Aberness Care Ltd (Agency) Nurse Agency 39 Dee Street Aberdeen AB11 6DY Telephone: 01224 593232 Type of inspection: Announced (short notice) Inspection completed on: 9 May 2018 Service provided by: Aberness Care Limited Service provider number: SP2012011913 Care service number: CS2012311049
About the service Aberness Care Ltd (Agency) is registered to supply or introduce registered nurses to older people and adults with dementia, illness, life limiting conditions, learning disabilities, physical disabilities and mental health problems. The company is based in Aberdeen city centre and provides both registered nurses and care workers to registered care services throughout Aberdeen and Aberdeenshire. These care services are known as 'clients'. The Care Inspectorate regulates the placement of registered nurses in services, not care workers, which means that this inspection focused on the placement of nurses. The aim of the service is "to provide a 24 hour service to help alleviate the shortage of health care personnel in care homes, community and hospitals". This service registered with the Care Inspectorate on 25 January 2013. What people told us Aberness clients at the time of this inspection were care homes. The service was not supplying nurses for individuals living at home. Therefore all of the feedback we received about the agency came from clients who were care home owners or managers. For this inspection we received views from two clients who used the services of Aberness. Comments from clients included: - "Professional service". - "Reliability covering shifts". - "Professional staff, wearing appropriate uniform". - "Qualified staff provided follow our policies and procedures". - "Any issues or concerns we raise are dealt with promptly and efficiently". - "Excellent working relationship with Aberness". - "Service and standard of staff provided has improved dramatically". - "I am always delighted with the quality of the staff that are provided". - "The nurses from this agency and I have to say they are a pleasure to have in the building". - "They are competent and helpful and work well on their own and as part of our team". - "When I phone the agency I am always greeted in a professional and friendly manner and they keep me updated as to the status of the search for staff regularly". Self assessment The service had not been asked to complete a self assessment in advance of the inspection. We looked at their own improvement plan and quality assurance paperwork. These demonstrated their priorities for development and how they were monitoring the quality of the provision within the service. page 2 of 9
From this inspection we graded this service as: Quality of Information Quality of care and support Quality of staffing Quality of management and leadership 4 - Good 5 - Very Good 4 - Good 5 - Very Good Quality of information Findings from the inspection We found that Aberness operate to a good standard in relation to the information they provided to clients. Good use was made of technology that allowed clients and staff to access information when they need it. Clients receive information that is right for them. Aberness's website, which was due to be updated, was a good source of information for both staff and clients. It included contact information. This meant that clients and staff could contact someone at Aberness 24 hours a day. It is important that clients views are sought. Regular review meetings, both formal and informal, between the agency and the clients take place. This system helped the manager match nurses with care homes, ensuring that people experienced care from nurses with the right knowledge and skills. Clients benefit from a culture of continuous improvement. The business contracts, for care home clients, included information about how to make a complaint to the agency and how to make a complaint to the Care Inspectorate. However, these contracts were not always signed. The management team should consider developing their contracts to highlight their expectations of the information required by the clients regarding the changing needs of their residents and is communicated to the agency in a timely manner. This will ensure the nurses supplied have the right knowledge and skills. The management team were implementing systems and process to ensure they were compliant with the General Data Protection Regulations (GDPR) coming into effect in May 2018. We received positive feedback from clients of the service about the information provided and the quality of communication. Clients told us they liked receiving, in advance, a profile of the nurses they had booked. Advanced information was useful because it included information about the nurse's professional registration, qualifications, vetting and experience. This level of information resulted in better forward planning because the client knew who to expect and how to best use the nurse's skills and experience. Requirements Number of requirements: 0 page 3 of 9
Recommendations Number of recommendations: 0 Grade: 4 - good Quality of care and support Findings from the inspection The quality of care and support was very good. Although we did not have feedback from people experiencing care, care home managers told us the agency nurses supplied by Aberness delivered very good quality care. Clients told us that branch staff at Aberness were approachable and friendly and worked hard to match their needs with the skills of the agency nurse. We received consistent positive feedback from clients about the quality of nurses booked. The agency provided good staff training opportunities in areas considered essential to providing a good standard of care. For examples: training about moving and handling people, health and safety and adult support and protection. The majority of practice concerns were about medication errors. When an error occurred the service was quick to address this and made good use of reflective practice and refresher training. The content of medication training had good detail and provided a good basis for further discussion with staff. It also signposted nurses to some useful sources of additional learning. Direct evaluation of nurses' practice also took place to make sure this was satisfactory, in line with reflective practice and the refresher training. The manager had systems in place to record visits and reviews with care home managers that identified strengths and improvements needed. This included consideration of the care and support offered by agency nurses to people in the care homes. The agency were continually building up their client base. We discussed the importance of hearing the views of people in the care home about the quality of care they experience from agency nurses. This would reflect the principles of the new Health and Social Care Standards that highlight the importance of involving people in evaluations of the quality of care. We suggest that the manager could meet with some residents the nurses had cared for, use short questionnaires to gather people's views or attend resident/carer meetings. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good page 4 of 9
