We inspected AMG Nursing and Care Services – Crewe, on 24, 25 ,and 26 August 2016. As this was a domiciliary care agency service, we contacted the manager 48 hours’ before the inspection. This was so that we could ensure that staff were available at the office. At the last inspection in September 2013 we found the service met all the regulations we looked at.

AMG Nursing and Care Services (Crewe) is a domiciliary care agency that provides personal care for people in their own homes. The office is based in Crewe and is part of a larger organisation, AMG Nursing and Care Services that provides care in other areas of the UK.

The service did not have 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. There was a manager in post who had applied to register with the Commission.

We found that people were positive about the service that they received. They told us that they felt safe and well supported. We found that staff understood their responsibilities to report safeguarding concerns and to protect people from abuse or harm. Staff had received appropriate training and knew how to report concerns appropriately. However, not all staff knew where they could report concerns to outside of their organisation.

There were sufficient staff to meet the needs of people receiving a service. The service was recruiting new staff. People told us that staff always arrived on time and calls were not missed. The service had introduced a call monitoring system to support the monitoring of calls. However some people reported issues with the consistency of staff and said that many different staff provided their care. Other people told us that they had a regular small team of staff. The manager had taken steps to address people’s concerns about the consistency of staff.

We found that there were robust recruitment procedures in place. Medicines were administered safely. People were supported to take their medicines by staff as prescribed. However, the auditing of medication administration records needed to be more robust.

We found that staff were appropriately skilled and trained to meet people’s needs effectively. The manager told us that one of the service’s strengths was the training available to staff by qualified nurses, employed within the organisation. We found that staff completed a robust induction prior to starting work in the service. Staff received regular and on going training. However the service needed to ensure that all staff had completed specific training required to meet individual needs.

The provider had a policy on The Mental Capacity Act (MCA) that followed the relevant principles, however the management team had not ensured that this was fully implemented within its service, regarding appropriate mental capacity assessments. We recommend that the service finds out more about training for registered managers, based on current best practice, in relation to The Mental Capacity Act (2005) and adjust their practice accordingly.

People told us that staff were caring and treated them with kindness. We found that people and their relatives were very happy with the support that they received and told us that staff treated them with dignity and respect. Staff demonstrated a good understanding of the importance of treating people with compassion and dignity.

We found that people received care that was personalised to their needs. The majority of people we spoke with felt that the staff knew them well and knew how to support them. Care plans were thorough and person centred. They were reviewed on a regular basis and any changes to people’s needed were responded to appropriately.

People knew how to raise concerns and we

We visited one person who used the service and their relative in their own home. We spoke with two people who used the service and three relatives of people who used the service on the telephone. They all told us that they were happy with the support they received from the agency. One relative told us; "We have a lot of confidence in the Branch Manager - she does a good job." One person who used the service said; "They have been a great service and they were highly recommended to us."

We looked at consent issues and found that the service was working with the people and their relatives to ensure that the care was provided in the way they wanted and was consistently meeting people's needs.

We looked at the medication procedures in place and saw that people who used the service were supported with their medication by staff who were trained and followed the correct procedures.

We looked at the support that staff received. We looked at the systems in place and found that staff received various types of support which included regular supervision, a six monthly appraisal and all mandatory training as well as specific training to meet particular people's needs.

We looked at the quality assurance systems in place and saw that the service was carrying out sufficient checks to ensure that they were providing a good service.

We completed an unannounced inspection visit on 25 February 2013 to AMG Nursing and Care Services (Crewe). We spoke with four people who used the service and a relative who told us that they were happy with the care and the service they or their family member received. During our inspection we met the new manager and the Client Assessment and Health and Safety Manager and spoke with four staff members.

We reviewed three care plans and risk assessment documentation and found the care plans were drawn up with the people who used the service and their relatives and contained signatures to demonstrate this further. However, in one person's daily communication log we saw that some information about their care had not prompted a care plan review.

We spoke with four staff members and saw that staff received safeguarding vulnerable adults training as part of their induction process and that there was a thorough staff recruitment process and policy in place.

The people we spoke with told us they had no complaints or concerns they wished to raise and had an awareness of the complaints procedure. We found that some historic complaints from 2012 within the complaints log were not auditable on the day of the visit and requested that this information to be forwarded to Care Quality Commission following the inspection. We found that recent complaint documentation was auditable and contained the information expected.

We spoke to people who use the service and asked their views about how they and their relatives are involved in making decisions about their care and treatment and how the service is run.

People told us they have information about the service, which they keep in their home and they told us they are kept up to date with any new information by the staff that supported them.

They felt the standard of care provided by the staff was very good. People using the service and their relatives/next of kin told us that staff who support them treat them well and with respect.

However they also told us of problems they had encountered on occasions such as, staff being changed at the last minute and sometimes turning up late.

Two people felt one thing that could be improved was to have the same staff and felt that if they have the stability of the same staff it would help with the care and support needed for their relative. They suggested they should have the names of staff being supplied so they always knew in advance who was coming on duty.

Most people commented they were happy with the care they received and would tell someone if they were not. Everybody told us they would ask to talk to somebody in the office if they were not sure about the care and treatment received.

People who use the service made the following comments about the staff who supported them:

Three people said the staff were very good and know what they are doing.

“The staff are very good”

“…the staff are very helpful”

“…they have been very good, staff are very polite, clean, no trouble with the carers…”

“…the support has been excellent the staff are very good,,,,,,,,, the girls are first class, we don’t really have much to do to with the head office….”

“ We wouldn’t hesitate to recommend them.”

‘If we have the same staff sent it makes it a lot easier…. we do get different staff and this can affect the care and the stability….”