The inspection took place on 18 and 19 April 2018. It was unannounced on the first day and announced on the second day. This was the first inspection at the service.

AMG Nursing and care Services is a domiciliary care service offering personal care and support to 96 adults within their own homes across the Cheshire West and Chester area.

There was a registered manager at the service at the time of our inspection. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Safeguarding policies and procedures were in place and staff had all received training. Staff demonstrated understood about the different types of abuse and were able to describe the process if they had to alert any concerns they had.

The recruitment procedures at the service were robust. Records showed that enough staff were employed to meet people's needs. All staff had undertaken a comprehensive induction and had completed shadow shifts with an experienced member of staff. Mandatory training was up to date and staff had undertaken additional training to meet people's individual needs. Staff received regular support and supervision and had their competency checked. This meant staff had the right knowledge and skills to support people.

The registered provider undertook an assessment prior to a person using the service. The information from this was used to prepare person centred risk assessments and care plans. People and their chosen relatives were fully involved in the assessment and development of their care plans. Regular reviewed were completed to ensure information remained up to date. Daily records were consistently recorded to reflect the support people had received.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

Medication policies and procedures were in place. Staff had completed training and been assessed as competent to complete this task. The service worked in accordance with best practice guidelines.

People received support from regular staff that they had developed positive relationships with. Staff promoted people's independence and offered them choice.

People described staff as kind and caring and told us they treated them with dignity and respect.

The registered provider had a complaints policy that was readily available for people and their relatives. People told us they felt confident to raise a concern or complaint and felt their concerns would be listened and responded to.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that the registered provider had policies, staff had received training and guidance was available for staff in relation to the MCA. Staff demonstrated a basic understanding of this topic.

The registered provider had regular audits in place as part of their monitoring systems. These identified areas for development and improvement within the service.

Up to date policies and procedures were available to support the running of the service and these were regularly reviewed.