We carried out an announced inspection of the service on 14 and 15 May 2018. This was the provider’s first inspection from the date of registration in 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham City. It provides a service to older adults and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (Nottingham City) receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of our inspection, 325 people were receiving personal care as part of their care package.

There was a registered manager at the service. 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.

Risks associated with people’s needs had not been consistently assessed and planned for. Some risk assessments used to instruct staff of action required to manage risks, were insufficiently detailed or not completed.

Shortfalls were identified in the management of medicines; best practice guidance was not always followed.

Accidents and incidents were recorded but there was an inconsistency in how one incident had been responded to. Incidents were reviewed to consider if there were any lessons that could be learnt.

There were sufficient staff to meet people’s needs. New staff were constantly being recruited due to the size of the service. Staff’s availability to pick up new care packages was considered. Safe staff recruitment checks were in place and followed.

Staff had received training in infection control and food hygiene. Staff followed best practice guidance in the management of risks associated with infection and cross contamination.

Staff received an induction and ongoing training, but shortfalls were identified in the ongoing support provided to staff.

People’s nutritional needs had been assessed, but these needs were not always sufficiently supported and effectively managed.

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. However, staff had limited knowledge of how to respond if people no longer had capacity to make some specific decisions. Some mental capacity assessments and best interest decisions had been made, but these had not always been consistently completed.

People’s healthcare needs were monitored and action was taken when changes occurred such as informing the person’s relatives and representatives or health and social care professionals.

Staff treated people with respect and kindness, they were caring and compassionate in their care and approach. Independence was promoted and privacy and dignity respected. People had access to information about independent advocacy services.

There were plans in place, which detailed people’s care and support needs but these lacked detail in places and had not always been updated when required.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

People received opportunities to share their feedback about the service. The provider and registered manager had met their registration regulatory requirements.

The provider had systems and processes in place to regularly review the quality and safety but these had not always been effectively managed. The provider’s internal auditor found shortfalls in