We undertook an announced inspection of Northwood Nursing and Care Services Limited. We told the provider two working days before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the registered manager and staff might be not be available to assist with the inspection if they were out visiting people.

Northwood Nursing and Care Services Limited provides a range of services to people in their own home including personal care. People using the service had a range of needs but were mainly older people, some of whom were living with dementia. At the time of our inspection 48 people were receiving personal care in their home. People were paying for their own care and the support offered to them could be short or long term including providing 24 hour live in care and support to the person.

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.

During our last inspection on 12 and 13 November 2015 the provider was not meeting the legal requirements in relation to ensuring people safely received their medicines, that risk assessments clearly outlined any identified risk to the person and/or others and the quality monitoring systems in place had not effectively picked up any issues in relation to medicines management and risk assessments. At this inspection we found that improvements had been made in these areas in order to meet the regulations.

Medicine Administration Records (MARS) were audited to ensure care workers were signing when they had administered medicines to people using the service. The medicine policy and procedure had been reviewed and it outlined the different types of medicine support given to people. Care workers followed the information recorded in people’s care plans.

The general risk assessment had been updated and identified risks were recorded so that care workers knew how to safely support people.

Audits and checks had improved and were regular to ensure any areas of improvement were identified and action taken to ensure people received a quality service.

Regular office meetings were held with different staff members to ensure there was constant communication about tasks that needed to be completed and to ensure everyone had up to date information about people who used the service and care workers.

People and their relatives gave us complimentary comments about the service they received. People felt happy, safe and well looked after.

People's needs were assessed and care was planned to meet these needs. People’s needs were regularly reviewed.

There were appropriate procedures to safeguard people and the staff were aware of these.

The care workers usually arrived on time and stayed for the agreed length of time. People had the same regular care workers.

People had consented to their care and treatment and were involved in decisions about their care.

People's healthcare needs were recorded and the care workers and senior staff liaised with other professionals to make sure these were met.

There was an appropriate complaints procedure and complaints were investigated and acted on.

Care workers received inductions, training and support. They enjoyed working for the provider and they felt they had the information and support they needed to care for people. They had been recruited in an appropriate way and their work was checked to assess how they were working. This was done through observing them in people’s homes, meeting with them to discuss their work and asking for feedback from the people who used the service.

We undertook an announced inspection of Northwood Nursing and Care Services Limited on 12 and 13 November 2015. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

Northwood Nursing and Care Services Limited provided a range of services to people in their own home including personal care. The serviced provided regular visits, full day support, overnight care and live in carers. At the time of our inspection 60 people were receiving personal care in their home. The people using the service were paying for their own care.

The service was last visited on 24 October 2013 and had met all the regulations that were inspected.

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.

The records produced relating to the administration of medicines were not accurate. Care workers had changed the times when medicines were taken with only verbal confirmation from a healthcare professional.

The provider had generic risk assessments in place but they had not identified possible risks in relation to specific issues for people using the service and provide care workers with guidance on how to reduce these risks.

People using the service felt safe when they received care and support. The provider had processes in place to respond to any safeguarding concerns. There was a procedure in place to record and investigate any incidents and accidents.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

Detailed assessments of need were carried out which were used to develop the person’s care plan. People using the service and care workers felt the service was well-led and effective. There were regular team meetings and care workers felt supported by their managers.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines and risk assessments. You can see what action we told the provider to take at the back of the full version of this report.

We found the service to be well organised with a detailed and consistent system of records both for those that used the service and for the staff that worked for the agency. All relevant policies and procedures that would be expected of a domiciliary care agency were well documented and readily available, including information on safeguarding, whistle blowing, complaints and recruitment policy.

People told us that the care workers spoke to them with courtesy and respect and were attentive to their needs. The people we spoke with told us that they were happy with the standard and continuity of care that was provided and considered that their individual needs and wishes were taken into account. They felt that the care provided was reliable, and that there was a good collaborative working relationship with staff.

People were aware of a complaints procedure and were confident that they could relay any concerns about the service if they needed to do so.

Staff felt well supported and suitably trained and there was a clear and rigorous selection process in operation. Records were managed securely and we were shown evidence of robust systems in place to monitor the quality of the service by the management team.

We spoke with one person using the service, a relative, two staff members and the provider. People told us that the care delivered by the agency was good and met their needs. One person said,” the care provided is extremely good. I have used the service for over ten years and it has not changed at all”. A relative told us that the agency was very reliable and the staff were very friendly and kind.

People confirmed that they were involved with their care planning and their care was continuously reviewed with their involvement. People felt respected by staff and said that their dignity and privacy were always maintained. We found that people were visited prior to signing up for services to discuss the care or treatment they required, the terms and conditions and the fees for the services provided.

People told us that they knew how to make a complaint and said that they felt able to raise any concerns they had. The agency provided people with information on how to make a complaint when they first signed up for services there were no complaints recorded for the service at the time of our inspection.

We found that there were appropriate systems in place to protect people from harm as medicines were only administered by trained staff and there were systems in place to monitor this.

There were good systems in place to manage the staff recruitment and training and staff were provided with training to enable them to carry out their job effectively.

People who use the service said that their care package was discussed with them before they began to use the service. Everyone we spoke with said the service was able to provide the care package they wanted and needed. They also said that if they had any extra requests, the provider was able to meet them quickly. One person said using the service was ‘a very fortunate choice by my daughter’.

People said risk assessments of their homes had been done to ensure their home was safe or if changes/equipment was required for their care.

Most people said their care was provided by the same care staff in all but the most exceptional circumstances. Most people said the staff arrived on time and were very friendly including that they were ‘punctual, very kind, very nice.’ In addition, people told us that the staff seemed to take interest in their hobbies.

People who had used the service for at least a year said they had received questionnaires asking for their views on the service. A number of people said that they had also had lots of discussions with the service regarding the care they had received.

People said they would speak to staff if there were any concerns or if they needed any changes. One person said 'the office was very cooperative'.