About the service:

Greys Nursing Limited is a domiciliary care agency. It provides personal care to people living in their own homes. Not everyone using Greys Nursing Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection the service was providing personal care to five people.

People’s experience of using this service:

People and relatives were generally satisfied with the care they received from regular staff who knew them well. However, people’s care records provided insufficient information about their care needs and preferences and the support they required from staff.

Medicines were not managed safely. There was a lack of documentation to show what medicines people were prescribed, who administered them and whether they had been taken.

Risks to people were not fully identified, assessed and recorded.

Systems in place to monitor and oversee the quality of the service were not effective as issues we found in relation to medicines, risk management and care planning had not been identified or addressed.

Staff were safely recruited and received the training and support they needed to undertake their role.

People and relatives said staff were kind and caring, treated people with respect and maintained their privacy and dignity. They said staff arrived on time and had enough time to provide support without rushing.

People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, person-centred care and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Good (report published 18 October 2016)

Why we inspected: This was a planned inspection based on the rating awarded at the last inspection.

Follow up: We will ask the provider to submit an action plan to show how they will make improvements. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Greys Nursing Limited on 26 September 2016. The provider was given three days notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to ensure the registered manager can be available.

The last full inspection took place on 27 June 2013, when we found the service was meeting the regulations we looked at.

Greys Nursing Limited is predominantly a nurse agency providing nurses and care workers to hospitals and the care sector. They are currently providing a domiciliary care service to six people in their own homes. At the time of our visit only two people were receiving a personal care service. It is the ‘personal care’ element of the service we regulate. There was 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 who used the service told us they felt safe with the care they received. We found there were appropriate systems in place to protect people from the risk of harm.

Robust recruitment processes were in place and followed, with appropriate checks undertaken prior to staff working at the service. This included obtaining references from the person’s previous employer as well as checks to show staff were safe to work in the care sector.

We found that people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs.

Staff had opportunities for on-going development and the registered manager ensured they received induction, supervision, annual appraisals and training relevant to their role.

The staff we spoke with were able to describe how individual people preferred their care and support delivered and the importance of treating people with respect in their own homes. We saw care plans were in place, which had been agreed with people using the service, to ensure people received the care and support they wanted.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005.

People received a consistent service from regular carers who they liked and found caring and helpful. People told us the registered manager was approachable and they would be able to talk to them if they had any concerns.

There were systems in place to get feedback from people who used the service to see if any improvements could be made and various audits to monitor the quality of the service.

At the time of our visit Greys Nursing Limited provided personal care to three people. All three people had complex needs which meant they were unable to speak with us about their experiences. We used a number of different methods to help us understand the experiences of people who used the service, such as reviewing care records and speaking with people’s relatives.

We spoke with the relatives of two people who used the service. They said staff respected their relative’s wishes and asked their relative’s permission before they provided support. One person said staff were “respectful and sensitive to my relative’s needs”.

Both relatives told us they were happy with the care and support the service provided. One said their relative received a “consistently good standard of care”. Another said it was a “really good service” and they felt their relative was “in safe hands” with Greys Nursing Limited staff.

We found there were appropriate arrangements in place for the management of medicines and staff were supported to deliver care safely and to an appropriate standard.

Both relatives we spoke with told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

We found that the provider was providing domiciliary care to two people. This meant that there were limited records for us to look at.

Both the people who had used this service had significant health problems which meant we were not able to speak to them to get their views.

Staff told us that there was some paperwork in place to help them meet people’s needs. One member of staff said that they used their past experience to help decide what they needed to do.

The agency had carried out their own compliance checks to make sure staff were suitable to work with people.

We saw evidence that the agency was developing quality systems to check care and records but there is no formal quality monitoring taking place.

We found that records were not sufficiently detailed to make sure people were not at risk of unsafe or inappropriate care.