The inspection took place on 17 April 2018.

Nurse Plus and Carer Plus (UK) Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to adults, but predominantly to older adults, including people who may have a physical disability, a learning disability, sensory loss, mental health problems or people living with dementia living in Bexhill-on-Sea, Hastings, Battle and the surrounding area. At the time of our inspection around 54 people were receiving a service, of which 44 were receiving the regulated activity of personal care.

The service did not have 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. There was a new manager who was present during the inspection. An application was in process for the new manager to become the registered manager for the service.

Staff told us there had been a lot of changes during the last six months. There was a new manager and office staff, and a number of care staff had also left the service. This had affected the consistency of care staff providing care calls and some systems, for example the sending out of rotas, had not been maintained. Senior staff told us of their own quality assurance audits. Through these they had identified areas of improvement and told us of the action plans which already in place to address this and of the work already completed to ensure the quality of the service delivered. Feedback from all the staff showed they were confident of the new management, they felt listened to and areas for improvement had been or were already being addressed. The service was moving forward after a difficult period. People spoke well of the care provided by their regular care staff. They told us their main concern was the lack of rotas and knowledge of who was due to provide their care and when care staff were due to complete their care call. Not everybody was sure of who to contact with any concerns. Senior staff from within the organisation were present during the inspection. They acknowledged there had been a period when staff changes had resulted in a lack of continuity of service provided. They told us they had reviewed the care provided and they had supported the manager and all been following an action plan to address issues raised.

Systems had been maintained to keep people safe. People told us they felt safe with the care provided. One person told us, “Yes I do very much so and we get on well together.” A relative told us,” Yes when regular carer visits, she has developed a good relationship.” They felt they could raise any concerns they had. People remained protected from the risk of abuse because staff understood how to identify and report it. Assessments of risks to people had been developed. Staff told us they had continued to receive supervision, and be supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People told us their regular care staff had the knowledge and skills to provide their care and support.

People's individual care and support needs continued to be identified before they received a service. Care and support provided was personalised and based on the identified needs of each person. People told us they felt listened to, supported to be independent and they were involved in decisions about their care. They spoke of their care plans having been reviewed and of their preferences having been considered within this process. One relative told us, “We had a review one week ago, and husband’s likes, dislikes and decisions of care needs were discussed.” Another relative told us, “W

This inspection took place on 17 December 2015. To ensure we met staff at the service’s main office, we gave short notice of our inspection.

This location is registered to provide personal care to people in their own homes. The service provided personal care support to sixty people in the community.

People who used the service were younger and older adults with physical or mental health needs or learning disabilities and people with palliative care needs.

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 2008 and associated regulations about how the service is run.

Eleven out of twelve people had continuity of care staff to support them with their care needs. Most people reported that no care calls were missed. However two people said their calls had been missed and one person said they had experienced calls at times they had not agreed. Staff said they were aware of occasional missed calls, but this did not happen regularly. The lack of consistency of care in this minority of cases did not meet people's preferences for continuity of care staff. The registered manager was in the process of implementing improvements to improve continuity of care staff to meet people’s needs.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and protect people from harm. Risk assessments took account of people’s right to make their own decisions.

Accidents and incidents were recorded and monitored to identify how the risks of reoccurrence could be reduced. There were sufficient staff available to meet people’s needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were administered and recorded safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew people well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed and were regularly reviewed.

Staff were competent to meet people’s needs. Staff received on-going training and supervision to monitor their performance and professional development. Staff were supported to undertake a professional qualification in social care to develop their skills and competence.

Staff had completed training in the principles of the Mental Capacity Act 2005 (MCA). Staff were able to explain the requirements of the legislation and how they protected people’s rights to make their own decisions. People had mental capacity assessments in place to determine whether they had the capacity to consent to their care and treatment following guidelines set out in the MCA 2005 Code of Practice.

The service supported people to prepare meals that met their needs and choices. Staff knew about and provided for people’s dietary preferences and needs.

Staff treated people with kindness and respect. People were satisfied about staff conduct when their care and treatment was delivered. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were involved in their day to day care and support. People’s care plans were reviewed with their participation and people’s relatives and relevant others were invited to attend the reviews and contribute.

People were referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and care preferences. Staff promoted people’s independence and encouraged people to do as much as possible for themselves. 

People received care that was based on their needs and preferences. They were involved in all aspects of their care and were supported to lead their lives in the way they wished to.

People’s views and opinions were sought and listened to. Feedback from people receiving support was used to drive improvements.

There was an open culture that put people at the centre of their care and support. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.

There were quality assurance systems in place to ensure essential standards of care and drive service improvements. The registered manager promoted an open and inclusive culture that encouraged continuous feedback from people and staff.

People we spoke with told us their privacy, dignity and independence were always respected. One person told us," They are always very polite and they discussed my likes and dislikes beforehand."

We examined four people’s care plans and spoke with six people who used the service and found that people’s needs were assessed and regularly reviewed to deliver the support they required. One person said, "The staff all know my requirements."

We spoke with staff and examined records and found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We examined four staff files and spoke with staff to ensure that appropriate checks had been undertaken before staff began work.

We were shown the Provider’s complaints policy and saw there was an effective complaints system in place.

People we spoke with told us that they had the same staff most days. One person said, “I really like that, she’s marvellous.” People told us that staff were kind and respected them and their home.

We looked at care plans and saw that people’s needs were assessed and they received care and treatment that reflected the assessed need. One person told us, “they get on with what they are doing.” Another person told us, “I enjoy their care.”

We looked at the training plan and saw that staff received training that was designed to help them meet the needs of the people they cared for. One member of staff told us, “I have never felt let down by the training.” We saw that staff received training in safeguarding vulnerable adults and this was updated every year.

There was a system in place to assess and monitor the quality of service that people received. We saw that people were sent questionnaires to ask them about the service they received. People we spoke with told us that they did not have any complaints but if they did they knew how to raise them.