Nestor Primecare Services Limited

Further Education and Skills inspection report Date published: 4 September 2014 Inspection Number: 434046 URN: 58929 Nestor Primecare

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Summary of key findings for learners

 Too many apprentices do not complete their advanced level qualifications.  There is too much variation in the achievement of qualifications between different groups of apprentices.  Assessors are not yet confident or sufficiently well trained to develop apprentices’ English and mathematics skills.  More able apprentices are not challenged enough to extend their knowledge and skills.  Managers do not use data well enough to identify and act on areas where performance is not good.  The system of observing assessors does not provide a clear judgement on the quality of teaching and learning.  Apprentices’ understanding of how to apply their learning to the care of clients from diverse cultural backgrounds is underdeveloped.

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Summary of key findings for learners

 Apprentices develop good domiciliary care skills that help them to perform more confidently at work.  Assessors provide flexible levels of support and guidance to the majority of apprentices to enable them to successfully combine achieving qualifications with their demanding shift patterns.  Apprentices are very positive about their learning and are keen to progress to higher level qualifications.  Directors and senior managers have developed an ambitious strategy to transform the quality of teaching and learning for all company staff, and have made a good start on implementing their plans. Inspection dates 28 July–1 August 2014

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This inspection: Requires improvement-3

Previous inspection: Satisfactory-3 Outcomes for learners Requires improvement-3 Quality of teaching, learning and assessment Requires improvement-3 Effectiveness of leadership and management Requires improvement-3

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What does the provider need to do to improve further?

 Increase assessors’ confidence and expertise in developing apprentices’ English and mathematics skills and make sure that written feedback to apprentices includes the correction of spelling, punctuation and grammar.  Continue with the programme of engaging branch managers in working with assessors to support apprentices to complete their qualifications, and provide the branches with the performance management data to take action to close the achievement gaps between different groups of apprentices.  Increase the number of apprentices completing their advanced qualifications by being explicit with learners about the requirements and demands of the qualifications, and adapting work schedules to enable those taking the qualifications to complete them on time.  Encourage assessors to use the findings of initial assessment to plan programmes that give more able apprentices the chance to extend their skills and knowledge beyond their

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What does the provider need to do to improve further?

apprenticeship frameworks through extra training in specialist subjects and by offering additional units.  Extend the range of paper-based and electronic learning materials so apprentices can become more independent in researching materials for their assessments.  Improve the observation of teaching, learning and assessment by placing greater emphasis in the reports on the impact of teaching on apprentices’ learning, and ensuring that both the grade and the actions for development are clearer.  Improve the analysis and use of data by managers to identify areas of both underperformance and good practice by making sure that managers at all levels of the company have regular access to and understand how to interpret qualification success rate data.  Increase apprentices’ understanding of the potentially diverse cultural backgrounds of their clients and how they might need to adapt their practices accordingly through the development

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What does the provider need to do to improve further?

of a range of case studies and scenarios that can be used by assessors at reviews and in teaching sessions.

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Inspection judgements

Outcomes for learners Requires improvement  Outcomes for learners require improvement. The proportion of apprentices who achieve their qualifications is just below the national level, with completion within timescales at just above the national level. Success rates and the timely completion of qualifications have improved over the past two years, but the pace of improvement is too slow.  There is too much variation in the achievement of qualifications at different levels. Learners on advanced apprenticeships, a fifth of the total number, fail to complete their qualifications because they leave the employer. This is partly due to the inheritance of poor quality provision from one of the two employers before they merged, and partly due to the turnover of staff within the care sector, but it remains an area for improvement.  Since the last inspection, the company has increased its levels of specialist support in the

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Inspection judgements

development of English and mathematics skills. Learners are more confident in using these skills at work, such as when they calculate dosages or interpret medical instructions, a key requirement for domiciliary carers. However, too many apprentices do not achieve their functional skills mathematics qualifications.  Some groups of apprentices do better than others in completing their qualifications. Ethnic minority apprentices do less well than their White British counterparts. There are some significant variations in achievement between apprentices in different regions. Managers have identified these gaps, and actions are being taken that are beginning to have an impact. Male apprentices, for example, who have lagged significantly behind females for the past three years, are now performing better according to in-year data. However, males are still under represented on the apprenticeship programme compared to their overall proportion among carers in the

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Inspection judgements

company.  Apprentices develop skills that help them to perform their roles at work better. They acquire specific practical knowledge about moving and handling, infection control, and emergency first aid, which they apply to improve the care of their clients. The confidence of apprentices grows, helping them to operate more effectively in often challenging contexts, supporting vulnerable people and their families.  Branch managers comment on apprentices’ improved professional practice, confidence to work as a team, and the ability to communicate more effectively. Apprentices are increasingly able to reflect on their own practice when caring for a service user in their own home. Some apprentices are extending their knowledge and skills by completing additional training, such as specialist feeding techniques and palliative care.  Those apprentices who complete their qualifications progress well. Many carers who enter the

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Inspection judgements

apprenticeship programme have few or no qualifications. For many of them this will be their first formal learning since leaving school. Of those that succeed, a large number are retained by the company two years after they finish the qualification. The collection and analysis of more detailed progression data, tracking the link between qualifications and promotion, for example, need to be developed further.

