Nurse Plus & Carer Plus (UK) Ltd in Chichester is a domiciliary care agency registered to provide personal care to people living in their own houses and flats in the community. It provides a service to older people, people with a learning disability, physical disability, people living with a mental health condition, dementia, sensory needs or people who misuse drugs and alcohol. Not everyone using Nurse Plus in Chichester receives a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care which means help with tasks related to personal hygiene and eating. Where people receive personal care we also take into account any wider social care provided. At the time of our inspection, two people were supported with their personal care needs by the provider.

At our last inspection in December 2015 we rated the service as Good. At this comprehensive inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Quality systems and audits were in place to monitor the service people received. We found audits had not identified some discrepancies in care plan documentation relating to the Mental Capacity Act 2005 and the recording of staff competency assessments. Quality processes had not identified aspects of the care plans that required improvement, such as recording activities, and changes in people’s needs such as deterioration in health and/or mobility. The provider recognised these areas needed to be addressed. The impact of this was reduced due to the size of the current service.

Good systems and processes to keep people safe had been maintained. Risks to people had been identified and assessed on a regular basis. Staff received guidance on what actions to take to manage risk to help ensure people were safe. The provider had a lone worker policy to ensure staff were kept safe in the community.

People continued to be protected from avoidable harm. There was a safeguarding policy and staff received training. Staff knew how to recognise the potential signs of abuse and followed the procedure regards what action to take to keep people safe. A relative told us, “They are really good. They do keep her safe and comfortable.”

The acting manager ensured that when new staff were employed appropriate recruitment practices continued to be followed. Staff received an induction and ongoing training and were supported to undertake additional training they identified. Staff were supported to work towards a National Vocational Qualification (NVQ) and the Provided funded their study. Staff told us they had regular supervision and appraisal as well as contact with each other. Staff told us they felt well supported by the acting manager and the wider management team. One member of staff told us, “I really enjoy working for Nurse Plus, they stick to the book and do things the right way, I feel quite proud to work for them.”

People were supported to maintain their health and had assistance to access health care services when they needed to. Staff supported people by arranging healthcare appointments for them. A GP told us that when carers had concerns about people’s health they were contacted appropriately. People were supported to receive their medicines safely by staff that were trained in administering medicines.

One relative told us the provider was caring and kind, “They are very patient with her. They understand it’s frustrating for her, and they are very empathetic.” Staff understood the person's emotional and health needs as well as their social history and this was reflected in the care plan. Staff supported people to have choices over food and drink. People were supported to remain as in

Nurse Plus & Carer Plus UK Ltd is registered to provide personal care for people in their own homes. It does not provide nursing care. On the day of our visit the service provided personal care to 12 people with a range of needs including older persons and those living with dementia. People were supported with personal care as well as support such as live- in care, individual care packages and 24 hour 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 which applies to domiciliary care. Staff were trained in the Mental Capacity Act 2005. The service had policies and procedures regarding the MCA and staff were trained in this.

People, and their relatives, said they felt safe with the staff. There were policies and procedures regarding the safeguarding of adults. Staff were aware of the correct procedures to follow if they considered someone was being neglected or poorly treated.

People received a reliable service from regular staff. There were sufficient numbers of suitably experienced staff employed to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People were supported by staff to take their medicines and this was recorded in their care records. Checks were carried out to ensure staff were competent to administer medicines and that staff were following the correct procedures.

Each person had a care plan which gave guidance to staff on supporting people safely. Risks to people were assessed and recorded. These included environmental assessments for people’s homes so staff knew any risks and what they should do to keep people and themselves safe.

There was suitable training, support and induction for staff so they could support people effectively. Staff told us they received an induction which prepared them for their role before they worked alone with people.

People were supported to eat and drink where this was appropriate or requested by people. The service supported people to access healthcare professionals when needed.

People were supported by staff who were kind and caring. People were able to express their views and said they were encouraged to be independent. People said they were treated with dignity and respect.

People said their needs were regularly reviewed and they were contacted on a regular basis to ensure that their current needs were being met. People and their relatives told us staff engaged with people in social activities.

People and their relatives concerns were listened to and acted on. People and their relatives were aware of the service’s complaints procedure and said they felt able to raise any issues which were resolved to their satisfaction.

The provider carried out audits and checks that the service was providing safe, effective and reliable care to people. This involved seeking the views of people, their relatives and staff. We identified that the system of monitoring care appointments needed to improve as there was no record of any cancelled appointments which meant it was difficult to check if care was provided as agreed with people.