This inspection was carried out between 14 and 15 August 2018 and was announced. Two days’ notice of the inspection was given because we needed to be sure that people who wanted to speak to us were available during the inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

Nurse Plus and Carer Plus provides a service to adults, older adults, people living with dementia or mental health needs, physically disabled people and people with a learning disability or autistic spectrum disorder. There were 90 people receiving a service at the time of our inspection. One person’s relative told us, “They are kind and caring. I can see they are out for the best for my love one and help me”.

The registered manager was leading the service. A registered manager is a person who has registered with the CQC 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.

At the last inspection on 6 July 2017, we asked the provider to take action to make improvements to the way they managed people’s medicines. At this inspection we found that the shortfalls had been addressed and the service that people received had improved.

People’s medicines were well managed. Guidance was available to staff and people received their medicines as their healthcare professional had prescribed. Changes in people’s health were identified quickly and staff supported people to contact their doctor. People were supported to eat and drink enough. Staff followed safe practices to prevent infections.

Equality, diversity and human rights were at the forefront of how support was provided. The strong person-centred culture was shown through the exceptionally kind, caring and compassionate approach from the registered manager and all members of the staff team. Everyone we spoke with told us the staff were kind, caring and friendly, and treated them with dignity and respect at all times. They told us staff knew them well and provided their care in the way they wanted. People were given privacy. Everyone was supported to be as independent as they wanted to be. People received care in the way they preferred at the end of their life.

People received care tailored to them. Assessments of people’s needs had been completed and any risks had been identified with people and their relatives. Guidance was available to staff about how to keep people safe and provide each person’s care in the way they preferred. Staff supported people to take part in leisure activities they liked.

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. Everyone was able to make decisions for themselves and staff supported them to do this.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. People and their representatives told us they were confident to raise any concerns they had with staff and that these would be acted on. Complaints received were investigated and responded to. Action was taken to prevent them occurring again.

There were enough staff available to give people the support they needed, when they needed it. Staff arrived at the agreed time and stayed for the required length of time. People told

The inspection took place on 6 and 10 July 2017 and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection.

Nurse Plus and Carer Plus (UK) Limited provide care and support to people in their own homes. The service is provided to mainly older people and some younger adults. At the time of the inspection there were approximately 120 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Dover, Deal and surrounding areas. Visits can range from half hourly calls to providing 24 hour support.

The service is run by 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.

Medicines were not being managed safely. Medicines were being left out for people to take after the staff had left their homes without full risk assessments in place to ensure this practice was safe. Medicine records were not clear to confirm that people were receiving their prescribed medicines.

Risks associated with people’s care had been identified, and guidance about how to manage risks and keep the person safe were in place. People told us that staff always wore gloves and pinnies to carry out personal care in line with infection control procedures.

People and relatives told us they felt safe whilst being supported by the staff. Staff had received training on how to keep people safe and had a good understanding of how to recognise and report any suspicion of abuse or harm.

People told us that the staff were reliable and they received their care from regular staff. Staffing levels were kept under review and there was ongoing recruitment to ensure there were sufficient staff to cover the calls.

Staff completed training in line with their role. Their competencies were observed to ensure they had the knowledge and skills to keep their practice updated. Staff completed a full induction, which included shadowing experiences staff so they were aware of people’s needs and routines.

People said the staff asked for their consent at each visit. Staff told us how they offered people choices to make their decisions about their care. Staff had an understanding of the Mental Capacity Act 2005 (MCA) and how it impacted on the people they supported.

People were supported with their health care needs and to access the doctor or other health care professionals, such as community nurses or occupational therapists. The office staff ensured that any health care issues reported to the office were followed though to ensure that people received the help they needed.

People and relatives told us that they were supported to eat, drink and maintain a healthy diet.

People and their relatives told us the care plans were personalised to ensure that people received care and support consistently and according to their wishes. People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.

People said staff were kind and caring. People said staff were responsive to their needs and listened and acted on what they said. People were treated with dignity and respect and their independence was encouraged wherever possible.

People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the service provided. Any negative feedback was used to drive improvements to the service. People felt there had been many changes at the office, which had improved the delivery of care.

The registered mana