity Act 2005. We found mixed evidence on whether people’s rights had always been upheld and their views respected.

There were sufficient staff deployed to meet people’s needs.

People received care with their nutrition and hydration needs. Staff provided care and support to help people with their meals and drink in a way that met their known preferences.

We found five breaches of the Health and Social Care Act 2008 (Reg