The inspection took place at the service’s office on 06 June 2017.

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 and people who have a learning disability. At the time of the inspection there were approximately 20 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Canterbury, Faversham, Herne Bay, Whitstable and surrounding areas.

There was a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager was responsible for the day to day control of the service.

People’s medicines were stored safely in their homes. Some people took their medicines independently with no involvement from staff. Other people did need prompting or support and guidance from staff to take their medicines as prescribed by their doctor. Staff were trained to support people with their medicines and senior staff checked they were competent to do so. The guidance for staff about ‘as and when’ medicines was not consistent and we have made a recommendation about this.

People told us they felt safe and trusted the staff that supported them. One person commented, “I feel very safe with the carers”.

Risks to people were identified, monitored and reviewed. Risk assessments gave guidance for staff on how to manage risks. Staff knew how to protect people from the risk of abuse and the action they needed to take to keep people safe. Staff completed regular training about how to keep people safe. The provider had a whistle-blowing policy and staff knew they could take any concerns to other organisations if they had concerns. Staff said they felt confident to whistle blow.

There was sufficient staff employed to give people the care and support that they needed. People told us they received care from regular staff and their calls were usually covered in times of sickness and annual leave.

The provider’s policies were followed when new staff were appointed. Checks, including references and criminal records, were completed to make sure staff were safe to work with people. The registered manager followed the provider’s disciplinary process when required.

People said the service was effective and reliable. The provider had a training programme and staff completed refresher training to make sure they had the skills and knowledge to carry out their roles effectively. Staff attended regular one to one supervision meetings with their line manager and annual appraisals were completed.

People felt informed about, and involved in, their healthcare and were empowered to have as much choice and control as possible. Staff understood the key requirements of the Mental Capacity Act 2005 (MCA) and how it impacted on the people they supported.

People were supported to maintain a balanced diet. Staff supported people to maintain good health. Staff knew people’s routine health needs and kept them under review.

People spoke positively about staff and told us they were kind and caring. People said, “The staff are nice” and “The carers are very kind to me". People were happy with the care and support they received. Staff knew people well.

People were involved in writing and reviewing their care plans. Staff were knowledgeable about people’s likes, dislikes and preferences.

People told us they did not have any complaints but would speak to staff in the office if they had any concerns. They said that staff listened to them and sorted out any issues. Each person had a copy of the complaints procedure in their care plans in their home, an

The inspection took place on 18 and 20 April 2016, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. This was the first inspection since the service had moved to new offices.

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 and people who have a learning disability. At the time of the inspection there were approximately 25 people receiving support with their personal care. The service undertakes visits to provide care and support to people in Canterbury, Faversham, Herne Bay, Whitstable and surrounding areas.

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.

People told us they received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about some areas of medicine management.

Risks associated with people’s care had been identified, but there was not always sufficient guidance in place for staff to ensure people remained safe.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. However care plans varied in the level of detail and all required further information to ensure people received care and support consistently and according to their wishes. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

Quality monitoring systems were in place. However the audits and systems in place to monitor the quality of service people received were not totally effective in identifying where improvements could be made.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had their needs met by sufficient numbers of staff. People received a service from a team of regular staff. Staffing numbers were kept under constant review. New staff underwent an induction programme, which included relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role and some staff had gained qualifications in health and social care.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection. Some people chose to be supported by family members when making decisions. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health. People told us staff were observant in spotting any concerns with their health. The service worked jointly with health care professionals, such as community nurses and an occupational therapist.

People felt staff were very caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their ap