This inspection took place on 26 and 27June 2017 and was announced. We announced the inspection because the service provides care to people in their own homes and we wanted to be sure there would be someone at the office to speak with us. This was the first time we had inspected this service at this address, although it had previously operated from a different address in Northumberland. The service was registered at this address with CQC in August 2016. Following the inspection we spoke to a range of individuals during the week commencing 3 July 2017.

G&P Healthcare Ltd provides nurse-led care in people’s own homes. Nurses carry out visits to plan people’s care and to regularly monitor people’s needs and the care provided. Delivery of care is provided by trained care workers. At the time of our inspection the service was supporting 14 packages of care, delivering support to 15 individuals. Nine of the individuals being supported were children or young people.

The service had a registered manager who had been registered since July 2016. 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. The registered manager was also the nominated individual for the service provider.

The provider had in place a safeguarding policy and staff had received training in relation to the safeguarding of vulnerable adults and children. Staff said they would report any concerns to the manager or senior staff. There had been two recent safeguarding incidents in the service which had been dealt with appropriately and reported to the appropriate authorities. Risk assessments were in place linked to care delivery in each person’s home. Regular checks were maintained to ensure the risk assessments were up to date.

Staffing was delivered through the development of teams around individual care packages. People told us that in the main they were support by the same group of care staff. Staff told us there were sufficient staff to deliver individualised care. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience. Medicines were managed and handled safely. There were plans in place for the use of ‘as required’ medicines and the use of covert medicines, where necessary. Specialist instructions were available if medicines were administered through PEG feed systems.

People were supported to access adequate levels of food and drink. Where specialist feeding systems were in use staff had received training of how to do this safely and appropriately. Staff had their competency monitored in the use of these feeding methods.

Structures were in place to ensure staff had regular training and updating of skills and staff confirmed this was the case. Records indicated the majority of staff had completed all mandatory training. Staff told us, and records confirmed there were regular supervision sessions for all staff members and each staff member had an annual appraisal.

The registered manager had a good understanding of the Mental Capacity Act 2005. No one being supported by the service had any restrictions on their freedom granted by the Court of Protection. Where people did not have capacity to make decisions best interests decisions had been taken and documented. It was not always possible to be sure family members had been fully involved in these decisions. We have made a recommendation about this.

We observed good and relaxed relationships between people and staff. Staff understood about people’s individual needs and personalities. People were supported to access health care professionals and services to help maintain their wellbeing. Specialist advice was sought and acted upon, where necessary. Staff un