We conducted an announced inspection of Parkgate Nursing Agency on 24 March 2017. We gave the provider 48 hours’ notice to ensure the key people we needed to speak with were available. At our last comprehensive inspection on 19 February 2016 we found one breach of regulations in relation to staffing. Following this we conducted a responsive inspection of the service on 4 August 2016. At this inspection we found improvements had been made in relation to staffing, but found the service was in breach of regulations in relation to safe care. At this inspection we found the provider was meeting this regulation.

Parkgate Nursing Agency provides care and support to people living in their own homes. There were 40 people using the service when we visited.

There was a registered manager 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.

Risk assessments and care plans contained detailed information for care staff. All records were reviewed within six months or sooner if people’s needs changed.

Care staff assisted people to take their medicines safely. Care workers told us they had completed medicines administration training and understood how to safely administer medicines.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated a good level of knowledge about their responsibilities under the Mental Capacity Act 2005. Care records demonstrated that people were provided with care after obtaining their valid consent.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. Care records contained a good level of detail about people’s needs and preferences.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision and appraisals of their performance. There were enough staff employed to meet people’s needs and visits were appropriately arranged to ensure people’s needs were met.

Care workers supported people to maintain a balanced nutritious diet where this formed part of the package of care being provided to them. People were supported effectively with their health needs and were supported to access a range of healthcare professionals.

People using the service and staff gave positive feedback about the registered manager and told us they provided feedback about the service. They knew how to make complaints and told us they felt listened to and there was a complaints policy and procedure in place.

The organisation had effective systems in place to monitor the quality of the service. The registered manager reviewed various areas of the service on a regular basis. Information was reported to the CQC as required.

We conducted an inspection of Parkgate Nursing Agency on 4 January 2016. At this inspection a breach of regulations was found in relation to staff training and support. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this area.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to the breach found. We also received some information of concern prior to our inspection which we followed up during this inspection. This report only covers our findings in relation to the above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parkgate Nursing Agency on our website at www.cqc.org.uk.

Parkgate Nursing Agency provides care and support to people living in their own homes. There were 26 people using the service when we visited.

There was a registered manager at the service. 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.

At our previous inspection we found that risk assessments and support plans were provided by the referring social worker. The managers of the organisation told us they visited people to assess whether the information they had been provided was correct, but they did not produce their own care plans or risk assessments. As a result we found some information had not been updated in one person’s care record. However, the registered manager confirmed that she had visited the person and that their needs had not changed. This was confirmed by the referring social worker after our inspection and we were sent a copy of their report with updated risk assessments. At our recent inspection we found the provider was completing some risk assessments. However, we found one example where a risk assessment had not been completed for one person who had an identified moving and handling risk and for one other person we found they had been provided with care and support for a period of three weeks and senior staff from the service had not visited the person to conduct any assessments which could have put the person at risk of avoidable harm.

The provider reported risks to relevant agencies such as the local authority and worked with them to help mitigate against possible risks. The provider also worked with other organisations such as the fire service and implemented advice from them to help protect people from harm.

At our previous inspection we found care workers training records were incomplete and care workers did not receive formal supervision or appraisals of their competence to carry out their roles to ensure any development needs were met. At this inspection we found supervisions were being conducted and these included a discussion of care workers training needs. Training records were clear and comprehensive and each care worker had a training plan that detailed what learning they were required to complete by the end of the year. Appraisals had not yet been conducted, but were planned for the end of the year.

During this inspection we found a breach of regulations in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an announced comprehensive inspection of this service on 28 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to medicines management and staff training and support. During this comprehensive inspection on 16 February 2016 we checked that the provider had followed their plan and to confirm that they now met legal requirements.

Parkgate Nursing Agency provides care and support to people living in their own homes. There were 26 people using the service when we visited.

There was a registered manager at the service. 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.

At this inspection, we found that improvements had been made so that medicines were managed safely but we found that there were still some improvements to be made in relation to staff training and support.

Care workers told us they had completed medicines administration training within the last three years and were clear about their responsibilities.

Risk assessments and support plans were provided by the referring social worker. The managers of the organisation visited people to assess whether the information they had been provided was correct, but they did not produce their own care plans or risk assessments. As a result we found some information had not been updated in one person’s care record. However, the registered manager confirmed that she had visited the person and that their needs had not changed. This was confirmed by the referring social worker after our inspection and we were sent a copy of their report with updated risk assessments.

