This inspection took place on 7 June 2018 and was announced. We gave the provider 48 hours to make sure a member of the management team was available in the office to meet with us.

This was our first inspection of this service since registration with us on 6 March 2017.

Nursing Direct is a domiciliary care agency that provides personal care and nursing care to people living in their own homes. People had a wide range of complex nursing needs. The agency provided care to people across a large area which included Peterborough, Sussex and London. There were 23 people receiving services from Nursing Direct at the time of our inspection.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not always carry out assessments in line with the Mental Capacity Act 2005 when there was reason to suspect people lacked capacity. This meant there was a risk people may receive care inappropriately. However we were not concerned this was the case with people using the service at the time of our inspection. The provider took immediate action when we raised our concerns in carrying out MCA assessments and arranged ‘best interests’ meetings where they had assessed people lacked capacity.

Staff training was developed and delivered around people’s individual needs. The provider developed a staff training package for each person in relation to their needs. The provider assessed each staff member was competent in all aspects of care before they were able to lone work with them. Training was also tailored to the individual needs of staff and nurses were provided with training in specialist clinical skills to enable them to meet people’s needs.

The provider managed people’s medicines safely. Staff received training in medicines management, including in specialist techniques people required to administer and monitor their medicines.

The provider had suitable recruitment systems to check staff were safe to work with people. There were enough staff to support people safely. People were involved in the recruitment of staff. People met with staff selected to support them before their care began to check they wanted to receive care from them.

The provider assessed risks relating to people’s care and put robust risk management plans in place to guide staff. Care plans informed staff about people’s individual needs, and the best ways for staff to care for them.

People felt safe with the staff who supported them. Staff understood how to respond if they suspected anyone was being abused and received training from the provider to refresh their knowledge.

Staff were supported through a programme of supervision, appraisal and mandatory training to help them understand their role and the best ways to care for people. Care workers were also encouraged to complete diplomas in health and social care to further their knowledge.

People received the necessary support from staff in relation to eating and drinking including support with any specialist equipment. The provider also catered to people’s ethnic and cultural needs. People were supported with their day to day healthcare needs.

Staff treated people with kindness, dignity and respect and respected their privacy. Staff developed good relationships with people and understood their needs and preferences. People were involved in their care and were supported to maintain their independence.

The provider had systems in place to investigate and respond to concerns and complaints appropriately.

The provider had systems in place to assess, monitor and improve the service. The provider also gathered feedback from people and staff and used this as part of impr