Care service inspection report

Care service inspection report Full inspection Newcross Healthcare Solutions Aberdeen Branch Nurse Agency Suite K Woodburn House 4/5 Golden Square Aberdeen Inspection completed on 16 May 2016

Service provided by: Newcross Healthcare Solutions Limited Service provider number: SP2005007230 Care service number: CS2012313215 Inspection Visit Type: Announced (Short Notice) Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 21

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of information 5 Quality of care and support 5 Quality of staffing 5 Quality of management and leadership 5 Very Good Very Good Very Good Very Good What the service does well We found that the service was very good at keeping people informed about what it sets out to provide. The people who used the service were very happy with the staff and with the service. What the service could do better The service was performing to a high standard. The manager and staff intended to continue to develop the service in line with client's requirements. What the service has done since the last inspection This was the service's first inspection since registering in April 2015. Conclusion Overall, this branch of Newcross provided a very good service to their clients. The manager and office staff team were keen to fully engage with the page 3 of 21

inspection process. The Registered Nurses employed were trained, motivated and worked closely with the office team to ensure they met the needs of the clients and the residents within the care home sector. page 4 of 21

1 About the service we inspected Inspection report Newcross Healthcare Solutions Aberdeen Branch is registered as a nurse agency. It provides both registered nurses and care workers to other care services, such as care homes and support services (known as clients). At the time of this inspection the service was not providing care to people in their own homes. The provider, Newcross Healthcare Solutions is a UK wide company, with a management structure across Scotland to support the individual managers of the registered services. The headquarters of Newcross Healthcare Solutions is based in Devon, England. The service's aims and objectives states: 'Newcross Healthcare Solutions strives to provide care and support of the highest standards. Exceeding the expectations of its clients and using the latest technology to provide a service with low administrative overheads and high professional standards.' This service registered with the Care Inspectorate on 28 April 2015. This was the services first inspection since becoming registered. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com Recommendations A recommendation is a statement that sets out actions that a care service provider should take to improve or develop the quality of the service, but where failure to do so would not directly result in enforcement. Recommendations are based on the National Care Standards, SSSC codes of practice and recognised good practice. These must also be outcomes-based and if the provider meets the recommendation this would improve outcomes for people receiving the service. Requirements page 5 of 21

A requirement is a statement which sets out what a care service must do to improve outcomes for people who use services and must be linked to a breach in the Public Services Reform (Scotland) Act 2010 (the "Act"), its regulations, or orders made under the Act, or a condition of registration. Requirements are enforceable in law. We make requirements where (a) there is evidence of poor outcomes for people using the service or (b) there is the potential for poor outcomes which would affect people's health, safety or welfare. Based on the findings of this inspection this service has been awarded the following grades: Quality of information - Grade 5 - Very Good Quality of care and support - Grade 5 - Very Good Quality of staffing - Grade 5 - Very Good Quality of management and leadership - Grade 5 - Very Good Inspection report This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.careinspectorate.com or by calling us on 0345 600 9527 or visiting one of our offices. page 6 of 21

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following a short notice announced inspection to Newcross Healthcare Solutions Aberdeen Branch's office in Aberdeen. The inspection was carried out by one Inspector. The inspection took place between 9.30am and 3pm on Monday 16 May 2016. Feedback was provided to the manager and the Head of Quality and Business Development in Scotland on the day of the inspection. As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We sent 30 care standards questionnaires to the manager to distribute to the staff. Three staff, returned completed questionnaires to us prior to the inspection. During this inspection we gathered evidence from various sources, including the following: We spoke with: - three clients (managers of care homes who use the service) - the manager - the Head of Quality and Business Development in Scotland. We looked at: - Information/service pack - Evaluation/feedback from clients and staff page 7 of 21

- Incident records and investigation records - Complaints records - Staffing records including: * Supervision Records * Training Records * Training Schedule * Recruitment - Quality Assurance systems - Electronic database. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firescotland.gov.uk page 8 of 21

