This inspection was announced and took place on 9, 10 and 29 February 2016. We told the provider one day before our visit that we would be coming to ensure that the people we needed to talk to would be available. At the last inspection in October 2013 the service was meeting the requirements of the regulations that were inspected at that time.

Essential Nursing and Care Services provides personal care and support to people who live in their own homes. At the time of our inspection they were providing 1400 hours of personal care per week to 210 people.

Essential Nursing and Care Services has 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that their care and support needs were met and that staff were kind, caring and respectful. People also said they felt safe and had confidence in the staff that worked for the service.

Staff knew people well and understood their needs. Care plans were detailed and regularly reviewed. This meant that there was always information for staff to refer to when providing care for people.

The provider had implemented satisfactory systems to recruit and train care workers in a way that ensured that relevant checks and references were carried out and staff were competent to undertake the tasks required of them. The number of staff employed by Essential Nursing and Care Services and the skills they had were sufficient to meet the needs of the people they supported and keep them safe.

People were protected from harm and abuse wherever possible. There were systems in place to reduce and manage identified risks and to ensure medicines were managed and administered safely. Staff understood how to protect people from possible abuse and how to whistle-blow. People knew how to raise concerns and complaints and records showed that these were investigated and responded to.

There was a clear management structure in place. People and care staff said was the managers were approachable and supportive. There were systems in place to monitor the safety and quality of the service.

During our inspection in July 2013 we found shortfalls in the way that care needs were assessed and planned for, the assessment and monitoring of the quality of service provided and standards of record keeping. This inspection was carried out to ensure that the service had made the necessary improvements to comply with the regulations.

We spoke with the registered manager and one member of senior staff. We also checked three care plans, other related records and reviewed the quality management systems of the service.

We found that care planning systems had been reviewed and new documentation had been introduced. This meant that people's needs were fully assessed and planned for. With regard to quality monitoring issues, we found that the service had reviewed their internal communications and recording of these. Monitoring of various aspects of the service to check that people had received the service they required had also been reviewed and increased. The standard of record keeping had improved and accurately reflected the care required, when and how it was provided.

This meant that systems were in place to ensure that care and treatment was fully assessed and planned for in a way that should ensure people's safety and welfare. Also, that the service had suitable systems in place to monitor the quality of the care provided and to ensure that it was supported by accurate record keeping.

This was an unannounced inspection of the service. We did this inspection because we had received information of concern from a local authority with regards to the agency's medicines procedures.

We met with four people who used the service as part of our inspection. We also talked with the relatives of two people who used the service. They told us that they had confidence in the agency's ability to meet their needs and spoke positively about the care workers who visited them. People told us that they felt they received the help they needed with their medicines.

Our inspection found that the agency had some procedures in place to promote the safe administration of medicines. Staff also received training to ensure they were competent to carry out this task. However, there were some gaps and inconsistencies in record-keeping which meant that it was not always clear that people received the help they required with applying creams. Also, records did not always evidence that medicines were being given as prescribed. We have made a compliance action for the agency to address these shortfalls to ensure that their procedures are fully robust and are consistently implemented.

We inspected Essential Nursing and Care Services as part of our planned programme of inspections. We also followed up on a compliance action which we set during our inspection in January 2013.

During this inspection we met with three people who used the service and spoke to three family members of people who used the service. People told us that care workers were kind and helpful. One person told us "I have never known a carer like this. They are so patient and kind”. Another person told us “I look forward to their visit, especially if xxx is on the rota, she is my ray of sunshine”.

During our inspection in January 2013 we found that the agency did not have effective recruitment procedures in place. This meant that the required checks on staff to ensure that they were suitable to work with vulnerable people had not always been carried out. We checked this during our inspection and found that newly employed staff had been properly checked.

We found shortfalls in the way people's care was assessed, monitored and delivered. People's needs were not fully assessed, and planned for. This placed people at risk of unsafe care.

Quality assurance systems were not being used effectively which meant the service had not identified for themselves the issues that we found during this inspection. We also found shortfalls in the record keeping of the service: staff were not keeping accurate records and some copies of records were not being stored appropriately.