We inspected Inter-County Nursing and Care Services Limited, Chichester, on the 17 September 2018. The inspection was announced. We gave the provider two days’ notice of the inspection. This ensured that staff were available in the office and people were prepared, to receive a telephone call, from the inspection team.

Inter-County Nursing and Care Services Limited, Chichester is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection the service was providing care to 29 people who lived in, or around Chichester. This service provided both planned visits to people’s home and a live-in service.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating had not changed since our last inspection.

At this inspection we found the service remained Good.

The service provided safe care. Staff considered how to maintain people’s safety and followed safeguarding procedures. There were sufficient staff available for the care visits and they had appropriate pre-employment checks, before starting work. The service provided continuity of care. Staff received relevant information, before visiting people for the first time. People’s medicines were managed appropriately and there was a good standard of infection control.

Staff received sufficient training, to maintain high standards of care. If the service was due to support new people, with specific care needs, additional training was sourced. New staff received training and were assessed, before visiting people on their own. Staff received regular supervision and told us that they felt supported by the management team.

People received a good standard of care. People were assessed before care visits started and were involved in planning their care. Assessments included a full review of the individual’s needs and were person-centred. Each person had appropriate risk assessments and care plans were detailed and specific. People’s communication needs were identified and there were systems in place to provide information in an accessible format, when needed. Ways of maintaining people’s independence and encouraging social activities, were documented, within the care plans. People were supported with their eating and drinking. The service liaised with health care professionals, for example GPs, as necessary. The service provided end of life care and consideration was given to the needs of relatives and staff at this challenging time.

There was a registered manager in post, who was supported by the provider. The service continuously monitored the standard of care provided, with a variety of audits and quality assurance systems. There were systems in place to ensure lessons were learnt if things did go wrong. The service actively sought feedback, from both people and staff, with the aim of continually improving the standards of care provided. They worked closely with outside organisations and reviewed and updated their policies and procedures regularly. They had a complaints procedure in place and people told us they felt complaints were dealt with in a quick and appropriate manner.

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. We received positive comments from people and their relatives about the kind and compassionate care they received. People’s privacy and dignity was maintained and consideration was given to ensuring information was kept confidential and secure. People told us they were supported by staff and that the service responded to their changing needs.

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Inter-County Nursing & Care Services Chichester provides care for people in their own homes. On the day of our visit the service was providing care to 19 people with a range of needs including older persons and those living with dementia. People were supported with personal care as well as support such as live in care, individual care packages and 24 hour care.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults. Staff were aware of the correct procedures to follow if they considered someone was being neglected or poorly treated.

People received a reliable service from regular staff. There were sufficient numbers of suitably experienced staff employed to meet people’s needs. Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people who may be at risk.

People were supported by staff to take their medicines and this was recorded in their care records. Checks were carried out to ensure staff were competent to administer medicines and that staff were following the correct procedures.

Each person had a care plan which gave guidance to staff on supporting people safely. Risks to people were assessed and recorded. These included environmental assessments for people’s homes so staff knew any risks and what they should do to keep people and themselves safe.

There was suitable training, support and induction for staff so they could support people effectively. Staff told us they received regular training and that they had a good induction before they started to provide support to people.

People told us their care workers obtained their consent when providing care and support. Staff had received training in the Mental Capacity Act (MCA) 2005 and associated legislation. There was information in the staff handbook to guide staff if they thought a person lacked capacity to consent.

People were supported to eat and drink in line with their individual needs. The agency supported people to access healthcare professionals when needed.

People were supported by staff who were kind and caring. People were able to express their views and said they were encouraged to be independent as possible. People said they were treated with dignity and respect. A complaints procedure was in place that enabled people to raise concerns.

People said their needs were regularly reviewed and they were contacted on a regular basis to ensure that their current up to date needs were being met.

The provider had a policy and procedure for quality assurance. The manager and senior staff carried out checks to help to monitor the quality of the service provided. Quality assurance surveys were sent out to people, relatives and staff each year by the provider to seek their views on the service provided by Inter County Nursing & Care Services Chichester.

On the day of our visit Inter-County Nursing & Care Services Chichester was providing personal care for 17 people in their own homes. We met with the manager and reviewed the service's records and five people's care records. We followed this by telephoning two service users and three relatives of service users where we discussed their experiences of the service. We also spoke with three members of staff.

People and their relatives were all complimentary about the service that they received from the agency.

One person told us, "I have nothing to grumble about, my carers are kind, and helpful. I get everything that I need from them". A relative told us,"Inter-County are the best of any providers that I have used, and I have used plenty. They stand head and shoulders above any other agency". They went on to say, "The wrap around care that they provide 24 hours a day seven days a week is excellent, my mother is very content with her care".

We found that people had planned care that met their needs. We also found that people’s consent had been obtained prior to treatment where appropriate.

We found that the service had followed safe recruitment processes. We saw that staff had been trained appropriately and took infection control seriously.

We found that the service had sytems in place to monitor the quality of the service that they were providing.

We spoke with five people who used the agency and found that they were all very complimentary about the service that they were receiving. They said that care workers treated them with respect and that they felt safe with the care and support that they received.

Everyone said that they had been given a copy of their care plan, and that they had regular contact with the manager to review their care.

Everyone who we spoke with said that care workers arrived on time for visits and that their care workers stayed for the agreed length of their visit time. Most of the people we spoke with told us that they received the same staff on a regular basis and that this had helped them to build up a relationship of trust with their care workers.

One person said, "The quality of care is all you could wish for".

Another person said that the agency was, "Simply first class".