The inspection took place on 30 and 31 July 2018 and was announced. This was the first inspection of the service since it moved to its new location in May 2018.

Nurse Plus and Carer Plus (UK) Limited is a large nationwide care agency. The Exeter branch provides care staff to work in registered services. They also work with the Rapid Response service to provide urgent care to people at home on discharge from hospital, or to prevent hospital admission. In addition, the service provides personal care to people living in their own houses and flats in the community. This is the area which is registered with the Care Quality Commission (CQC) and features in this inspection. At the time of the inspection seven people were receiving a personal care service in the form of a sitting service. Five of these people received this support at night time to enable their family carer to have a break. The other two people had ‘block visits’ during the day.

The service was not completely safe. Risk assessments, did not consistently provide the guidance staff needed to minimise risks when people living with dementia experienced agitation and distress. The risks were mitigated because staff knew the person well and had a good understanding of their needs. In addition, family members were present and could be consulted in an emergency. However, the information was not documented for new staff. We discussed this with the registered manager who advised they would ensure care records were updated to contain the information staff needed to support people safely.

People told us they felt safe. They said they received a consistent and reliable service. Before people began receiving a service an assessment was carried out to assess any risks to the person and to the staff supporting them. Where people needed assistance with medicines, staff had received training and knew how to support people safely. Nurse Plus and Carer Plus (UK) Limited had a system for identifying the most vulnerable people, which meant their needs would be prioritised if there were any problems affecting service provision. People were protected from abuse and harm because staff had completed training in safeguarding adults and children, and knew how to recognise and report safeguarding concerns. Safeguarding concerns were managed appropriately, with Nurse Plus and Carer Plus (UK) working with other agencies as required to ensure concerns were fully investigated and action taken to keep people safe.

Staff had the skills and knowledge to meet people’s needs effectively. They received a comprehensive induction and training on a range of topics relevant to the needs of the people who used the service. Staff were well supervised and told us they were well supported.

The service was caring. People were supported by consistent teams of staff who knew them well and understood their needs. Staff worked in a person-centred way, promoting independence and treating people with dignity and respect. Their role included providing support to family carers. One member of staff said, “It’s important to give them [family carer] the opportunity to ‘de-stress’. It’s important to let everything out.” People’s rights were protected because staff had a clear understanding of the Mental Capacity act 2005 (MCA) and described how they used it to ensure any decisions made were in the person’s best interests. They told us they always asked for consent before commencing any care tasks and supported people in their decision making as far as possible.

People received a responsive service. A care plan was drawn up with each person before the service started. The care plans were person centred and contained easy to read and clear information about the support required and the person’s background and interests. They explained how to support and encourage people to remain independent. The service was proactive in identifying any communication needs and staff were able to describe how they facilitated effecti