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Inspection judgements

The quality of teaching, learning and assessment Requires improvement  Teaching, learning and assessment require improvement and reflect the variable outcomes for apprentices. The majority of apprentices enjoy their training, make expected progress and are on track to complete their qualifications on time.  Apprentices benefit from suitably qualified and occupationally competent assessors. Assessors use their knowledge and experience effectively to support and motivate apprentices and ensure that they develop a good range of practical skills essential for sustained employment in domiciliary care. The majority of apprentices are keen to continue training on to the next level.  Initial assessment is accurate in identifying apprentices’ literacy and numeracy starting points. However, the results are not used effectively to personalise learning sufficiently. For example, apprentices with prior experience in the sector who have the ability to make quicker progress, or

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Inspection judgements

study in more depth, are not always challenged to do so.  Training generally provides effective practical demonstrations and exercises, such as dressing wounds and how to make an emergency service call. Apprentices benefit from prompt feedback on their marked work and this helps them improve their care practice. Assessors are positive in their verbal feedback but do not always provide sufficient detail to enable apprentices to extend their work further. There is insufficient stretch and challenge for the more-able apprentices.  A broad range of assessment methods is used, such as witness testimonies, work product and assessor observations, to ensure apprentices are able to demonstrate the required knowledge and competence. However, there are insufficient paper-based and electronic learning resources for apprentices to independently research material for their assessments. Technology is used, but there are missed opportunities for assessors and apprentices to record evidence

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Inspection judgements

electronically.  Assessors provide good levels of support and guidance and maintain regular contact with apprentices. Branch managers, assessors and supervisors provide effective support for apprentices who fall behind to catch up quickly with their training. Apprentices value the responsive support and flexible approach of assessors. Sessions to meet the needs of apprentices and the care setting include weekend, late and early morning visits.  There is insufficient development of apprentices’ English and mathematics skills. Whilst assessors are keen to support apprentices to improve their skills, they are not all yet trained sufficiently to do this effectively. Apprentices are able to apply mathematical skills required for the safe administration of service users’ medicine. However, assessors do not routinely correct spelling, punctuation and grammar mistakes in apprentices’ written work.  Initial advice and guidance ensure that most apprentices taking intermediate qualifications have

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Inspection judgements

a suitable understanding of the expectations and requirements of the qualification. However, apprentices progressing to the advanced level are less well prepared for the demands of the qualification, contributing to the low levels of completion. Some assessors are not clear about what additional support they can provide apprentices, for example those with dyslexia.  The promotion of equality and diversity in teaching, learning and assessment is not yet developed sufficiently. Apprentices demonstrate the importance of recognising and respecting individual preferences and promoting choice in personal care. However, assessors do not routinely plan and develop a deeper understanding of cultural differences through reviews or taught sessions.

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Inspection judgements

The effectiveness of leadership and management Requires improvement  The merger of Nestor Primcecare Services (Nestor) and Allied Healthcare has seen a steady amalgamation of practices, with more rapid change in the last year. Careful and detailed research identified key issues contributing to high staff turnover and weaker management and delivery of care in some areas. Directors have started implementing significant and ambitious projects to create a single vision and unified culture to deliver more consistent approaches across the business. A detailed people strategy provides a clear framework for change, with substantial investment planned for staff training at all levels.  Directors, operational management and learning and development staff have high expectations about how training is starting to improve the business and reduce staff turnover. Staff are enthusiastic about the training provided and those who complete an apprenticeship programme

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Inspection judgements

are far more likely to stay in the business than those who do not achieve a qualification. Plans are in place to develop more coherent career pathways for those who complete training and achieve qualifications, but it is still too early to measure their impact.  Learning and development managers monitor the qualification success rates for the apprenticeships and workplace learning programmes, but do not use the data to set targets for managers and assessors. Managers do not routinely share qualification success rate data with directors or business managers to explore the performance of different branches. The data are not analysed in sufficient detail to help identify areas of good performance for sharing and areas for improvement.  Managers and assessors make good use of regular management information about apprentices’ current progress compared to expected progress. Delivery managers effectively manage

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Inspection judgements

assessors’ performance through monthly individual meetings. Assessors access a good range of personal and professional development opportunities.  Observations of teaching, learning and assessments require improvement. Nestor is moving from a paper-based to an on-line system. It is not currently possible to gain a complete overview of assessors observed on different activities or identify where there is better practice to share. Observations focus too much on the performance of the trainer or assessor rather than the impact they have on the learner. The methodology used to calculate grades does not provide a clear judgement on the effectiveness of the session observed.  The self-assessment report provides a reasonable overview of the provision and recognises many of the strengths and areas for improvement identified by inspectors. However, it does not provide enough information about the variations across the regions. A couple of improvements