Quality of staffing Findings from the inspection The quality of staffing was good. Nurses told us they felt well supported and had good access to training. There was annual appraisals and monitoring of training which meant that nurses had opportunities to discuss, reflect on and improve how they cared for people. Clients gave positive feedback about the nurses Aberness supplied. They told us that being supplied with the same staff was important to them and that the agency worked hard to provide this continuity. This meant that the agency supplied care services with nurses who were familiar with the care homes they worked in. It also meant that agency nurses were more likely to have a better understanding of the care needs of the people they were supporting. Staff we talked to said that training opportunities at the agency were good. The service was good at providing mandatory training for new staff, and annual updates which staff need to complete before being eligible for work. The provider had in-house trainers. This allowed the service easy access to a trainer who could provide staff training locally. We discussed the importance of ensuring nurses being supplied to care homes were practicing at an appropriate level with regard to dementia care, depending on the placement. This will help reassure people with dementia that nurses know how to care and support them well. The training that was organised should cover all areas addressed in the Promoting Excellence in dementia care resource available at http://www.sssc.uk.com/ workforce-development/supporting-your development/promoting-excellence-in-dementia-care. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 4 - good Quality of management and leadership Findings from the inspection Nurses had been recruited in a way that made sure they were safe to care for people. Recruitment practices were very good, documented clearly and logically and relevant checks were undertaken. The system held an audit trail of registration details of nurses, their revalidation date and annual payment to the Nursing Midwifery Council. When the agency places nurses in care homes the home also has a responsibility to ensure that nurses were properly recruited and have the right skills to care for people. Aberness should ensure its clients' contracts make this clear. Aberness should continue to remind care services of their responsibility to advise them of any special page 5 of 9
skills needed by the agency nurse. This will help to reassure people experiencing care that the nurse agency is placing nurses using the most up-to-date information from the care service. Feedback from care services about the agency manager and staff in the branch was positive. They had established good working relationships with care home providers and were in contact with them regularly. The manager had a detailed development plan which included clear objectives around performance management of registered nurses, relationships with care services and internal team development. This was an indication that the service had a good focus on the agency's current operations and future development. The manager also had a very good understanding of their reporting responsibilities to the Care Inspectorate around significant incidents or concerns. The provider had an appropriate complaints procedure. We read a sample of complaints. These were dealt with in a timely manner and investigated appropriately. Each complaint or any investigation into staff practice was always reviewed after a month to ensure the concern was resolved. The service continued to demonstrated that it sought feedback on strengths and areas for improvement. The provider had well established quality assurance systems including regular audits of the branch, their key functions and processes. This demonstrated that the service was very good at evaluating what it did well and what needed to improve. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service must ensure that accurate quality assurance records are maintained in all areas and are used to plan and improve the service, with a clear audit trail for assurance. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011-4 (1) (a) make proper provision for the health, welfare and safety of service users. page 6 of 9
Timescale: three months after receipt of this report. This requirement was made on 16 November 2017. Action taken on previous requirement The service demonstrated that it sought feedback on strengths and areas for improvement. The provider had well established quality assurance systems including regular audits of the branch, their key functions and processes. This demonstrated that the service was very good at evaluating what it did well and what needed to improve. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service should ensure it has comprehensive records of training, skills and specific experience of nurses and that staff have appropriate support and development. National Care Standards for Nurse Agencies - Standard 4: Management and Staffing Arrangements; 4.6 You know that the nurse agency keeps accurate records of the specific qualifications, skills and experience of individual nurses, and details of all the tasks they have done. 4.7 You are confident that the nurse agency keeps up-to-date records of the continuing professional development required by the NMC of each nurse. It has policies, procedures and systems in place to assess and monitor the nurses' performance. This recommendation was made on 16 November 2018. Action taken on previous recommendation We found that the training records and files were comprehensive. Appropriate staff supervision, monitoring of practice and annual appraisals were being undertaken. Poor practice was dealt with appropriately. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 7 of 9
Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 21 Nov 2017 Unannounced Information Not assessed Care and support 3 - Adequate Environment Not assessed Staffing Not assessed Management and leadership 3 - Adequate 28 Nov 2014 Unannounced Information 5 - Very good Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 5 - Very good 13 Nov 2013 Unannounced Information 4 - Good Care and support 4 - Good Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate page 8 of 9
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can 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. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 9 of 9