The inspection took place between 19 to 25 September 2018 and was announced. At the last inspection we rated the service overall as ‘Requires improvement’ at this inspection we saw the required improvements had been made in safe and effective. Within well led the improvements we required at the last inspection had been made, however other areas of concern were raised in the well led domain.

This service provides care at home to older adults and younger adults living with a range of health conditions and needs to live independently in the community within the Nottingham area. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 140 people were receiving personal care as part of their care package.

Nationwide Care Services Ltd had not got a registered manager, however, the provider had recruited a manager who was due to commence their role in October 2018. During the managers absence the service had been overseen by the regional 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 2008 and associated Regulations about how the service is run.

The out of hours service was not always responsive to meet people’s needs in messages being shared or in supporting staff when the office was closed. Communication was not always offered to provide people with information about their weekly calls. Some staffs travel time had an impact on them not being able to meet the required call times.

Staff felt supported by the regional manager and the local office staff. Supervisions and local team meetings provided staff with the support they required for their roles. Partnerships had been developed with health and social care professionals. Complaints had been responded to.

People received support from regular staff or small teams of staff. All staff had received the correct recruitment checks to ensure they were safe to work with people. Staff had received training in how to protect people from harm and how to reduce the risk of infections. Risk assessments had been completed and guidance was provided. Medicine was managed safety and lessons had been learnt when errors had occurred, the changes made had driven improvements.

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. Staff ensured they obtained consent before providing care. Staff had received training for their role and additional training was available to reflect individual needs. People were supported with their meals and followed guidance from health care professionals to support people’s health care needs.

Staff provided regular support to people which had enabled relationships to be developed. People felt able to continue to have a level of independence supported by the staff. Their dignity was maintained and staff showed respect for people. Information was stored to maintain confidentiality and the information detailed the care agreed to be provided.

Care plans had been developed with the people and or relatives. Reviews provided people with the opportunities to share their views in addition to a quality survey. When people’s needs changed the care plans were updated. All information was included which considered people’s religious or sexual needs.

We carried out the inspection on 27 June 2017. The registered manager was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available. The provider’s office that the service is registered at had recently moved location.

The service is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection there were 120 people receiving personal 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 2008 and associated Regulations about how the service is run.

People and their relatives told us that they felt safe. Staff were aware of their responsibility to keep people safe from avoidable harm. Safe recruitment practices were followed. Staff felt able to recognise and report safeguarding concerns.

Risk associated with activities of people’s care had been assessed and measures were in place to prevent avoidable harm. The environment was checked and equipment was checked and maintained in order to keep people safe.

People could not be assured that they would receive their care calls at the agreed times. The provider had identified this and made improvements but these were still in their infancy at the time of our inspection.

Records relating to people’s medicines were not robustly maintained this meant that there was a risk that people had not receive their medicines as prescribed. People were satisfied with how they were supported to take their medicines and staff had received training and competency checks around medication administration.

Staff had received training and supervision to meet the needs of the people who used the service. Their practice was checked to ensure that they were competent in their roles. Most staff told us that they felt supported.

People were supported to maintain their physical health and action was usually taken when a concern was raised. Staff supported people to have enough to eat and drink.

People were not supported in line with the requirements of the Mental Capacity Act (MCA). Where people were suspected of lacking the capacity to make decisions for themselves assessments had not been taken to confirm this. We have made a recommendation around the services implementation of the MCA.

People were supported by staff who understood that they should be treated with dignity and respect. People felt that staff took time with them to provide their care. People’s independence was promoted and encouraged.

People generally received support from staff that knew them well. Staff understood people’s individual needs.

People and their relatives were involved in planning their care. Reviews took place to ensure it continued to meet their needs. They had been asked for feedback about the service that they received.

Complaints were dealt with in line with the service’s policy, however informal complaints had not always been logged.

Staff were clear on their role, the expectations of them and the aims and objectives of the service. Where necessary the provider’s disciplinary procedures had been implemented. Staff felt that communication between them and the office staff required improvement.

Systems were in place to monitor the quality of the service being provided and drive improvement. When concerns had been identified these had been addressed. However there were times when audits had not identified areas of concern to be addressed.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.