This inspection took place on the 31 October 2016 and was announced.

Nurse Plus and Carer Plus (UK) Limited – Swindon provides a domiciliary care service to enable people living in Swindon and the surrounding areas to maintain their independence at home. There were 38 people using the service at the time of the inspection, who had a wide range of physical and health care needs.

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.

We found that arrangements were in place to monitor staff attendance at work and to minimise the number of missed calls. However, people told us that staff had not always been available to attend a call and to provide care to people at the agreed time.

We looked at medication administration records (MAR) held within the agency office. We saw that apart from some gaps in MAR records, these had been completed appropriately. People were satisfied with the staff handling of their medicines and told us they received their medicines in a timely manner.

People told us they felt safe and trusted staff. Staff had completed safeguarding training and had access to the guidance and contact numbers of the local authority. Staff members were able to recognise if people were at risk and knew what action they should take to protect people from harm. People were kept safe as safeguarding incidents were reported and acted upon.

The provider operated safe recruitment practices. These included seeking references from previous employers and checks with the Disclosure and Barring Service. This helped to make sure that only suitable staff of good character were employed by the service.

Staff received comprehensive induction training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf and in their best interests.

Records were stored securely, protecting people’s and staff’s confidential information from unauthorised persons, whilst remaining accessible to authorised staff. Relevant processes were in place to protect the confidential information.

People received a personalised service. When initial assessments were carried out, the level of support people required was identified. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

Most of the people told us the management team responded promptly to their concerns. People were provided with opportunities to express their views regarding the quality of the service through satisfaction surveys and regular visits of coordinators to review their care.

The registered manager and the provider carried out a comprehensive programme of regular audits to monitor the quality of the service and plan improvements. The registered manager monitored people's support and took action to ensure they were safe and well. People’s welfare, safety and quality of life were scrutinized through regular checks on how people’s support was provided, recorded and updated. We found that accidents and incidents had been recorded appropriately. There was evidence that learning from the incidents and investigations was reflected on and appropriate changes were implemented to enhance t