This inspection took place on 28 July 2018 and 10 August 2018 and was announced. This was the first inspection of the service since they registered with CQC in July 2017.

This service is a domiciliary care agency providing specialist nursing care. It provides personal and nursing care to people living in their own houses and flats in the community. It provides a service to people with cancer and long term medical conditions. The service regularly provided end of life care.

There was 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.

People received safe care. The provider had considered risk and there were systems in place to ensure all care provided was tailored to people’s individual needs and risks. Where incidents had taken place staff escalated them appropriately and took action to reduce the likelihood of them recurring. Staff understood how to safeguard people from abuse and acted in line with local guidance when they identified concerns.

People received their medicines safely. Staff had received training in how to manage medicines and we saw evidence of staff working closely with healthcare professionals where medicines were required. Staff had strong links with local community nursing organisations which people benefited from. There was regular communication between these organisations which had helped to identify and respond to changes in people’s health. Staff were trained in how to provide care in a way that reduced the risk of infections spreading.

Staff had received appropriate training and support for their roles. Nursing staff received clinical supervision and support to maintain their knowledge. Staff felt supported by management and there were systems in place to enable good communication between staff and the provider. Staff had regular supervision and appraisals to discuss their work and their performance.

People told us that staff were kind and caring and supported them in a way that enabled relatives to have breaks from their caring roles. Staff involved people in their care by offering choices. The provider asked people questions about their preferences and diverse needs so that care could be tailored around these. People told us that staff were respectful when visiting their homes and staff were knowledgeable about how to provide support in a manner that promoted dignity. Staff arrived at the times that they were expected and the provider was in the process of improving the system for receiving referrals to speed the process up for people.

End of life care was delivered in a sensitive and person-centred way. People’s wishes for their end of life care were identified and reviewed regularly by staff and community healthcare professionals Changes to people’s needs were quickly identified with prompt action taken. Staff gathered important information about people’s routines and preferences. People and their relatives were regularly asked about the quality of the care they received and asked if they wanted to make any changes. There was a complaints policy in place and complaints had been responded to in line with the provider’s policy.

Regular checks were undertaken on the quality of the care that people received. The provider carried out a variety of checks and audits to monitor care and people and their relatives were involved of this. Staff practice was frequently observed to ensure best practice was being followed. People had consented to their care and staff understood what to do if people were unable to provide informed consent.