About the service: Nursing Solutions is a domiciliary care service that was providing personal care to 41 people aged 65 and over at the time of the inspection.

People’s experience of using this service: The service did not have a robust auditing system in place. Audits that were completed lacked detail and were not completed regularly.

The service did not have a clear or accurate oversight of safeguarding incidents. However, people we spoke with told us that they felt safe and staff were able to tell us how they would respond if they suspected abuse.

Risks were not consistently assessed and risk assessments were not always updated when something changed. This meant that records may not include details of the most recent level and types of risk. However, people told us that they felt the care they received was safe.

No evidence of capacity assessments or best interests was available at the time of the inspection. However, one person was assessed as lacking capacity to make some decisions and relevant assessments had not been completed. The record included details of how the person may be assisted to make their own decisions. This meant that although records were not complete, people were being supported to make their own decisions rather than decisions being made for them.

Although people had experienced missed visits, there was no effective system to monitor these so that causes could be identified and actions taken to prevent recurrence.

People told us that the service responded to their needs and that visits could be changed informally by ringing the office.

People spoke positively about the registered manager and management team. People told us that they could approach the registered manager and care staff with concerns or complaints when necessary,

People told us that they received care from staff who were kind and that care visits were completed by staff that they knew.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (March 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Follow up: We will review the report on actions the provider intends to take following the inspection. We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

We undertook this inspection of Nursing Solutions on 12 and 15 January 2018. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection. The service was registered to provide a regulated activity with the Care Quality Commission in August 2017. This was the service’s first inspection since registering and had not been previously rated.

Nursing Solutions provides personal care and support to older people in their own homes in the Weston-Super-Mare area. At the time of our inspection there were 30 people receiving personal care and support from the service.

A registered manager was in post at the time of our inspection. 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.

Audits were not fully effective in monitoring and improving the quality of the service provided. This was due to shortfalls found during the inspection relating to body maps, Mental Capacity Act records and analysis of incidents and accidents and complaints.

People felt safe and had regular staff who visited them. Medicines were administered safely although care plans required body maps of where staff should administer their creams. Risk assessments were in place to keep people safe. Staff were knowledgeable about identifying and reporting and safeguarding concerns.

People were supported by staff who had pre-employment checks undertaken on their suitability to work with vulnerable adults although one member of staff required a Disclosure and Barring Service check since working for Nursing Solutions.

People received support from staff who received training, supervision and an annual appraisal. All staff felt happy with the support from the manager and provider at the service. Staff supported people as directed in meeting people’s nutritional and hydration requirements. Staff enabled people to make their own decisions. However care plans had no information when people were unable to make decisions themselves.

People were happy with the care they received and felt staff were kind and caring. Staff were able to demonstrate how they promoted people’s independence and privacy.

Care plans contained important information about people and their lives. Where people needs changed the service was responsive to identifying this and ensuring appropriate referrals to health care professionals were made. People felt able to make complaints and there was a complaints policy in place.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.