The inspection took place on 20 October 2016. This was an announced inspection. We gave the provider 48 hours’ notice of the inspection as this is a domiciliary care agency and we wanted to ensure the manager was available in the office to meet us. This service was last inspected on 18 February 2014. At this inspection, we found the provider to be compliant.

Golders Green Nursing is a domiciliary care service run by Mrs Claudia Alexander. The service was provides personal care and nursing care to over 25 people with dementia and older people in their own homes. At the time of inspection 30 people were receiving services.

The service had a registered manager 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 using the service and their relatives were very happy with the service and found staff caring, kind and professional. The feedback from community professionals was very positive and demonstrated that the service worked in collaboration with various healthcare professionals in delivering a person-centred service that met people’s individual health and care needs. People’s nutrition and hydration needs were met including their cultural specific dietary requirements. People were happy with staff’s punctuality and found them reliable and trustworthy. They were assisted and supported with medicines and encouraged to self-medicate were appropriate. There were detailed daily care delivery records giving a clear account of how people were supported. However, the service did not maintain separate medicines prompting and administration records.

Staff were skilled, experienced and well-trained and able to demonstrate their understanding of the needs and preferences of the people they cared for by giving examples of how they supported people. They told us the registered manager provided on-going support and received regular supervision. The registered manager was in the process of reviewing and introducing a new staff appraisal system. The service followed safe recruitment practices, carried out appropriate recruitment checks before staff worked with people. The service was in the process of renewing staff’s Disclosure Barring Service criminal record checks.

Care plans were person-centred and recorded people’s individual needs, likes and dislikes. They included personalised guidance on how staff were to meet people’s needs and preferences. Risk assessments were detailed and provided sufficient information and instructions to staff on the safe management of identified risks.

The service followed appropriate safeguarding procedures and staff demonstrated a good understanding of protecting people against abuse and their role in promptly reporting poor care and abuse.

The service implemented good procedures around Mental Capacity Act 2005 and worked with professionals where necessary in supporting people that lacked capacity to make decisions.

The service had good systems and processes to assess, monitor and improve the quality and safety of the care delivery. The registered manager regularly visited people’s homes to seek their feedback and observe staff supporting people with their care needs, and addressed any concerns raised immediately. The service was in the process of reviewing annual feedback survey forms. People and their relatives told us they were extremely happy with the registered manager and found them approachable and compassionate.

We have made a recommendation about a review of medicines administration record sheet.

The provider and staff spoke about people who used their agency in a respectful and professional manner. We spoke with relatives who told us people were treated with dignity and respect by staff. One relative told us the staff, "Always deliver a caring and knowledgeable service." A person who used the service said, "They are great, caring, very competent and responsive."

We found people's care and support needs were assessed by the provider who is a trained nurse. One person said, "The staff are very experienced and use their initiative, I do not need to keep telling them what to do." A relative told us, "I am involved in care planning and all aspects of care."

We saw evidence that staff had been trained in safeguarding vulnerable people. We spoke to two nurses and one care worker who told us they had completed safeguarding training. They were able to discuss the different forms of abuse with us.

We found there were sufficient numbers of staff with the right competencies, training and knowledge to provide safe, effective care. We noted there were systems in place to be able to respond to changing circumstances within the service.

We saw evidence that the provider regularly monitored the quality of the service provided. This involved audits of staff training, nurse registrations and the quality of support and care provided to people. We noted that risk assessments and support plans were updated and reviewed regularly.

We spoke with two relatives of people who use the service, along with considering the results of the agency’s last quality survey of people. Everybody was happy that people’s care needs were met by the agency. “The standard of care is first class,” one relative told us. “She is being given the best possible level of care,” another relative said. Everyone said that they would recommend this agency to others. The provider told us it was only through recommendations like this, and from healthcare professionals, that new people came to use the service.

Everybody told us staff treated them with respect, and listened to and acted on their views and preferences. They praised the quality of staff provided by the agency. “There is a mixture of nurses and carers and I have faith in all of them,” commented a relative.

Staff were appropriately supported and trained to deliver care to people. This included through the provider’s regular visits to staff and people who use the service. “The main strength of the agency is that it provides a personal and single point of contact with the provider who is very hands-on and available on a mobile at all times,” a relative told us. Feedback from staff confirmed that they felt well supported.

The agency’s last survey of people who use the service and their relatives, during 2012, found high levels of satisfaction amongst people. Where any dissatisfaction was expressed, the provider took action to address matters.