This comprehensive inspection took place on 21 and 22 February 2018. This was the first inspection for this service. The inspection was announced and we gave two days’ notice of this inspection. This was because they provide care to people in the community and we wanted to be able to speak with people using the service and ensure the registered manager was available.

This service is a domiciliary care agency and provides care for people with complex medical needs in their own homes It provides a service to both adults and children. At the time of the inspection, there were three people being supported in their own homes by the agency.

There is a registered manager in post. 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 risks of abuse to people were reduced because there was an effective recruitment and selection process in place. Staff were able to demonstrate a good understanding of how to recognise and report abuse. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

People received a service that was based on their needs and wishes. A bespoke care team supported each person, which meant staff knew people very well. Care plans were personalised and contained detailed information about the support people needed. Staff were specifically trained according to the needs of the person. Staff competencies were assessed annually.

Clinical review meetings were held regularly to ensure the support was meeting people’s needs. The service was flexible and responded to people’s requests where possible. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.

Relatives spoke highly of the quality of care given by the nurses. They said they trusted the nurses to have the skills to keep them safe. People had positive relationships with their nurses and nobody expressed any concerns about any of the care provided.

People received their medicines on time and in a safe way.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

There had not been any accidents, incidents or complaints. Policies and procedures were in place which would ensure any accidents, incidents or complaints would be effectively dealt with in a timely way.

Environmental risk assessments were completed for every new person using the service. This included checks to ensure their home was safe with adequate access, heating and lighting.

There were effective audit and monitoring systems in place to check the people received good quality and safe care. Staff felt well supported and worked as a team to provide people’s care.