We carried out this inspection on 18 September 2018. The inspection was announced a few days in advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. At the last inspection, in April 2018, the service was rated Good. At this inspection we found the service remained Good.

Right Nurse Care Services provides personal care to people living in their own homes in the community. Services are provided across Cornwall to adults of all ages who have a range of complex needs, including physical disabilities, learning disabilities, mental health needs and dementia. At the time of our inspection the service was delivering 475.5 hours per week for eight people. These services were funded either privately, through Cornwall Council or NHS funding.

People were unable to us about their experiences of using the service due to their complex health needs. However, people’s families told us they were happy with the care their relative received and believed it was a safe reliable service. Comments included, “The service is very reliable and I am confident that the team can deal with any unforeseen circumstances” and “Very happy with the service provided.”

People were treated respectfully and staff asked how they wanted their care and support to be provided. Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. People who needed help taking their medicines were appropriately supported by staff.

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person.

People were supported by dedicated staff teams who were employed and trained to work specifically with each person using the service. There were suitable arrangements in place to cover for staff absences, this included office staff covering shifts and a group of care staff who had been trained to work in multiple teams. Relatives told us, “The team are very ‘stable’ and dad is very familiar with them all” and “Generally speaking there is a consistent team caring for my sister, some of whom have been doing it for years.”

The service acted within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

The service had robust recruitment practices, which meant staff were employed suitable to work with vulnerable people. Training records showed staff had been provided with all the necessary training which had been refreshed regularly. Staff told us they found the training to be beneficial to their role. Staff said they were encouraged to attend training to develop their skills, and their career.

Staff told us they enjoyed their work and received regular supervision, appraisals and training. Staff were complimentary about the management team and how they were supported to carry out their work. The management team were also clearly committed to providing a good service for people.

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service p

This inspection took place on 01 April 2016 and was announced. This meant we gave the provider notice of our intended visit to ensure someone would be available in the office to meet us. The service was last inspected in November 2013; we had no concerns at that time.

Right Nurse Care Services is a domiciliary care provider based in Cornwall providing personal care and support to people in their own homes. On the day of the inspection nine people were receiving a service. Right Nurse Care Services support people who have complex needs and support packages ranged from four hours a day to twenty-four hour support. People using the service had varied health care needs including physical disabilities, learning disabilities, mental health needs and dementia.

The service had a registered manager in place. 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.

Relatives told us they felt the care and support provided by Right Nurse Care was safe. Comments included; “I’ve no qualms about that [the person’s safety]” and, “She is totally safe with them.” An external healthcare professional told us; “I would certainly consider them safe.”

Staff had received training in safeguarding adults and children and were aware of the service’s safeguarding and whistleblowing policies. Information on how to raise a concern was available on notice boards in the office and on-line. The organisation’s safeguarding policy contained the most up to date information for local reporting procedures.

Care plans contained associated risk assessments for a range of areas. Where people had been identified as being at any increased risk more detailed assessments were put in place to address the area of concern. The registered manager continually re-assessed people’s circumstances to help ensure that people were kept safe while maintaining their access to full and meaningful lives.

There were sufficient numbers of staff available to keep people safe. The service recruited staff to match the needs of people using the service and new care packages were only accepted if suitable staff were available and when current packages were clearly established. There was a robust recruitment process in place to help ensure staff had the appropriate skills and knowledge required to meet people’s needs.

People received care from staff who knew them well, and had the knowledge and skills to meet their needs. Staff normally only worked with two or three people at any one time. This meant they were able to get to know people and their support needs well. Staff told us; “You can get to know people really well and give continuity of care. It’s what people want.”

Staff were supported by a robust system of induction, training, supervision and appraisal. Team meetings were held regularly to allow staff to raise any areas of concern. Staff and management emphasised the importance of creating and maintaining clear and open lines of communication.

The registered manager had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Staff spoke of the importance of ensuring people were supported to make decisions and their right to do this even if staff considered the decisions to be unwise.

Relatives were highly complementary about staff and the support they received from Right Nurse Care Services. Comments included; “It’s been an absolute saviour, brilliant!”

People’s relationships with friends and family were recognised and respected. When people did not have family to support them efforts were made to ensure they received independent support from a local advocacy

We spoke with five people who used the service or their relatives by telephone during the inspection. The people we spoke with were highly complimentary of the care they had received from Right Nurse Care Services. Comments included, “brilliant, I am very very impressed”, “they are amazing, they have worked extremely hard at understanding the needs of my parents”, “splendid, I am very pleased with them” and “the quality of carers in the team is exceptional”.

People’s privacy, dignity and independence were respected and care was planned and delivered in a way that was intended to ensure people's safety and welfare.

People’s health, safety and welfare was protected when more than one provider was involved in their care because the provider worked in co-operation with others.

The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.