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a fully completed self assessment document from the provider. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. Taking the views of people using the care service into account During this inspection there were no individuals receiving a care or support service directly from the Agency. However, the Agency supplied staff to other Regulated Services (for example residents in care homes). We did speak to three managers or deputies running care services, to seek their views on the quality of the service provided by Newcross. These are regarded as Newcross's clients and so we have included their views in this section. The care home managers spoke highly of the Agency regarding the supply of Registered Nurses. However. they indicated that the Agency sometimes had difficulty filling requests for carers or support staff. Taking carers' views into account We did not specifically seek family's views during this inspection. page 9 of 21

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 0: Quality of Information Grade awarded for this theme: 5 - Very Good Statement 2 We provide full information on the services offered to current and prospective service users. The information will help service users to decide whether our service can meet their individual needs. Service Strengths We found that the information provided to new or potential clients was detailed and informative. Clear information including what the Agency sets out to provide, the fees and contact details were shared and fully explained. The Agency actively sought feedback on their service and staff. Clients could provide feedback in a number of different ways. The management team used this information to improve and further develop their service. There were examples of client's wishes and views being incorporated into the type of service they received. We received very positive feedback from Care Home managers regarding the quality of the service and staff provided by the Agency, specifically in relation to Registered Nursing staff. Areas for improvement The manager and staff should continue to maintain and further develop the very good practice in place regarding the quality of information supplied to clients. page 10 of 21

Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Statement 4 We ensure that information held about service users is managed to ensure confidentiality and that the information is only shared with others if appropriate and with the informed consent of the service user. Service Strengths We found that the Agency managed confidential information very well. The systems and processes in place took into account good practice and legislative requirements. All staff were made fully aware of their accountability and responsibility regarding confidentially during their induction into the Agency. Areas for improvement The manager and staff should continue to maintain and further develop the very good practice in place regarding data protection and confidentiality. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 page 11 of 21

Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 3 We ensure our service provides care staff who are most suitable to meet individual service user needs. The care and treatment received by the individual service user, is supported by evidence based practice and up to date policies and procedures. These reflect current legislation (where appropriate Scottish legislation). Service Strengths The Agency's recruitment process focused on the skills, knowledge and experience of potential staff. Staff were allocated according to their suitability to meet the client's needs. Feedback from the services that use the Agency stated that they were happy with the suitability of the Registered Nurses supplied. The manager visited clients on a regular basis to ensure that the Agency continued to meet their needs in relation to their staffing requirements. The skills, knowledge and experience of staff were discussed. The clients' records were updated to reflect any changes in needs or requirements. For example one service specifically requested female staff, to accommodate a specific need within that service. Where concerns or issues were raised regarding poor practice this had been dealt with promptly with the support of the organisation's clinical team. Detailed good practice policies and procedures were in place. These were readily available to all staff and also clients through the agency's 'MyNewcross' electronic database. page 12 of 21

Areas for improvement The manager and staff should continue to maintain and further develop the very good practice in place which supports the good care and support. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 4 We are confident that within our service, all medication is managed during the service user's journey to maximise the benefits and minimise any risk. Medicines management is supported by legislation relating to medicine (where appropriate Scottish legislation) and current best practice. Service Strengths We had no concerns regarding how medication was being managed or assessed. All Registered Nurses undertake a medication assessment as part of their training and development. Clear, concise and detailed medication polices were readily available to all staff. Systems were in place to record, monitor and investigate any medication errors identified. Clients were encouraged and supported to report on any concerns they may have in relation to practice including the management of medication by staff. Any concerns would be fully investigated with the support of the organisation's clinical team. page 13 of 21

Areas for improvement The manager and staff should continue to maintain and further develop the very good practice in relation to the safe administration of medication. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 5 - Very Good Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service Strengths The recruitment files we examined confirmed that the recruitment processes were in line with good practice. All staff undertake a comprehensive induction day, within the office in Aberdeen. This includes appropriate training and discussion on relevant policies and procedures. The skills, knowledge and experience of new staff were fully considered as part of the recruitment and induction process. Shadow experiences for less experienced staff were available if identified as a requirement during the induction process. Staff sign the 'Newcross Pledge' as part of their induction. One of the 10 pledges stated "I pledge to deliver quality and excellence in all that I do." This ensured that staff were fully aware of their responsibly to demonstrate the organisation's desired behaviours and culture when providing care and support. page 14 of 21

