The inspection took place on 21 January 2019 and was announced.

Consultus Care And Nursing Ltd domiciliary care agency providing live-in care to people. It is registered to provide nursing care and personal care to people in their own homes. The agency is registered to provide a service to older adults, people living with dementia, mental health, physical disabilities, sensory impairments and care at the end of their life. At the time of this inspection, 17 people received live-in nursing or personal care country-wide in England and Wales.

At our last inspection on 07 and 09 June 2016 we rated the service good. At this inspection on 21 January 2019 we found the evidence continued to support the rating of good overall. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post, who started in September 2018. 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.’

Medicines were managed safely. Action was taken to address any shortfalls that were identified. Nurse and care staff had been trained to administer people’s medicines.

People and their relatives felt safe with the nurses and care staff. Staff received training about safeguarding and understood their responsibilities to protect people from harm and abuse. Staff followed the provider’s policy and procedure; staff also accessed the local authorities protocol.

Potential risks to people, staff and others had been assessed and mitigated. People were protected from the prevention and control of infection.

There were enough staff with the right skills and knowledge to meet people’s needs. Nurses and care staff were recruited safely. Staff felt supported in their role by the management team.

People's needs were assessed prior to receiving live-in support from the agency. Care plans contained specific guidance for staff to follow regarding how to meet people's needs. People were supported to remain as healthy as possible with support from health care professionals. Staff supported people to maintain their nutrition and hydration.

People were involved in their care and staff sought people’s consent prior to any care tasks. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff knew people well and were aware of their likes, dislikes and personal histories. People were treated with dignity; respect and their privacy was maintained. Staff were kind, caring and promoted people's independence.

Care plans were person-centred and responsive to people’s needs. Some people that received care at the end of their lives were supported to have a pain-free death. People were supported to maintain contact with people that mattered to them.

People's views were sought and acted on to improve the agency. Systems were in place to enable people to make a complaint.

Systems were in place to monitor the quality of the service people received. Lessons were learnt and action was taken when any shortfalls were identified.

Further information is in the detailed findings below

This inspection was carried out on 07 and 09 June 2016 by one inspector. It was an announced inspection.

Consultus Care And Nursing Ltd is registered to provide nursing care to people in their own homes. We inspect the part of the service that provides live-in nursing care to people, and not the part of the service that recruits self-employed care workers as this part is not registered with, nor is regulated by the Care Quality Commission. At the time of this inspection, 15 people received live-in nursing care country-wide in England and Wales.

There was a newly registered manager who had been in post for five months. 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 were trained in how to protect people from abuse and harm. They were aware of the procedures to follow in case of abuse or suspicion of abuse, whistle blowing and bullying.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs and ensured continuity of one to one support. Thorough recruitment practice was followed to ensure staff were suitable for their role.

Records relevant to the administration of medicines or the supervision of medicines were monitored. This ensured they were accurately kept and medicines were administered to people and taken by people safely according to their individual needs.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before nursing care was provided. This ensured that the nurses could provide care in a way that met people’s particular needs and wishes.

Staff had received all training relevant to their registered nurses qualification, and had the opportunity to receive further training specific to the needs of the people they supported. They received regular one to one support from a team of consultant nurses, to ensure they were supported while they carried out their role. They received an annual appraisal of their performance.

All nursing staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation. People’s mental capacity was assessed and meetings were held in their best interest when appropriate.

Staff sought and obtained people’s consent before they provided support. When people declined or changed their mind, their wishes were respected.

Staff supported people when they planned their individual menus and ensured people made informed choices that promoted their health. They knew about people’s dietary preferences and restrictions.

Staff used inclusive methods of communication. Relatives told us that nurses communicated effectively with people, responded to their needs promptly and treated them with kindness and respect. Relatives told us that people were satisfied with how their nursing care was provided. Clear information about the service, the management, and how to complain was provided to people. Information was available in a format that met people’s needs.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of nursing care, likes and dislikes and reflected how people wanted their nursing care to be delivered.

Staff promoted people’s independence, e

We spoke with six family carers or other advocates for people receiving a service. They all told us information provided by the service helped people decide the service was appropriate to their needs. They said nurses established people’s consent to receive care, on an on-going basis.

Nurses constructed a care and nursing plan as a priority when a person began to receive a service. People we spoke with said users and their representatives were very involved in care planning. All the records we saw had evidence of review with people’s signed agreement, within the previous six months. Plans gave clear guidance on people’s preferences for how they were nursed and supported, and how to promote independence. They also contained details of people’s social and cultural needs and preferences and promoted a ‘whole person’ approach to care.

Records showed all aspects of a person’s plan were routinely monitored, and action was taken to address any identified needs and changes. A person’s relative told us “(my relative) used to have constant infections before using this service. They’ve had none since, because of the monitoring and the nurses’ attention to infection control.” Plans included guidance to nurses on responses to life threatening emergencies, tailored to individual placements. They had on-call access to nurse consultants at all times.

We spoke to the registered manager. We did not speak to people who used the service on this occasion. All of the people spoken with on our previous inspection of 5 October 2012 were entirely satisfied with their care and support.

Robust recruitment procedures were in place to protect people who used the service.

People spoke very positively about the staff and felt that they fully supported their care and support needs. People said that staff were calm and relaxed, spoke with them in a respectful way and respected their privacy. One said: “When they are about it is all very relaxed and very calm”.

People told us that their care and support was personalised to their needs. People said their preferred names were always used.

People were aware of their care needs assessment and care plan. They confirmed that they and sometimes their family had been involved in discussions about their care and support. One said: “We are involved 100%” and another said, “Completely involved”.

People felt that the service had recruited a high calibre of staff and that staff had the right skills and experience to meet their needs.

People told us that they felt safe when staff lived in their homes. One said: “Yes definitely I do indeed”. People confirmed they had been asked to give feedback on the service provided. One said “We are delighted, faultless from the time I rang and the quality of care cannot be faulted”.