The inspection of the office took place on 05 October 2017 and on the 12 October 2017 we obtained feedback from people who used the service. The inspection was announced. This was the first inspection since the service was registered on 02 November 2016

District Nursing Herts Ltd is registered to provide personal care for people who live in their own homes. At the time of our inspection there were four people were being supported.

People gave consistently positive feedback about the service they received. People were supported to live their lives in a way which enabled them to maximise their enjoyment and fulfilment. Staff always went the extra mile to encourage and support innovation and demonstrated a positive ‘can do’ attitude. The service was supported by a team of professionals employed by the provider to enhance people’s experiences and ensure timely interventions when required. The provider and registered manager continually strived for perfection demonstrating an appetite to continually provide excellent person centred and bespoke care to individuals. They were continually experimenting with the use of IT to ensure people and their relatives were involved in the development and took ownership of different aspects which underpinned the ethos of the service.

The service had a registered manager who was also the provider’s director of nursing and clinical Development. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe and were protected from the risk of harm. Staff were aware of what constituted abuse and how to report and elevate any concerns. Risks to people's safety had been assessed and measures put in place to mitigate risks, where possible and people were encouraged and supported to remain as independent as possible. The provider used technology to help keep people safe. Staff had been recruited through robust recruitment checks and there were sufficient staff employed to meet the needs of people who used the service. People were supported to take their medicines safely by staff who had the necessary skills.

Staff had received a range of training to give them the knowledge and skills they needed to support people effectively. They were supported through regular supervision with their line managers and attended team meetings. People who used the service had consented to their care and were supported to make their own decisions. Staff were aware of the Mental Capacity Act 2005 and worked within its principles. People were supported to eat a range of meals and supported to drink enough to keep them hydrated. If there were any concerns about weight loss or gain they were referred for professional input from a dietician. People’s health and well-being was well managed and they had access to a range of healthcare professionals attached to the service.

People's experiences of the service were very positive. They told us they were supported by staff who often went the extra mile and who were caring and kind. People were at the hub of the service and their care was assessed and planned with their full involvement. People were treated with dignity and respect and their privacy was maintained.

People's needs were fully assessed and discussed prior to the service being provided. People received a personalised service which met their individual needs respected their choices and promoted their independence. Care plans were detailed, and provided staff with person centred information in a timely way. Care plans were reviewed regularly and whenever there was a change to the person’s needs or abilities.

The service was flexible and any additional support was provided where necessary. People knew how to make a complaint