First City Nursing Services Chippenham is a domiciliary care agency which provides nursing and personal care and support for people living in their own homes in the Chippenham area. At the time of our inspection four people using the service were receiving the regulated activity of personal care.

We carried out a comprehensive inspection on 22 December 2016. The inspection was announced which meant the provider was informed in advance that we would be visiting. This was because the service is provided to people in their own homes and we wanted to make sure the registered manager, or someone acting on their behalf, was available to support the inspection.

There was a registered manager in place at the time of 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’s needs were assessed before they started to receive support from the service. People and their relatives were involved in the planning and reviews of care, were supported to make decisions, and were given the opportunity to provide feedback on a regular basis.

Systems were in place to manage risks and protect people from abuse. Staff had received training, were aware of their responsibilities and knew what actions they needed to take to make sure people were protected.

Recruitment checks were in place to make sure staff were suitable for their role. Staff received training to make sure they had the appropriate skills, knowledge and experience to provide the care people needed.

Staff understood how to support people with personal care whilst maintaining their privacy, dignity and independence. One person told us, “I can’t fault the service at all, it’s perfect.”

People’s concerns were listened to and acted on. A complaints procedure was in place, and we were told that complaints would be investigated and responded to in accordance with the provider’s policy.

Robust systems were in place to assess, monitor and mitigate risks to people and to improve the quality of the service provided.

We spoke with three people who received support and a relative. Each person told us they chose to use this service. One person added that they had heard good things about them beforehand. A relative said the carers were "excellent" and added "they're a lovely bunch and they are always so happy".

People told us they were involved in planning their care and were happy about the care they received. They each told us that their needs were being met and that they had no complaints. They added that staff them knew them well and treated them with kindness. One person told us "they always arrive with a smile". Another person said "they're so efficient, and do things so quickly, sometimes".

During our visit, we spoke to the registered manager, their deputy and three employees. Each of the employees said that they felt supported by the managers. They also told us they received a good amount of training. One employee told us "the training is very good and useful for the people we work with". Another told us about their induction, and said "this work was new to me, so I found the induction really useful".

There were systems in place that protected people from abuse. People we spoke to said they felt safe when the carers visited. One person told us "they're a lovely bunch and they make me feel nice and safe every time they come in".

The service sought out the views of people and their relatives regarding the quality of care, and looked to improve wherever possible.

We spoke with three people who received a service from first City Nursing. They all chose to use the agency and one person said that they had done so because it had been recommended to them. One person described “an excellent service” that “would never let you down”. They all told us their needs were being met, had no complaints but would know what to do if they did so.

The office staff cooperated during our inspection and the care staff we spoke with were happy to talk with us. They said they felt supported, appreciated the training opportunities available and appreciated the feedback they received.

People were given appropriate information about the service provided, were consulted and involved in planning thier care. People were happy about the care they received that was documented, evaluated and reviewed. Arrangements were in place to ensure that people were protected from abuse.

Staff were supported to carry out their work. There were training and development opportunities and careful monitoring of staff performance. the provider used this and other measures to monitor the quality of service including reviewing complaints as they were made.

People told us about how the agency understood about their individual care needs. One person said “they do everything I ask, they come at the right time, fit in with my family and are always here when they need to be”. A relative said that their relative’s care plan was regularly reviewed and changed when needed, as their relative’s condition was changing. A person said they appreciated the way that care workers “hold back and let me do the things I can do”.

People told us that the agency was interested in them as individuals. One relative told us they were “impressed” with the respect the agency had shown their relative when they assessed their needs. A relative said that they found that the agency were very “concerned” about the person and made sure that they provided care in the way that the person wanted, respecting the person’s changing wishes and needs.

People told us that they liked the staff. One relative told us that the person “likes them very much”. Another person described the managers as “nice and efficient”. A relative said that the agency “are very good at communicating, they e-mail me and ring me about all sorts of things and any change.” People said that the agency’s systems supported their relative. One person said “they write everything down, so I know they’ve been taken” about their relative taking their tablets. Another person told us that if there needed to be a change of care worker, they were always told about this, but they did not mind the change “as I know them all anyway”.