This inspection was announced and took place on 17 November 2016. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure they were available.

AMG Nursing and Care Services provide personal care for people in their own homes. At the time of our inspection, there were 58 adults and eight children receiving personal care from the service. Personal care was provided for people with a range of health conditions or injury; often with related physical, mental or learning disabilities. Personal care was also provided for people living with a life limiting illness or receiving end stage of life care at home. There was a registered manager for the service at the time of this inspection. This is a person who has registered with the Care Quality Commission. They are responsible for the day to day management of the regulated activity of personal care at the service. Like providers, as a registered person they have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in August 2014 the provider was meeting the requirements of the Health and Social Care Act 2008 and related care standards.

People felt safe and were confident their homes and personal possessions were safe when they received care from staff at the service. People, relatives and staff were confident, knew how and were supported to raise any concerns they may have about people’s safety. The provider acted swiftly following concerns raised to ensure people were safe.

Overall people received timely care from staff who were safely recruited and deployed. Risks to people’s safety from their health conditions, equipment or environment assessed before they received care and regularly reviewed. Staff understood and followed people’s written care plans to provide people’s care in a way that helped to help mitigate any identified risks from this. This showed people were protected from the risk of harm and abuse.

The provider’s arrangements and procedures for staff equipment, instruction, communication and reporting procedures helped to ensure staff followed safe systems of care and related work practice. Staff were trained and understood the actions to follow where there was potential for medical emergencies to occur in relation to people’s health conditions. People’s medicines were safely managed.

Staff were trained, checked, supervised and supported to perform their role and responsibilities for people’s care. People, relatives, local care commissioners and community professionals were satisfied with care provision, which they often described as good or excellent. Staff understood people and children’s health and related, often complex personal care needs. People and children were effectively supported to maintain their health or nutrition by staff who understood and followed their related personal care plan requirements.

Staff understood and followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent or appropriate authorisation for their care. Staff supported people in a way that helped to inform, respect and follow their decisions about their care; and which enabled people and children’s rights and best interests.

People and children received care from staff who were kind and caring; treated them with respect; promoted their dignity, rights and choice in their care. This meant staff understood and followed the provider’s stated aims and values for people’s care, which aimed to ensure this.

People were informed and involved in planning, agreeing and reviewing their care in a way that was meaningful to them. Staff understood and followed what was important to people for their care and how their health condition and illness affected them. People receiving care and their relatives, felt they mattered.

People received individualised, timely and consistent personal ca

We spoke with two people who used the service who both told us that they were happy with their care. One person told us "they are polite and able to meet my needs". We spoke with two relatives of people who used the service. They told us "the staff are all excellent and they do an excellent job" and "the service has been brilliant, they are very accommodating".

We spoke with two staff members who both felt well supported in their roles. One staff member told us "they're a good company to work for".

We found that people had detailed care and support plans. These contained information about peoples like and dislikes and things that were important to them. However, we found inconsistencies in peoples care and support plans that meant that there was a risk that the care being provided did not meet people's needs and ensure their safety.

We saw that appropriate checks had been carried out on staff to ensure that they were suitable to carry out their roles. We saw copies of the providers safeguarding adults policy that provided staff with information about types of abuse and the reporting guidelines. We also saw that the provider had a copy of the local multi-agency safeguarding policy available that contained relevant contact details.

We were told that the agency had 57 carers and were providing care to 27 people.

We spoke with three people who used the service who told us that they were happy with their care. One person told us " they are caring and able to meet my needs." We spoke with two relatives of people who used the service. They told us "the care staff are all excellent and they do a good job.”

We spoke with three staff members who told us “they were well supported in their roles. One staff member told us " they're a good agency to work for andthat the management were.”

We found that people had detailed care and support plans. These contained information about peoples like and dislikes and things that were important to them.

We found that care plans and risk assessments are reviewed on a regular basis or when peoples care needs change ensuing their safety and welfare.

We saw that the manager had systems in place to monitor the quality of the service and that most areas were assessed and records kept.

We found that records and personal information on people was not stored correctly.