About the service: The Independent Nursing and Care Agency (INCA) is a domiciliary care agency providing care and support to mostly older people who live in the community. At the time of our inspection there were 18 people using the service and receiving personal care.

People’s experience of using this service:

¿The registered manager did not ensure the management of medicine was safe at all times. They could not evidence that staff were assessed as competent to handle medicine.

¿The registered manager did not always record the way they reviewed, assessed and monitored the quality of service provided. They did not always record they had carried out audits to check the quality of service provision and people’s care records.

¿The registered manager encouraged feedback from people and relatives, which they used to make improvements to the service.

¿Not all staff had completed recent training refreshers as per their annual timetable. The registered manager had planned and booked training when necessary to ensure all staff had the appropriate knowledge and skills to support people. Staff had ongoing support, supervision and appraisals. They felt supported by the registered manager and senior staff.

¿We have made a recommendation that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

¿People felt safe while supported by the staff team who made them feel reassured. Relatives agreed with this.

¿Staff understood how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. The registered manager had the knowledge to identify safeguarding concerns and to act on these appropriately.

¿The service assessed risks to the health and wellbeing of people who use the service and staff. Where risks were identified action was taken to reduce the risk where possible.

¿People received care that was designed to meet their individual needs and preferences. 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 their privacy and dignity were promoted. People felt the staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to improve and maintain their independence with personal care.

¿Staff felt the registered manager was approachable and considerate. They had good communication, worked well together and supported each other. The registered manager praised the staff team for their hard work and appreciated their contribution to ensure people received the best care and support.

¿Recruitment processes were in place to make sure, as far as possible, people were protected from staff being employed who were not suitable.

¿The staff monitored people's health and wellbeing and took appropriate action when required to address concerns.

¿People's right to confidentiality was protected and their diversity needs were identified and incorporated into their support plans where applicable.

Rating at last inspection: At the last inspection the service was rated Good in all the domains (Report was published 05 October 2016).

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

Enforcement: Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor all information we receive about this service. This informs our ongoing assessment of their risk profile and ensures we are able to schedule the next inspection accordingly.

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

This inspection took place on 1 and 2 August 2016 and was announced.

The Independent Nursing and Care Agency (INCA) is a domiciliary care agency providing care and support to mostly older people who live in the community. At the time of our inspection there were 27 people using the service and receiving personal care.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Staff training records and the registered manager indicated which training was considered mandatory by the provider. Not all staff had completed recent training refreshers to ensure people were not at risk being supported by staff who may not have up to date knowledge and skills. However, this training had been booked for later in the year. Staff received supervision meetings with their manager. They felt supported to do their job and could ask for help when needed.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Staff numbers required to attend the visits were assessed according to people’s needs, staff skills and experience. Some people commented that the timings of visits were not always on time as specified in the care plan. However, people and relatives were complimentary of staff’s care and support.

People received their medicines when required and medicines administration systems were in place. People's health and wellbeing was monitored and appropriate action was taken when required. The provider carried out checks to ensure staff were of good character and suitable for their role.

People were treated with respect and their privacy and dignity was promoted. People said their care and the support workers were good and supported them in the way they wanted them to. Staff were responsive to the needs of the people they supported and enabled them to improve and maintain their independence with personal care tasks. Risks to people's personal safety were assessed and plans were in place to minimise those risks.

People received support that was individualised to their specific needs. Their needs were monitored and support plans were kept under review and amended as changes occurred. People's rights to make their own decisions, where possible, were protected. Staff were aware of their responsibilities to ensure people's right to make their own decisions was promoted.

Quality assurance systems were in place to monitor the quality of the service being delivered and the running of the service. The service made improvements to ensure people received the best support. Staff felt they worked well together with the management which benefitted people and communication and support was good.

This service is currently registered with the Care Quality Commission to provide the regulated activities of nursing and personal care. However, only the regulated activity of personal care was being provided during the time of our inspection.

During our inspection we found the provider had put measures in place to strengthen the recruitment, interview and selection process. This was to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care and treatment. These included a revision of the provider's recruitment, interview and selection procedures. They reflected the requirement to obtain a full employment history and seek explanations for any gaps found. Existing staff recruitment files were reviewed to ensure they recorded satisfactory explanations for any gaps in employment histories.

This service is currently registered with the Care Quality Commission to provide the regulated activities of nursing and personal care. However, only the regulated activity of personal care was being provided during the time of our visit.

We spoke with people who use the services and their relatives. They were complimentary about the care received. One person told us "this service is good for me. “ A relative said “it is a brilliant service. “

Care was planned with the involvement of the people who use the service and their relatives or advocates, and reflected their individual needs.

All the required information checks were in place prior to the employment of staff with the exception of full employment histories. The provider was unable to provide a satisfactory explanation for these gaps in employment histories. This meant the provider did not have an effective recruitment process, to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable.

There were systems for monitoring the quality and safety of services provided to people. This included recording and investigating complaints, and collecting feedback from people who use the service and staff. Where improvements to services were required, these were made.

People told us the agency was run efficiently and they received a reliable and flexible service, from kind, helpful and well trained staff. They told us staff treated them with dignity and respect and they felt valued. They told us they were assisted to make appropriate decisions and choices and their preferences and wishes were recorded in their care plan.

We spoke with six people who received a service and/or their relatives. One person told us the carers were, “All very good” and they felt they were receiving “Good care”. They said the staff team were, “Well trained”, "Very friendly and very kind". Another person said, "Absolutely brilliant, can't fault them at all. Never a miserable face, always kind, absolutely fine".

This inspection was carried out to look at new concerns raised with the Care Quality Commission (CQC) since our last inspection on 6 August 2013. Those concerns related to how the provider was making sure there were enough staff to meet people’s needs in their homes. Another concern related to whether the provider was recognising and responding appropriately to allegations of abuse. Concerns were identified in relation to how the provider responded to issues and complaints received from relatives of users of the service. Further concerns related to completeness and accuracy of people’s records and whether the provider was notifying the CQC of incidents such as the death of a service user whilst care was being provided by the service.

This service is currently registered with the CQC to provide the regulated activities of nursing and personal care. However, only the regulated activity of personal care was being provided during the time of our inspection.

We found the provider had put measures in place to ensure that users of the service were safeguarded against the risk of abuse by identifying and responding appropriately to incidents involving allegations of abuse. People who use the service told us they felt safe and they trusted staff. This was confirmed by their relatives we spoke with. One relative told us, “X always feels safe. They (staff) always introduce themselves to X.” Another relative said, “They (staff) are very gentle with X.”

There were sufficient numbers of appropriate staff to ensure that the health and welfare needs of people using the service were met. Care worker rosters showed there were enough staff to meet people's needs.

There were processes in place for recording, investigating and resolving complaints from people who use the service and their relatives. The people we spoke with were aware of who they would speak to if they had any complaints.

The provider reported the death of a person who used the service. It did so in line with regulatory requirements.

People’s records and other records relevant to the management of the service were accurate and fit for purpose. People's care documentation was stored securely in the office and accessible only by care workers and management.