This inspection took place on 8 November 2018 and was announced. Focused Healthcare Limited provides nursing and personal care for children and young people living in their own homes. This service is a domiciliary care agency. At the time of the inspection there were 80 people using the service.

There was a registered manager in post at the time of the inspection. The registered manager was not present during the inspection because they were on long term sickness leave. An interim manager was managing operational aspects of the service with support from the provider. 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 the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our last inspection the service had changed to a new registered provider.

At our last inspection on 31 March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Risks for people were identified by staff. Risk management plans contained sufficient information for staff to manage and mitigate those risks. However, people’s daily records were not always completed as recommended. Staff followed the provider’s infection control policy to reduce the risk of infection.

Medicines were managed and administered safely. There were established systems in place for the administration, storage and disposal of medicines. We found the quality of the medicine administration records were not robust because staff did not always indicate when medicines were given to people. Staff completed training in medicines management and had their competency assessed.

There were established safeguarding systems and procedures in place. Staff understood how to protect people from harm and abuse. Safeguarding training was completed by all staff which helped them to take appropriate action to manage any allegations of abuse. These concerns were reported to a manager and to the local authority for investigation.

Enough staff were available and deployed to provide safe care to people. Safer recruitment processes were used to ensure suitable office based staff, nurses and care workers were employed at the service. Pre-employment checks were returned before staff were approved as suitable to work with people.

Relatives said staff were caring. Staff delivered care, support and treatment in a compassionate manner to ensure people received dignified care while maintaining their privacy.

Staff continued to receive an induction, training, supervision and appraisal. Staff were encouraged to explore and reflect on their jobs.

People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible for people. The provider’s policies and systems in the service supported this practice.

Staff asked people for their consent before providing care and treatment. People’s choices and wishes were recorded in health and care needs assessments. Care records were completed with and signed by people and their relatives. People were provided with copies of their assessments and care plan so they were aware of the support provided to them.

People had the care and support they needed that valued their levels of independence. This helped people continue their education and to take part in activities they enjoyed. Staff met people’s end of life needs when they required this specialist care and support.

Staff completed shopping for people when this was needed. Staff supported people with maintaining their nutritional needs which supported their health care condition and met their preferences.

The provider had a complaints p

This inspection took place on 31 March 2016 and was announced. Focused Healthcare Limited provides nursing and personal care for children and young people living in their own homes. At the time of the inspection there were 86 people using the service.

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 2008 and associated Regulations about how the service is run.

People were protected from harm. The registered provider had safeguarding processes and guidance for staff to keep people safe from harm. Staff took action to manage an allegation of abuse and raised safeguarding concerns with the local authority. There was a whistle-blowing policy in place so staff could raise concerns about the quality of care at the service. Staff identified risks to people and a risk management plan put in place to reduce them.

The service had sufficient staff employed to ensure people received their care safely. The registered provider had processes in place to ensure safe and suitable recruitment of staff. The registered provider had systems in place to support staff. Staff had regular training, supervision, appraisal and spot checks to support them in their caring role. Newly employed staff had access to an induction suitable for their role.

Staff managed people’s medicines so they received them safely. we found the registered manager monitored the quality of care delivered to people through regular reviews of the service. Staff completed regular audits of medicine administration records (MAR) charts, to ensure their accuracy. However, the medicine audits did not identify the gaps in the MARs we found they did not have codes on them to explain the reasons for the gaps in these records. The registered manager had taken action by redesigning records to insure they contained accurate and up to date information

The registered manager and staff had an awareness of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People or their relatives were supported to consent to care, support and treatment and to make care choices and decisions.

People had sufficient food and drink, which met their needs and preferences. People had their nutritional needs met by staff that were familiar with their specialist diets. Staff sought healthcare advice and support for people when their health care needs changed.

People and their relatives were treated with kindness and compassion and staff respected people’s privacy and their dignity. Staff knew people’s needs and care, treatment and support delivered to meet them. People contributed to an assessment of their needs and a planned their care, support and treatment. The registered provider had a system in place for people to make a complaint about the service.

The registered provider had a system in place, which sought feedback from people and their relatives, and the registered manager analysed them and took actions when required. The registered manager was aware of their responsibilities as registered manager with the Care Quality Commission.