We undertook an announced inspection of A1 Medical & General Ltd on 5 August 2018. We gave the registered manager short notice that we would be coming because the location provides a domiciliary care service and we wanted to ensure the registered manager was available.

A1 Medical and General is a nurse agency providing nursing and care services to private and NHS hospitals, prisons, nursing and care homes. The service is also registered to provide domiciliary care services and supported living services. The office is based in Doncaster and is close to public transport links.

Not everyone using A1 Medical & General Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was supporting two adults and two children with their personal care needs.

The last inspection of A1 Medical & General Ltd was on 1 September 2016 when the service was rated ‘Good’. At this inspection the service was rated ‘Requires Improvement’. This is the first time the service has been rated 'Requires Improvement'.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Although staff were aware of potential risks to people who used the service and others, information regarding risks was not available in people’s homes. This meant staff had no guidance to refer to and assist them with making decisions about risks.

People told us they felt safe in the care of the staff. Staff had a good understanding of abuse and their responsibilities in keeping people safe. However, safeguarding concerns were not always reported through the agreed safeguarding protocols to ensure people were protected from abuse and avoidable harm.

Our observations evidenced there were enough staff on duty to meet people's individual needs.

Checks were carried out prior to staff being offered a job at the service which helped to ensure people being employed were of good character.

Staff worked effectively with other organisations to ensure people's needs were met. People were referred appropriately to health care services if their care needs changed. However, a detailed written plan of care for staff to read and refer to was not available in each person’s home.

Staff were supported to receive the training and development they needed to care for and support people's individual needs. However, staff were not provided with a planned programme of one to one supervision and felt the support they received from the registered manager had recently deteriorated.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were positive about the care they received from the care workers and told us the staff were kind. Staff were cheerful and treated people with respect and kindness throughout our inspection. Healthcare professionals spoken with talked positively about the quality of care provided to people and said they had no concerns about this service.

The registered manager ensured regular staff who were known to people would attend visits which meant consistent care and support was provided to people.

There was a system in place for people and their advocates to report their concerns. People told us they could talk to the care workers about any worries or concerns and these would be dealt with quickly.

The registered manager had a good insight into the quality of care

We undertook an inspection of A1 Medical and General Ltd on 1 September 2016. The inspection was announced, meaning we gave the provider notice of our visit. This is in line with our current methodology for inspecting this type of service. At our last inspection in May 2013, the service was meeting the regulations we inspected.

A1 Medical and General is a nurse agency providing nursing and care services to private and NHS hospitals, prisons, nursing and care homes. The service is also registered to provide domiciliary care services and supported living services. The office is based in Doncaster and is close to public transport links.

At the time of our inspection five people were receiving a service which included or was likely to include personal care. This was part of a ‘short break’ scheme provided to young people and their families. Staff from the agency were booked for sessions of around three hours, spending time with a young person in their family home, or more often accompanying them out for activities in the local community. These sessions usually took place once or twice a week, and sometimes more often during school holidays.

There was a registered manager in post. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe and free from harm. There were appropriate numbers of staff employed to meet the young people’s needs and provide a flexible service.

Staff received regular training relevant to their roles and responsibilities. They had the skills, knowledge and experience required to support the young people with their care and support needs.

Staff knew the young people they were supporting well and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People told us they liked the staff and looked forward to them coming to their homes.

The young people were provided with appropriate support to eat and drink. Staff supported people to have access to healthcare services, when required.

Members of the management team were accessible and approachable. Staff, the young people who used the service and their relatives felt able to speak with them and provide feedback on the service.

As part of the inspection we spoke with two people’s close relatives by telephone to seek their views. They told us they were very happy with the care and support provided. The agency regularly supplied staff for a supported living scheme managed by a local authority. We spoke with the manager of the commissioning team. They said the service from the agency was ‘Excellent.”

People's views and experiences were taken into account in the way the service was provided. The parents we spoke with said the nursing and care staff were ‘Excellent.”

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People said that the nursing and care staff respected their dignity and encouraged them to be as independent as possible.

The provider had an effective system to regularly assess and monitor the quality of service that people received.