This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults. At the time of our inspection it was providing a service to five adults. One person was receiving care through private arrangements and four people were receiving care through the provider’s bridging service funded by the local authority and designed to enable people ready for hospital discharge to return home without delay.

First City Nursing Services-Cheltenham had 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.

The inspection took place on the 31 December 2018 and the 8 January 2019 and was announced. The service was previously rated 'Good' overall; at this inspection we found the service remained 'Good’.

We heard positive comments about the service from people and their relatives such as “Top marks” and “I would certainly recommend this company to other people.”

The service was outstandingly responsive to people's needs. People benefitted from a proactive and supportive approach to meeting their individual needs and enabling them to continue to follow their wish to live in their own homes. The service worked in a creative, co-operative and proactive way with commissioners of services, other service providers and voluntary organisations to ensure people and their relatives benefitted from joined-up care and support.

People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Staff were recruited using robust procedures.

People were supported by staff who had training and support to maintain their skills and knowledge to meet their needs. 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 were treated with respect and kindness and their privacy and dignity was upheld. People and their relatives were involved in the planning and review of their care and support. Concerns or complaints were investigated with lessons learned for improving the service.

Quality assurance systems were in operation with the aim of improving the service in response to people's needs. The management were approachable to people using the service, their representatives and staff.

Further information is in the detailed findings below.

We carried out an announced comprehensive inspection of this service on 3 and 4 March 2016. At this inspection we found that the service had not always recorded the lawful consent of people who did not have the mental capacity to consent to their care. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 21 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘First City Nursing Services Ltd Cheltenham’ on our website at www.cqc.org.uk’.

First City Nursing Services Ltd Cheltenham is a domiciliary care service which provides personal care and support to people of all ages with physical needs as well as people who have learning disabilities, mental health problems and sensory impairments. The service provides care and support to people who live in their own homes. The level and amount of support people need is determined by their own personal needs. We only inspected parts of the service which supported people with the regulated activity of personal care. At the time of our inspection there were three people receiving support with their personal care.

The service has a registered manager. 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 and associated Regulations about how the service is run.

At our focused inspection on the 21 March 2017, we found that the provider had followed their plan and the legal requirements had been met.

People’s care plans contained mental capacity assessments which clearly detailed where people could or could not consent to their care and documented other healthcare professionals involved in their care. Where people had the capacity to consent to their care, their consent and involvement was clearly recorded.

This inspection took place on 3 and 4 March 2016 and was announced. First City Nursing Services Ltd Cheltenham is a domiciliary care service which provides personal care and support to people of all ages with physical needs as well as people who have learning disabilities, mental health problems and sensory impairments. The service provides care and support to people who live in their own homes. The level and amount of support people need is determined by their own personal needs. We only inspected parts of the service which supported people with the regulated activity of personal care. At the time of our inspection there were seven people receiving support with their personal care.

A registered manager was in place as required by their conditions of registration. 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 and associated regulations about how the service is run.

People’s individual needs had been assessed before they started to use the service. Their support plans included information about how they preferred to be supported. People and their relatives had been involved in planning for their care. Their support plans gave staff details about how they preferred to be supported and cared for. Staff were knowledgeable about their needs, wishes and preferences. People’s risks had been identified and recorded to give staff guidance. The details of the lawful consent to receive care were not always evident when people could not make a decision about their care and support for themselves.

Appropriate referrals were made to specialist services and health care professionals if people’s needs changed. Some people required support in managing and administrating their prescribed medicines. Details of how people’s medicines which were prescribed to be used ‘as required’ are were not clear. We have made a recommendation about the management of some medicines.

People who received personal care in their own homes told us they felt safe amongst staff. They were visited by staff who had been trained and checked before they started to support people. Relationships between staff and people who use the service were friendly and warm. People were supported by staff who understood their needs and preferences to visit them regularly. Care was delivered in private and people were treated with dignity.

Recruitment checks had been carried out to ensure staff were suitable to work with people. Staff had been trained and supported to carry out their role. Staff rotas confirmed that there had been sufficient and regular staff to meet people’s needs.

People’s concerns were listened to and acted on. We were told complaints would be investigated and responded to in a timely manner in accordance with the provider’s complaints policy. The registered manager monitored the service and valued people’s feedback.

We spoke with three people using the service and relatives of people using the service.

Everyone we spoke to was complimentary about the standard of care. One person told us "they (staff) feel like a part of the family”. Another person told us “I’m very happy with them”.

People told us that their care plans reflected the care they received. One person told us "they know what to do when they come in”.

People told us that staff offered them choices in their daily routines and that they had all the information they needed. One relative told us “they make sure I’ve got everything about who to contact”.

People told us they had good relationships with staff and they felt staff had the skills necessary to do their jobs. For example, one person told us they felt staff were “very well trained”.

People received varying degrees of support with medication but everyone we spoke to told us this worked well. For example, one person told us “I have no problems with my meds”. Another person told us “I do the meds for myself and my husband at night and they help in the mornings”.

There was a quality assurance system in place and people told us they felt involved in their care and able to raise any concerns. One person told us "I’ve raised issues in the past with the manager and they dealt with it immediately".

When we visited First City Nursing Services we spoke to the manager at the agency, the care co-ordinator, the recruitment consultant and a care worker visiting the office. We also contacted a person using the agency, the relative of another person using the agency and another care worker by telephone.

The care plans gave staff detailed descriptions of what care people wanted. Daily records were also detailed and staff had recorded any changes. One person told us that the carers were competent and knew how to use the hoist equipment well. They told us, “overall I am happy”, with the agency.

One person told us they were able to call the agency and ask for time changes to fit in with their routine and they were always changed without hesitation. People always knew which care worker to expect and if they were any changes the agency notified them. A relative told us that they were “very happy with the care” and could contact the agency at anytime in 24 hours and they were always really helpful. The relative also told us that the agency takes any concerns raised seriously and will call or email information to them.

The agency only employs care workers with at least one year experience in care services. Recruitment records were complete and included a Criminal Records Bureau (CRB) check before care staff started work, then annually.

A person using the service told us that they are able to go out wherever they want to as staff can drive the adapted vehicle well.

They told us the agency is "good at sorting out concerns". They also told us that "the care plans are very good" and that they had helped the staff complete them.

A relative told us about the care staff, they said "they treat him well" and they felt the staff had a good relationship with the person. Another relative said, about a member of the care staff, "this one is very caring and committed".