Safeguarding adults from abuse procedures were documented and care workers understood how to safeguard people they supported. Care workers were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Care workers demonstrated a good knowledge of their responsibilities under the Mental Capacity Act 2005.

Care workers demonstrated a good knowledge and understanding of the people they supported, however, these details were not recorded in people’s care records.

People using the service and their relatives told us they were involved in decisions about their care and how their needs were met.

Recruitment procedures ensured that only care workers who were suitable, worked within the service. There was an induction programme for new care workers, which prepared them for their role. However, care workers training records were incomplete and care workers did not receive formal supervision or appraisals of their competence to carry out their roles to ensure any development needs were met.

There were enough care workers employed to meet people’s needs and where two care workers were required at a visit the provider ensured that this was always the case so that people’s needs were met safely.

People were supported to maintain a balanced, nutritious diet, where this was part of the package of care being provided to them. People were supported effectively with their health needs and were supported to access a range of healthcare professionals.

People using the service and care workers felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The provider’s systems for monitoring the quality of the service was not always effective. The registered manager reviewed all care records and daily notes completed by care workers, but this did not identify the issues we found. We saw evidence that feedback was obtained by people using th

This inspection took place on 28 January 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.

Parkgate Nursing Agency - 1 Boundaries Road is a domiciliary care agency providing personal care for people in their own homes. At the time of the inspection, there were 18 people using the service.

There was a registered manager at the service. 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 using the service and their relatives told us they felt safe receiving care from staff and had no concerns about their safety. They told us that the care workers were competent in carrying out their duties and followed safe methods when supporting them. Care workers respected people’s privacy and dignity. Some people told us that although their nutritional needs were met by the service, they were given limited choices and the quality of the food was sometimes basic. People were able to raise their concerns with the service and felt that the registered manager was approachable.

The provider followed robust recruitment procedures when appointing staff which included references, identity and security checks. Staff completed an induction which covered areas such as safeguarding, person centred care and effective communication.

Ongoing training was delivered mainly through DVDs and we found that it was difficult to track what ongoing training had been completed for staff apart from their induction. The provider had recently changed the way that training was delivered to make it easier to track the training of existing staff.

Although staff told us they felt supported, we did not see any evidence of formal appraisals that had taken place which were contrary to the provider’s own policy on supervision and appraisal.

We found that thorough risk assessments were carried out, in conjunction with an occupational therapist and a social worker. These considered people’s needs in terms of the moving and handling support needs and other areas. This meant the provider was able to make a judgement about whether people’s needs could be met. Risk assessments contained detailed notes, making use of pictures which helped to ensure that care workers had a complete picture of how to support people correctly.

Although staff supported people with their medicines, accurate records were not kept of when medicines were administered. We have made a recommendation to the provider about the safe recording of medicines.

Care plans were reviewed regularly and contained sufficient details for care workers to carry out their roles effectively. The provider worked well with healthcare professionals to provide a service that continued to meet people’s needs if there were any changes to people’s health, and appropriate referrals were made if required.

The provider carried out regular reviews of people’s views through the use of feedback surveys. Unannounced spot checks were also conducted and time was spent observing care workers performing their duties to monitor the quality of service.

Family members or carers told us that they were happy with the care and support they received from Parkgate Nursing Agency. Comments included "we are quite happy", "the carers are lovely, my relative likes them" and "yes I would recommend them to other people".

Feedback received from external professionals was positive about the service being provided particularly around the agency keeping both them and family members up to date with any changes or significant events. Comments included "information is always forthcoming" and "I find that they keep me updated about any changes". One commissioner told us "we use them for complex cases, their carers are very skilled in that area" and another professional reported "we are well satisfied".

We saw risks to people's safety and welfare were identified though assessments carried out by the agency. 'Job descriptions' were in place for each booked call that contained clear instructions for the carer as to the support required and had notes added as reminders for the staff member.

Comments from people who use the service and their family members included 'overall they are very good', 'I wouldn't change them' and 'very good'.

Feedback about the staff included 'the carers are nice people', 'very nice ladies' and 'I'm quite happy with them'. People told us that their carers came at the agreed times and would keep them informed if they were delayed for any reason.

The people we spoke with said they were happy with the service provided by the agency, and they liked the staff. One person said that staff were “usually late but always turned up."