This inspection took place on 14, 19 and 21 November 2018 and was announced. This service is a domiciliary care agency. Peach Nursing Limited is registered to provide personal care, treatment and support services to people in their own homes. It provides a service to older adults, people living with physical disabilities, people with sensory impairment and younger adults. At the time of the inspection there were 24 people using the service.

On 14 November 2018 we inspected Peach Nursing Limited office. On 19 November 2018 we visited people who used the service and on 21 November 2018 we spoke with people, staff and relatives to get feedback about the service provided.

The service had a registered manager, who is also the provider of 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 with complex neurological conditions were supported to live in their own homes by the service. The registered manager ensured that people were discharged safely from hospitals in to their own homes making all the necessary arrangements for people to receive seamless care from exceptionally well-trained staff and health care professionals involved in their care.

Staff received be-spoke training about each person before they started using the service and where possible supported people in the hospital or the health service they were using prior to being discharged home. This meant that people received safe and effective care immediately and their needs were fully met by staff.

The registered manager established close working relationships with lead neurologists, consultants, physiotherapists and GP`s involved in people`s care to ensure that people`s health care needs were fully met and people were safely cared for in their own homes.

People nutritional needs were effectively managed by staff both when people needed PEG feeds or any other diets which was based on their preferences or cultural needs.

People`s health and well-being improved due to the care and support they received, some people regained their independence and confidence; others had less infections and their condition stabilised which was significant due to the complexity of their medical conditions.

Risk assessments in place assessed risk to people as well as staff in terms of environmental factors and risk to people`s health and care they received. Risks were effectively managed and this protected people from the risk of harm. The registered manager regularly reviewed people`s care and support needs together with them or family members if appropriate. The service was flexible in increasing or de-creasing the support dependent on people`s needs.

People and where appropriate their families received clear information about what the service offered, costs involvement and clear agreements were signed by both the registered manager and the person commissioning their services. Each person had a bespoke care and support package. There was a team of staff allocated to each person which meant that people had continuity of care and support.

There were enough staff employed through robust procedures to meet people`s needs. Staff understood their roles and responsibilities. They were coached and mentored by the registered manager as well as had opportunities to develop their skills and careers further. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by staff who was kind, caring and delivered care and support to people in a respectful and dignifying way.

People and their relatives told us they were extremely happy with how they were supported and staff become part of their family. They also told us staff were sens

We carried out an announced inspection on 15 October 2015. Between this date and 23 October 2015, we spoke with people who used the service or their relatives and staff by phone.

The service provides care and support to adults in their own homes. People supported by the service were living with a variety of needs including chronic health conditions, physical disabilities and neurological disorders. At the time of the inspection, there were 25 people being supported by the service.

The service has a registered manager, who is also the provider of 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities to seek people’s consent prior to care being provided.

Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff that went over and beyond expectations of their role to ensure that people lived happy and fulfilled lives. Most relatives we spoke with had described the staff as being ‘part of the family’.

People were supported to pursue their interests and hobbies. Staff took pride in how they helped people to celebrate their birthdays and other important events.

People’s needs had been assessed, and care plans took account of their individual preferences and choices.

People were supported to access other health and social care services when required. Staff also supported people when they were being treated in hospital.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service.

The provider had effective quality monitoring processes in place.

We visited Peach Nursing Limited on 30 April 2013 as part of a scheduled inspection, but also to review improvements in the areas we previously found to be non-compliant.

During this visit, we saw evidence that the provider had addressed the concerns we had raised with them in relation to safeguarding processes and staff training and supervision.

Through our observations of telephone conversations with people who received care and their relatives, we found staff conveyed a professional and caring manner towards people.

We looked at the recruitment processes, including staff induction, and saw that the service aimed to provide a highly professional standard of care for people who received care and support. We were told by the manager that to ensure staff and the service could meet people’s needs fully, they were careful to ensure staff were selected to meet people’s needs. We noted that people in receipt of care were also accepted on a criteria basis following in-depth assessment.

We looked at the complaint processes within the service and saw these were robust. However, the complaints received were low in number. In comparison, we saw that a large number of compliments and thank you cards had been received by the service in response to the satisfaction of care provided for people.

We visited Peach Nursing on 16 October and 5 November 2012. We spoke with six relatives of people using the service. They told us how well their family members were treated and how their choices and independence were encouraged. We were told by all the people we spoke with that they and their family member had been involved in the development of their care plan.

People we spoke with said that staff were respectful and considerate. They felt able to express their views and talk about the care and support their relative needed. People we spoke with expressed confidence in the service to maintain improvements following a complaint.