We carried out this announced inspection on the 16 and 21 March 2018.The provider was given 24 hours’ notice because the location provides a domiciliary care service; we needed to be sure that staff would be available to talk with us.

Nurse Plus and Carer Plus (UK) Limited provide personal care and support to people in their own homes. At the time of our inspection the agency was providing a service for 125 older people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age.

We last inspected this service on 14 and 15 August 2014 and we identified one area where improvement was required in respect of staff were not consistently supported with their learning and development. During this inspection, we found that sufficient action had been taken and staff felt supported.

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.

We received positive feedback from people about the service. All the people who used the service expressed great satisfaction and spoke highly of the care staff. A complaints procedure was in place and people knew how to make a complaint if they needed to.

People felt safe with the service provided by Nurse Plus and Carer Plus (UK) Limited. The risks to people were minimized through risk assessments, staff were aware of how to keep people safe and the information provided staff with clear guidelines to follow. There were plans in place for foreseeable emergencies.

Relevant recruitment checks were conducted before staff started working at Nurse Plus and Carer Plus (UK) Limited to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Staff completed a wide range of training and felt it supported them in their job role. New staff completed an induction before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. Staff meetings were held regularly. There were sufficient numbers of staff to maintain the schedule of care visits to meet people’s needs.

People were supported to take their medicines safely from suitably trained staff. Medicines administration records (MAR) confirmed people had received their medicines as prescribed. Staff contacted healthcare professionals promptly when they had concerns about people’s health and wellbeing.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

Staff felt supported by the registered manager and could visit the office to discuss any concerns. There were systems in place to monitor the quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection.

The service provides care and support to people living in their own home. This may include personal care, help from staff to ensure people are eating and drinking enough, support to move position if people are at risk of skin damage, cooking and help with organising healthcare appointments.

The provider did not have effective arrangements in place to support staff with their personal learning and development. Records showed staff had regular meetings with their manager to discuss learning; however, they did not demonstrate plans were in place to develop their knowledge and skill set.

There is a registered manager at Nurse Plus and Carer Plus UK Ltd. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff were able to identify the different signs of abuse and were knowledgeable about the services protection processes and procedures. They consistently told us they would contact CQC and the local authority if they felt someone was at risk of abuse. Notifications received by CQC and discussions with the local authority safeguarding team confirmed this.

Staff received training appropriate to people’s needs and they were regularly monitored by a senior member of staff to ensure they delivered effective care. Staff told us the training provided helped them to deliver safe and effective care.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005 and worked with people to ensure their choices and decisions were respected. People told us they were able to make their views known and staff respected their decisions. They told us staff asked for permission before delivering care.

Relatives and healthcare professionals told us staff engaged with people effectively and encouraged them to maintain their independence. People’s records documented their hobbies, interests and described what they enjoyed doing in their spare time. Staff showed good understanding about people’s interests.

Records showed staff reminded people to attend various health related appointments. Examples of these included visits to see the GP and hospital appointments.

People received support that met their needs because staff regularly involved them in reviewing their care plans. Records showed reviews took place regularly or when someone’s needs changed. Relatives told us they were involved in reviewing their family members care.

The provider had effective arrangements in place to deal with complaints. Relatives told us any concerns raised were dealt with efficiently. People told us they were regularly updated with the progress of any complaints made.

There were clear lines of accountability and staff understood their responsibilities. Each member of staff provided us with a clear description of what was expected of them in their role.