This inspection took place on 22 November 2016 and it was announced. The provider had short notice that an inspection would take place. This was because the service provides a domiciliary care service to people in their own homes and we needed to ensure that the registered manager would be available to assist us.

Network Healthcare Professional Limited is a domiciliary care service providing care to people in their own homes in and around Swindon. At the time of the inspection the service was supporting 103 people.

There was registered managers 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 who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to manage safe administration and storage of medicines.

The service experienced some late calls but always ensured all calls were completed. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received quality care that was personalised to meet their needs.

People were supported to maintain their health and were referred for specialist advice as required. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s life histories and understood how these could influence the way people wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities of their choice in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

Leadership within the service was open, transparent and promoted strong organisational values. This resulted in a caring culture that put people using the service at the centre. People, their relatives and staff were complimentary about the management team and how the service was run.

The registered manager informed us of all notifiable incidents. Staff spoke positively about the management support and leadership they received from the management team.

We last inspected this service in September 2011 and we identified concerns about the monitoring of the service provided by the Agency. At this inspection we found that these concerns had been addressed.

We spoke with four people who used the care agency and one relative. They told us they had been involved in planning their care package and agreeing when it was convenient for them to receive it. People told us they were treated with dignity and respect and that the standard of care they received was very good.

The care plans we saw provided individual details of people's needs, wishes and preferences and the amount and type of care they would receive.

Staff were supported through training and the manager had effective systems in place to monitor the performance of the Agency.

You can see our judgements on the front page of this report.

We spoke to a number of people who use the service and some relatives. Feedback was positive. One person told us “I cannot fault them.” They said “they are all very nice to me and we have a good laugh and a joke”. They went on to say that the care staff were “very respectful and polite” and that they were “always clean and presentable.” A relative told us that the care staff were “competent, professional and really helpful”. They said that the staff had developed “a wonderful relationship and rapport” and her relative was “delighted” and “lifted” when staff arrived. They said that the staff made X feel important in their care.”

Network Healthcare Professionals Limited - Swindon (DCA) is a domiciliary care agency that provides personal care and support to people living in their own homes. This includes short term support for people who require a period of rehabilitation following illness. However the majority of people using the service required long term support to enable them to continue to live at home.

On the day of our inspection there were 74 people using the service.

There was a registered manager present. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People told us they had seen an improvement in the service over the past few months and they felt safe with the care staff. Staff had received training on safeguarding and demonstrated an understanding on how to recognise and respond to abuse. They all understood their responsibility to report any concerns to their management team and were aware of the importance of disclosing concerns about poor practice or abuse.

We found people who lacked mental capacity may be at risk of receiving care that was not meeting their needs and they had not agreed to because staff did not always understand the requirements of the Mental Capacity Act 2005 and its main codes of practice. People’s mental capacity was not always considered when providing them with personal care. However the registered manager was taking action to address this.

People’s risks were managed appropriately and they were involved in making decisions about any risks they may take.

Safe recruitment practices were followed and there were sufficient numbers of suitable staff to keep people safe and meet their needs. One member of staff said, "The office is trying to give us regular clients as this is really important because service users will have more trust with a regular person visiting."

People were supported by staff who had the necessary skills and knowledge to effectively meet their assessed needs. Staff had effective support, induction, supervision, appraisal and training. However we found no evidence they had completed training on the Mental Capacity Act 2005. This meant staff may not be able to identify people who lacked capacity and people may be at risk of receiving care that was not meeting their needs. However the registered manager was taking action to address this.

People told us they were involved in the planning of their care and these were taken into account in the assessment of their needs and the planning of the service. However we found people’s care records were not always accurate to identify the correct level of care, treatment and support given.

The service was caring because people who used the service, their relatives and professionals were positive about the care and support received from staff. Staff treated people with dignity, respect, compassion and kindness when providing care and support.

People felt listened to and were encouraged to make their views known about their care and support and these were respected. People told us the staff listened and acted on what they said.

The service was responsive to people’s needs because most people told us they were given information they needed when they needed it. Some people told us the company had not always informed them if a staff member was off sick and someone else was coming. One member of staff told us, "We are a good team of carers but communication is a problem." However the provider was taking action to ensure all visits were covered and office staff were responsive to changes if a member of staff was running late or not able to work.

People’s views on the quality of the service were taken into account but feedback had not been provided. People received personalised care but it was not always responsive to their needs. Most people told us they did not feel staff had sufficient time to provide them with the care they needed.

People felt confident to express their concerns or complaints about the service they received because concerns and complaints were encouraged and explored and responded to in good time.

All staff we spoke with confirmed they felt well supported in their role, they had opportunities to meet with their manager, and spot checks were carried out to monitor their practice. The registered manager supported learning, encouraged people and staff to raise concerns if they had any, and people told us improvements had been made to the service. Concerns and complaints were used as an opportunity for learning and improvement. Action plans were monitored to ensure they were delivered.

The service had a system to manage and report, incidents, and safeguardings. We saw incidents and safeguardings had been raised and dealt and the commission had been properly notified of relevant events.