Areas for improvement Although informal feedback was sought from clients on new staff, the manager should consider the more formal 'feedback form' system. This form ensures that feedback is obtained from the staff working with the Agency member of staff and not just the manager of the service. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service Strengths Staff were supported to undertake mandatory training, in line with good practice and encouraged to undertake developmental training to ensure they reach their potential. The organisation had identified their 'Top 12' development courses. Staff commented that they have ample training opportunities. Detailed and comprehensive training and development policies were in place to support staff development. There was an acknowledgement that due to the nature of the Agency it is difficult for the manager to monitor and assess staff directly. The manager relied on feedback from clients. All staff received an annual appraisal and informal one to one supervision throughout the year, based on the feedback from clients. Staff stated they felt well supported. All incidents, concerns and complaints were fully investigated by the manager. Where these concerns related to clinical issues, the manager was supported by the clinical team. The senior management responded promptly and effectively to support the manager address an issues that had been outstanding. page 15 of 21

Areas for improvement Although development training was offered to staff, due to the size of the service, this training was often provided outside Aberdeen. This had resulted in some training needs, identified through staff appraisal, not being attended. We were informed that the organisation was recruiting for a new training manager. We hope the availability of training locally will be reviewed. The monitoring of staff following a concern or issue relating to their practice or conduct was unclear. The manager should maintain formal records regarding all one to one meetings, especially in relation to follow-up actions and expectations. The dementia training offered to staff, should be mapped to the Promoting Excellence Framework and the Dementia Standards. This will ensure all staff have the appropriate skills and knowledge to support people with dementia. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report page 16 of 21

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 5 - Very Good Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service Strengths We received positive feedback from staff about working for the Agency. Their comments included: - "I have training opportunities. I have access to courses in Dundee if needed and contact with the training coordinator." - "The service provider does provide support and I have always found the manager approachable and knowledgeable in her role." - "I feel I have access to support from my manager when and if I need it." - "I feel there is many opportunities to learn new skills that benefit the holistic needs of the client." - "Newcross are good to work for. They offer opportunities and I am happy in my job." - "Those who use the service appear to be happy." The manager stated that team meetings had been difficult to establish and 'coffee mornings' in the office had been more successful. These were a positive opportunity for staff to meet and discuss practice and developmental issues. Staff were informed of changes and developments within the service and page 17 of 21

organisation. Staff were encouraged to voice their views and raise ideas and suggestions on improving the service. Their ideas, suggestions and views gained through the engagement surveys, 'helpdesk', 'MyNewcross' and through discussion were reviewed by the management team and the actions implemented were appropriate. Areas for improvement The manager should consider formally recording the 'coffee morning' meetings and sharing this information with those staff unable to attend. Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 Inspection report Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service Strengths There were comprehensive quality assurance systems in place, which focused how well the Agency operated. We saw a number of these quality assurance processes being used to determine how the service was performing. The audits took into account current legislation and Good practice guidance. Examination of results from the quality assurance audits showed that appropriate action had been taken to address any identified areas for development. The new manager took up post in January 2016. Staff spoke highly of the new manager and clients stated that they had met with her during recent meetings. Areas for improvement The Newcross branch in Aberdeen was a small Agency with the intention to expand. However, we received feedback from some clients stating that the Agency had difficulty filling requests at times, especially when supplying carers or support staff. The manager had been actively recruiting for suitable staff. page 18 of 21

Grade 5 - Very Good Number of requirements - 0 Number of recommendations - 0 4 What the service has done to meet any requirements we made at our last inspection Previous requirements There are no outstanding requirements. 5 What the service has done to meet any recommendations we made at our last inspection Previous recommendations There are no outstanding recommendations. 6 Complaints No complaints have been upheld, or partially upheld, since the service was registered. 7 Enforcements We have taken no enforcement action against this care service. page 19 of 21

8 Additional Information There is no additional information. Inspection report 9 Inspection and grading history This service does not have any prior inspection history or grades. page 20 of 21

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 21 of 21