About the service:

Battlefield Healthcare Limited is a domiciliary care agency. It provides nursing and personal care to people living in their own homes. Not everyone using the service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of this inspection 50 people were receiving assistance with their personal care needs.

People’s experience of using this service:

•People and their relatives were positive about the care and support provided. One person said, “The carers are brilliant. They are like friends to me.”

•Risks to people were monitored and procedures were in place to help keep people safe.

•There were safe systems for administration of people's prescribed medicines.

•People were supported by adequate numbers of staff who were safe and competent to work with them.

•People were protected from the risks associated with the control and spread of infection.

•Staff understood the importance of ensuring people's rights were understood and protected.

•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's health care and nutritional needs were monitored and understood by staff.

•People told us staff understood their needs and were kind, caring and compassionate.

•People had opportunities for social stimulation and were able to maintain links with the local community.

•There were effective governance systems in place to monitor and improve the quality of the service provided.

Rating at last inspection: The service was rated good at our last inspection (report published 2 August 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 23 June 2016 and was unannounced. At our previous inspection no improvements were identified as needed.

Battlefield Healthcare Ltd is registered to provide nursing and personal care to people living in their own homes. The service provides care to children and adults who may have a learning or physical disability, sensory impairment or dementia.

A registered manager was in post and was present during our inspection. 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.

People were supported to give their consent and make decisions about their day to day care. However, staff were not always clear on their responsibilities in supporting people who had no or variable capacity to make their own decisions. There was a risk people’s rights may not be promoted due to staff not having the information needed to inform them about people’s capacity to make their own decisions.

People were kept safe by staff who understood the risks associated with their care and support. Staff knew how to recognise when someone may be at risk of harm or abuse and knew how to report any concerns they may have about a person’s safety. People felt safe with the staff that supported them and were happy their property and personal possessions were kept secure.

People were supported by enough staff and were informed if staff were running late for their care call. People knew in advance which staff were providing their care and had the opportunity to request different staff if they felt they were not well matched with them.

People were happy with the staff that supported them and had confidence in their abilities. Staff received the training they needed to support people’s individual needs and this was kept updated. Where people needed support with eating and drinking staff provided this to make sure they had sufficient food and drink throughout the day. The provider worked with other healthcare professionals to make sure people’s healthcare needs were met.

People were kept involved in their own care and felt staff listened to and respected what they said. Staff found out people’s preferences and provided care and support the way people wanted it. People’s privacy and dignity was respected and they were supported to maintain their independence.

Staff were responsive to people’s changing needs and provided care that was personal to them and their specific needs. People had the information they needed to be able to raise concerns and make complaints. The provider sought people’s opinions on the care they received and used it to make improvements in the service they received.

People and relatives thought the service and staff were friendly, caring and fair. They felt listened to when they made suggestions for change and were happy that the provider responded to their comments. Systems were in place for the provider to monitor, assess and make improvements to the quality of the service that was provided.

People we spoke with were extremely complimentary about the service they received. One person told us it was, “A stroke of luck that I found them,” and that the service was, “Excellent, absolutely excellent”. Another person said that, “Nothing is too much trouble for them”. A relative of someone who received a service told us that they were, “Immensely impressed” with the staff.

Although people were very pleased overall with the service they received, two people mentioned that they sometimes had to explain their care needs to new staff. One person described this as, “A bit irksome”.

The staff we spoke with were generally satisfied with the support they received from the manager and the office team. Most staff we spoke with told us that they were often called by the office and asked to take on extra visits or shifts. Some staff said that they felt pressurised into agreeing to take on the extra work.

We found that care plans were comprehensive and person centred. We saw that the plans and associated risk assessments were regularly updated.

We saw evidence of a comprehensive training package, although one member of staff told us that the training sometimes lacked detail. An improved induction programme had recently been introduced for new members of staff.

We saw the provider’s complaints policy and procedure. People told us that they would be confident to speak with staff if they had a worry or concern.