This first comprehensive inspection took place on 05 and 07 December 2017 and was announced.

This service is a domiciliary care agency. It provides provides personal and on-going healthcare to babies, children and young adults with complex health needs in Nottinghamshire, Leicestershire and Lincolnshire. On the day of the inspection there were 23 people using the service.

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.

People's experiences of care were overwhelmingly positive. Relatives told us that staff were very kind, caring and compassionate and often went the extra mile to provide people with exceptional care. The staff were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations. People's care was personalised so that each person's support reflected their diverse needs. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with their families. Each person was treated as an individual and as a result their care was tailored to meet their exact needs.

There was a strong culture within the service of treating people and their families with dignity and respect. The staff and the registered manager were always available and listened to relatives and families and offered them choices and made them feel that they mattered.

Relatives felt that their family members were safe and protected from the risk of avoidable harm. Staff were knowledgeable about the risks of abuse and there were suitable systems in place for recording, reporting and investigating incidents. Risks to people’s safety had been assessed and staff understood the risks people could face because of their clinical conditions. There were sufficient staff employed to meet the range of care and support needs of people who used the service. Staff had been recruited using effective recruitment processes so that people were kept safe and free from harm. Medicines were administered, handled and recorded safely.

Systems were in place to ensure that people were protected by the prevention and control of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed with families and qualified healthcare professionals to ensure their care was provided in line with best practice and met their diverse needs. There were sufficient numbers of staff, with the correct skill mix to support people with their care. Staff received an induction process before they joined a care package and in addition they also received on-going training to ensure they were able to provide care based on current practice when supporting people.

People received enough to eat and drink and staff gave support when required. People were supported by staff to use and access a wide variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. People were supported to access health appointments when require and received continuing healthcare to meet their needs. People's care and treatment was provided once consent had been obtained in line with the relevant legislation.

Relatives and families were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people and families chose and preferred. Care plans were person centred and reflected how people’s needs were to be met. Records showed that families and rela