We inspected this service announced on 9 October 2018.

Complete Nursing Services Ltd is a domiciliary care service providing personal care to adults including those living with dementia and physical disabilities. At the time of this inspection there were 13 people using the service who were receiving personal care. The service’s offices are in Alvaston, Derby.

The service was previously inspected on 21 September 2017 where it was rated as ‘Requires Improvement’. There were no breaches but some areas were in need of improvement. These improvements have now been made which support our new rating of ‘Good’.

The service had a registered manager. This 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.

People and relatives told us the service was safe and the staff trustworthy and reliable. Care workers knew the people they supported well and understood where they might be at risk and what do to if they had concerns about their safety. The service was never short of care workers and people always got the support they needed.

People and relatives made many positive comments about the caring nature of the managers and care workers. The staff team was stable and established which meant people had regular care workers they could get to know well. People were involved in making decisions about their own care and support and contributed to or wrote their own care plans. They were treated with dignity and respect and their privacy maintained.

Care workers assisted some people with their medicines. People and relatives said there had been no issues with this and they were satisfied people’s medicines were managed safely. Care workers protected people from infection by wearing protective clothing, including disposable aprons and gloves, and keeping the home environment clean for them.

People and relatives said care workers had the skills and experience they needed to provide effective care and support. Care workers said they were satisfied with the range of training opportunities available to them. Records showed care workers completed a range of general and specific training courses to ensure they could meet people’s needs.

Care workers supported some people with their meals and information about people’s diets and how their food was to be prepared was in their care plans. Care workers supported people to access healthcare services where necessary and people and relatives said they knew what to do and who to contact if a person was ill. Improvements have been made to the way in which people and their families, where applicable, consented to the care and support provided in line with the principle of the Mental Capacity Act 2005.

People and relatives told us the service provided high-quality care. The positive culture of the service and its focus on people having a say in their own care and support was evident. The managers were knowledgeable about all the people using the service and their care and support needs. They told us they wanted the service to remain small as this did not want to lose this close contact with people, relatives, and care workers.

The managers carried out a series of audits and checks to ensure the service was running effectively. People told us the managers kept in regular contact with them to ensure they were engaged and involved with the service. Care workers said the managers were supportive and caring. Managers and care workers continuously learnt, improved and innovated to ensure the sustainability of the service.

This inspection took place on 21 September 2017 and was announced. The provider was given 48 hours' notice because the location provides domiciliary care and we needed to be sure that someone would be at the office.

At our previous inspection during October 2013 the provider was not meeting all the regulations we checked. We found that appropriate systems were not in place to gain and review consent from people, in regards to their care and treatment. At this inspection we found that some further improvements were still required in this area. We also found that the provider needed to make improvements under safe and well-led.

This was the first inspection since the provider’s registration of this office location on 18 August 2015. Complete Nursing Services Ltd is a domiciliary care agency providing personal care. This included people living with dementia, older people and people with a physical disability. At the time of this inspection there were 16 people who received personal care. The agency office is located in the Alvaston area of Derby.

There was a registered manager in post; they were also the service provider. A registered manager is a person who has registered with the Care Quality Commission. 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.

We found that the provider's systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements. Recruitment procedures were not thorough to ensure suitable staff were employed to work with people who used the service.

People who used the service were positive about the support they received and praised the quality of the staff and management. People told us they felt safe with the staff who supported them.

Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

Risk assessments and care plans had been developed where possible with the involvement of people and their representatives. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. People received their medicines as prescribed. However medicines management systems were not always effective.

The Mental Capacity Act (MCA) 2005 (MCA) helps to ensure that people are supported to make their own decisions wherever possible. Where people were identified as not having capacity there were no records of best interest decision making to show the care and support provided was in the person’s best interests.

Staff understood the needs of the people they were supporting. People were treated with dignity and respect by staff. The delivery of care was tailored to meet people’s individual needs and preferences. People were supported to maintain a diet that met their dietary needs. People were supported to access healthcare services as required.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People told us they felt if they raised any concerns these would be addressed by the registered manager.

People found the staff and management approachable. Staff felt supported by the management team. The provider had systems in place to get feedback on the quality of

Care they provided.