We carried out an announced inspection on 27 February 2018. At the time of the inspection three people were receiving care.

Centrepoint The Top Suite (trading as Holistic Caring Services) is registered with the Care Quality Commission for the regulated activity of Treatment of Disease, Disorder and Injury. This registration is appropriate to the provision of nursing services. However, the service was providing the regulated activity of personal care. We discussed this with the service manager who was also nominated individual. They agreed to submit an application to add personal care to the registered activities as a priority.

A registered manager was in post. However, the registered manager was not available on the day of the inspection. 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 not recruited safely in accordance with the provider’s policy or best-practice. Two of the three files we checked did not contain any evidence that references had been received prior to the person starting work.

A registered manager was in post. However, they were not actively involved in the day to day management of the service. This role was undertaken by the service manager who was also the director and Nominated Individual. This meant that the governance framework for the service was not clear or robust.

The service manager had completed a series of quality and safety audits on a regular basis. However, audit processes were not robust and had failed to identify the lack of references in the staff files that we saw. We made a recommendation regarding this.

The people that we spoke with had no concerns about the safety of services. People were protected from potential harm and self-neglect because staff knew people well and were able to recognise signs of abuse or neglect.

The care files that we saw showed clear evidence that risk had been assessed and reviewed regularly. Risk assessments were sufficiently detailed. Risk was reviewed by staff with the involvement of the person or their relative.

Staff were trained in the administration of medicines but because the services were community-based, they were not always responsible for storage and administration. Some people who used the service were able to self-administer their medicines; others received support from a relative. At the time of the inspection staff were not supporting people with the medicines.

The service manager was clearly aware of the day to day culture and issues within the service. We saw that they knew the people using the service and their staff well.

The service manager was able to articulate a clear vision for the service which maintained its focus on the provision of specialist services for people requiring end of life care. However this focus was not fully reflected in promotional materials or the provider’s statement of purpose.

The service manager worked closely with staff as they delivered care. This supported a culture of open communication.

The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with enthusiasm about the people that they supported and their job roles.

Care was delivered in accordance with people’s needs and choices and in conjunction with healthcare professionals. Policies, procedures and other documents made appropriate reference to legislation and standards including the Care Quality Commission’s fundamental standards.

Staff were trained to a basic level in a range of subjects which were relevant to the needs of the people using the service. Subjects included; safeguarding adults, moving and handling, adm