Rosie Nightingale Homecare

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.

The five questions we ask about services and what we found