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Inspection judgements

cited as strengths, such as the roll-out of training on the company’s core values and behaviours, are too recent to have had a positive impact on all learners. A number of areas for improvement noted at the last inspection are still requiring improvement and are not included in the current self-assessment report. Not all assessors and branch managers are aware of the findings of the self-assessment and the actions for improvement.  The learning and development team constantly evaluates and improves the training programmes to ensure they meet the needs of the business. A careful redesign of the four-day induction programme provides all new staff with the core knowledge needed, along with an overall appreciation of the job, before starting work in a branch. In the last three months, new staff are benefiting from a more structured coaching period to prepare them for their roles. New training courses, on topics such as care for people with dementia, meet the needs of

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Inspection judgements

apprentices and the business well.  All staff are strongly aware of the need to provide customers with dignity, privacy and respect in their role as carers. However, the promotion of equality and diversity is not consistent in training sessions. During review sessions, assessors tend to ask closed questions rather than exploring typical scenarios with apprentices to extend their knowledge and understanding. A few staff use language and behaviours in the branch offices and on assessment that do not provide good role models for apprentices.  Nestor meets its statutory requirements for the safeguarding of learners. Clinical governance directors and managers provide a very strong focus on safeguarding apprentices, employees and customers. Robust policies and procedures provide good guidance and support to apprentices on lone working and risk assessments. However, the policy on e-safety is not sufficiently detailed. Nestor has seen a positive increase in reporting through the whistle blowing

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Inspection judgements

process since it was moved from Human Resources to Clinical Governance. Nestor takes swift and appropriate action to address concerns reported.

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Nestor Primecare

Inspection grades are based on a provider’s performance:

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Nestor Primecare

1: Outstanding 2: Good 3: Requires improvement 4: Inadequate Overall 14-16 part-time provision 14-16 full-time provision 16-19 study programmes Traineeships 19+ learning programmes Apprenticeships Employability Community learning

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Nestor Primecare

The quality of teaching, learning and assessment 3 - - - - - 3 - -

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Nestor Primecare

The effectiveness of leadership and management 3 - - - - - 3 - -

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full contract year

Principal/CEO Mr D Gibson Date of previous inspection March 2012 Website address www.alliedhealthcare.com

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programme level

Level 1 or below Level 2 Level 3 Level 4 and above

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Apprenticeship level and age

Intermediate Advanced Higher 16-18 19+ 16-18 19+ 16-18 19+ 7 546 - 126 - - Number of traineeships 16-19 19+ Total - - -

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Number of learners aged 14-16

Full-time N/A Part-time N/A Number of community learners N/A Number of employability learners N/A Funding received from Skills Funding Agency (SFA)

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Contextual information

Nestor Primecare Services Limited is the legal entity for the brand of Allied Healthcare. Allied Healthcare is one of the country’s largest healthcare staffing providers with over 140 branches nationwide. The company holds contracts with over two thirds of commissioning local authorities and works with more than 100 primary care trusts. Allied Healthcare has 20,000 home care staff, support staff and registered nurses, and is a major provider of domiciliary care. Until the beginning of 2013−2014 Nestor Primecare and Allied Healthcare had separate contracts with the Skills Funding Agency to deliver apprenticeships to both 16- to 18-year-olds and 19+ adults. There is now one single contract under the Nestor Primecare Services Limited brand name.

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Information about this inspection

Lead inspector Charles Searle HMI Two of Her Majesty’s Inspectors (HMI) and five additional inspectors, assisted by the Head of Learning and Development as nominee, carried out the inspection with short notice. Inspectors took account of the provider’s most recent self-assessment report and development plans, and the previous inspection report. Inspectors also used data on learners’ achievements over the last three years to help them make judgements. Inspectors used group and individual interviews, telephone calls and online questionnaires to gather the views of learners and employers; these views are reflected throughout the report. They observed learning sessions, assessments and progress reviews. The inspection took into account all relevant provision at the provider. Inspectors looked at the quality of teaching, learning and assessment across all of the provision and graded the sector subject areas listed in the report above.

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Grade Judgement

Detailed grade characteristics can be viewed in the Handbook for the inspection of further education and skills 2012, Part 2:

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Grade Judgement

http://www.ofsted.gov.uk/resources/handbook-for-inspection-of-further-education-and-skills- september-2012

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Grade Judgement

guidance ‘Raising concerns and making complaints about Ofsted’, which is available from Ofsted’s website: www.ofsted.gov.uk If you would like Ofsted to send you a copy of the guidance, please telephone 0300 123 4234 , or email enquiries@ofsted.gov.uk .

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Grade Judgement

Learner View is a website where learners can tell Ofsted what they think about their college or provider. They can also see what other learners think about them too.

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Grade Judgement

To find out more go to www.learnerview.ofsted.gov.uk

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Grade Judgement

Employer View is a new website where employers can tell Ofsted what they think about their employees’ college or provider. They can also see what other employers think about them too.

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Grade Judgement

To find out more go to www.employerview.ofsted.gov.uk achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children's social care, and inspects the Children and Family Court Advisory Support Service (Cafcass), schools, colleges, initial teacher training, work-based learning and skills training, community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for looked after children, safeguarding and child protection.

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Grade Judgement

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