We inspected this service on 2 and 3 May 2017. This was an announced inspection and we telephoned two days’ prior to our inspection, in order to arrange home visits with people. On our previous inspection on 16 April 2015 we rated the service as Good.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home across south Derbyshire and south Staffordshire.

There were two registered managers in the service who worked together to manage the service. 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 as staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. There were enough staff to keep people safe and to meet their needs. People received their medicine and were supported to apply any cream they needed to keep well. They received support to manage their health. Where needed, people were helped to prepare meals and had access to food and drink that they wanted.

Staff were kind and caring and understood people’s needs and listened to and acted upon their views. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. They had detailed support plan that recorded their preferences and likes and dislikes. People’s support records were regularly reviewed with they were included in the process. People’s privacy and dignity were maintained and they felt staff treated them with respect.

Staff completed an induction prior to commencing their role. They had the skills and training needed and their performance was regularly reviewed to enable them to support people effectively. People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. Checks were carried out prior to staff starting work to ensure their suitability to work with people.

People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. People chose how support was provided. The provider had systems in place to assess and monitor the quality of care. People were encouraged to give their feedback and this was used to drive improvements.

This inspection took place on 16 April 2015 and was announced.

Mediline Nurses and Carers Limited provides personal care, nursing and support to people who live in their homes in Nottinghamshire, Derbyshire and Staffordshire.

There were two registered managers at the service 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 told us they felt safe with the care provided and we found staff were knowledgeable about how to protect people from the risk of harm. Any risks to people’s health were identified and assessed in ways that did not restrict their choices or freedom. Risks that may affect the provision of services to people were also risk assessed with contingency plans in place. Staff recruitment and deployment was managed safely. Action plans were in place to retain existing staff as well as to recruit new members of staff. Procedures were followed to ensure people receiving medicines did so safely.

People’s consent to their care had not always been sought in line with legislation and guidance, in response, the provider took prompt action to rectify this issue. People were cared for by staff with the skills and knowledge to meet their needs, including how to support people with their nutrition and hydration needs. People’s other health care needs were met and they were supported to access other healthcare provision when required.

People were involved in making decisions about their care and the principles of dignity, respect and independence were integral to the care provided. People felt supported by kind and caring staff. Staff understood the value of their relationships with the people they supported.

People’s opinions were valued and sought by the service and led to developments and improvements. Complaints were dealt with openly and feedback was encouraged. People and staff knew how to make their views known. People’s views and preferences were central to the care and support provided and ensured they received personalised and responsive care.

The provider included people and staff in service developments and promoted an open, inclusive and accessible culture. All levels of management were visible and demonstrated accountability for their responsibilities. Arrangements to check on the quality and safety of people’s care were robust and effective.

We spoke with five people who used the service and three relatives.

People told us they were happy with the care and support they received, and felt that their needs were being met. Comments received from people included ‘’my care worker is excellent and meets my specific needs, I have been supported to regain my confidence and involvement in the community, the staff are friendly and helpful and I look forward to their visits, the staff look after me really well.’’

People found the service to be reliable as they received the help they needed at their preferred times. People usually received consistent care from regular staff who knew their needs. People said they liked the staff that supported them, and described staff as caring and good at their job.

People told us they had agreed to the care, treatment and support they received.

People felt listened to and able to express their views and raise any concerns with staff if they were unhappy.

Three relatives we spoke with told us they were happy with the care and support their family member received. Comments received from relatives included, ‘’I cant speak highly enough of the care my family member receives; I have full confidence in the staff team, I’m really impressed with the service, there is nothing to fault about the care, and the continuity of staff has improved and the care is really good.’’

During this review people told us they found the service to be reliable and they had received the help they needed at their preferred times. People said they were happy with the care and service they received. One person said ''I cannot fault the service, the staff do a good job and are friendly and helpful.’’ Another person told us ‘’the service is flexible and meets my needs’’. Relatives we spoke with said they were happy with the care and support their family member received.

People told us that staff respected their privacy, dignity and independence.

People felt listened to and able to express their views and raise any concerns with staff if they were unhappy.

During 2011 several relatives and people who used the service told us that they did not receive a reliable service and were not happy with the care provided.

We spoke with 30 people who used the service including several relatives. We also received 46 satisfaction surveys from people. People told us that they were generally satisfied with the care and the service. Some people were very complimentary about the carers and the care they received. Comments included “They all do a marvellous job. I’d be lost without them; I think I get an excellent service; they all seem well trained and professional.”

Most people said that they found the service to be reliable and flexible, as they usually received the help they needed at their preferred times from regular staff that were aware of their needs.

Records showed that on occasions, some people had not received care from regular staff. Some concerns were also raised in regards to late or missed calls. The service had taken action to address the concerns.

People’s care records were clearly set out and included essential information to ensure they received appropriate care.

Overall arrangements were in place to ensure that peoples' medicines were handled properly. Most people told us their medication was dealt with properly by carers. They also said that they received their medicines regularly and on time.

People said that they felt listened to and able to raise any concerns about the service with staff.

The service was generally well managed. The effect on people using the service was that they generally received consistent standards of care and service.