This inspection took place on 28 November 2016 and was announced.

Advantage Nursing Agency Limited provides personal and nursing care to people who live in their own homes. The service employs both registered nurses and care workers to provide support to people. At the time of our inspection the provider confirmed they were providing personal and nursing care to 3 people.

There was a registered manager in post. 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse. Staff told us they were confident that if they reported abuse, the correct actions would be taken by the service.

People had detailed risk assessments in place to enable staff to support them with all their healthcare needs, and be able to remain as independent as possible. Staff understood positive risk taking and promoted this with people..

Staffing levels were adequate to meet people's current needs. We saw that enough staff were being employed to cover people’s needs appropriately.

The staff recruitment procedures were robust and ensured that appropriate pre-employment checks were carried out. This meant that staff suitable to the role worked at the service.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were confident that the training they received enabled them to work safely with people.

People told us that their medicines were administered safely and on time. Staff were all trained in medication administration.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. Staff were happy that they were being regularly supervised and supported.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

Where possible, people were able to choose the food and drink they wanted and staff supported people with this. People were supported to access health appointments when necessary and receive input from a variety of health professionals as required.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff understood people’s likes, dislikes and preferences.

People were involved in their own care planning and were able to contribute to the way in which they were supported. When people could not be involved in their own care planning, family members were involved on their behalf.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed. The service regularly sought feedback from staff and the people using the service.

The service provided direct support to people in their own home and at the time of our inspection was providing a service to four people. The manager told us the provider’s policy was that they only provided care for people in their own homes when they had a minimum of six hours care needs per visit.

We telephoned one person using the service and one relative of a person using the service. One person told us the staff “were all very good”. Another person told us that "staff always checked with them regarding their care.”

We looked the risk assessments and care plans of three people using the service. We found that risk assessments and care plans were detailed and developed with the person and/or their relatives indicating their preferences and consent for how care was provided.

People were protected from abuse or the risk of abuse. We noted the provider liaised with other professionals and complied with the local authority safeguarding policies and procedures.

We found the provider had systems in place to quality assure its services and was able to identify and manage risks related to the health, safety and welfare of people using the service.

We looked at seven staff files and spoke with four staff. We found the provider had effective recruitment and selection procedures in place and evidenced staff were skilled and experienced to provide the care required.

We found that the agency’s main business was in the provision of nursing and support staff to other providers. The agency also provided direct care to people in their home, with the agency having six service users at the time of our inspection. The manager explained that the agency's direct care provision was focused on intensive packages of care for people with complex needs. The manager told us that the agency have a policy of only providing care for people in their own homes when they had a minimum of six hours care needs per visit.

We telephoned a person who used the service and a relative of a person receiving services. The people we spoke to said they were happy with their regular health care assistants and gave us positive feedback about them. They told us their regular care worker knew their needs well and how they liked things to be done. A person who used the service said about the care they received, "They are quite good and meet my requirements."

The people we spoke to said that they had never had any concerns about the treatment they received from care workers. A person who used the service told us, "They are very approachable."

We found that the agency considered people's individual needs and circumstances when providing care. The staff at the agency reported that they were well supported by the management team. We also found that the agency had policies and procedures in place that quality assured the services they provided to people.

People using the service or their representatives told us that they were happy with the care provided. They said that staff always carry out their agreed care. People said that they were consulted about their plan of care and that regular care plan reviews take place.

People told us that they were supported by regular staff who know their needs well. The staff were helpful, respectful and polite.