This announced inspection took place on 3, 4 and 9 October 2018. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone would be available to speak with us. The last comprehensive inspection took place in June 2016 when we found one breach of the legal requirements in relation to good governance. At a follow up inspection carried out in February 2017 we found improvements had been made but we wanted to see that these were sustained. At this inspection we found that improvements had been sustained with some work still needed in this area, which the registered manager acknowledged.

Nation Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people including those living with the experience of dementia, those with mental health needs, with a sensory impairment, with drug/alcohol dependencies, younger adults and people with a physical disability and/or learning disabilities. The service offers support to people who require help with day to day care including personal care, meal preparation, cleaning services and companionship. When we inspected, the service was supporting 84 people with their personal care needs.

The service is required to have a registered manager and there was one 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.

The quality assurance processes in place were being used and work was ongoing to ensure these were used robustly so shortfalls were always identified and promptly addressed.

People and relatives felt staff maintained people’s safety when providing them with care and support.

Policies and procedures for safeguarding people were in place and the care workers and office staff knew how to report any suspicions of abuse including reporting to the local authority safeguarding team.

Individual and environmental risks were assessed and identified so action could be taken to minimise any risks.

The provider completed recruitment checks to help ensure prospective care workers were suitable to work with people. There were enough staff employed and deployed to meet people’s needs and systems were in place to provide people with consistent care workers wherever possible.

Staff who supported people with their medicines had received relevant training and knew how to do so safely. Staff and relatives confirmed that infection control procedures were followed to protect people from infection risks.

People were assessed to identify their needs and wishes and care plans drawn up to meet these. Staff received training to provide them with the knowledge and skills to care effectively for people’s individual needs.

Staff prepared simple meals and knew to report any concerns around people’s nutritional intake so this could be escalated to healthcare professionals, where required. Staff described the procedures they would follow if someone was unwell to include summoning healthcare professionals and the emergency services if required.

The registered manager understood their responsibility to act within the requirements of the Mental Capacity Act 2005 and to provide care and support in people’s best interests.

People and relatives said the staff were kind and caring and understood people’s needs and wishes. They confirmed that staff were respectful towards people using the service. Staff encouraged people to maintain as much independence as they could and respected their right to choose the care and support they wanted to receive.

Personalised care records reflected the care and support people wanted to receive. This included inform

This announced inspection was carried out on 28 February 2017. This announced inspection was carried out on 28 February 2017. We contacted the registered manager one hour prior to the inspection because the location provides a domiciliary care service and we wanted to check the registered manager would be available to meet with us. The last inspection of the service took place on 1, 3 and 8 June 2016. We rated the service as Good overall but identified one breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 as the provider did not always operate systems and processes effectively to monitor and improve the quality and safety of the services provided. These particularly related to a lack of audits of medicine administration records and of daily logs.

At this inspection we checked the auditing being carried out for MARs and daily logs and saw this was taking place and the majority of issues had been followed up and improvements made. This meant that the provider was now meeting legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ’Nation Care Agency’ on our website at www.cqc.org.uk.

Nation Care Agency provides a domiciliary care service for adults with a range of needs. The service offers support to people who require help with day to day routines including personal care, meal preparation, light housework, shopping and companionship. At the time of our inspection there were 85 people receiving personal care.

The service is required to have a registered manager and there was one in post. 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.

Improvements had been made in the auditing and monitoring of documentation including MARs and daily records and action taken to address shortfalls identified.

The inspection was carried out on 1, 3 and 8 June 2016 and the inspection was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure someone would be available to speak with us. Telephone calls to gain feedback about the service from people and relatives were made on 6 and 7 June 2016.

The last inspection took place on 23 January 2014 and the service was compliant with the regulations we checked.

Nation Care Agency provides a domiciliary care service for adults with a range of needs. The service offers support to people who require help with day to day routines including personal care, meal preparation, light housework, shopping and companionship. At the time of our inspection there were 84 people receiving personal care.

The service is required to have a registered manager and there was one in post. 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.

Some aspects of the service were not monitored effectively so shortfalls were not being identified and addressed in a timely way.

Risks were assessed and action plans put in place to minimise them. Staff knew when to summon the emergency services if someone was unwell.

Procedures were in place and being followed by staff to safeguard people against the risk of abuse.

Staff recruitment procedures were in place and being followed. There were enough staff to meet the needs of people using the service.

Staff understood medicines management procedures and provided the support people required to take their medicines safely.

Infection control procedures were in place and being followed to minimise any risks to people and staff.

Staff received training and supervision so they had the knowledge and skills to provide the care and support each person required.

Staff understood and respected people’s rights to make choices about their care and knew to act in their best interests.

People were supported to maintain their nutritional intake. Staff recognised changes in people’s healthcare needs and knew the processes to follow to ensure input from healthcare professionals was sought in a timely way.

People told us staff treated them with dignity and respect and maintained their privacy. Staff took the time they needed to give people the care and support they required.

Care records reflected people’s individual needs and wishes and staff understood these and cared for them in a person-centred way. People’s care and support was planned and reviewed when any changes were identified so people’s needs continued to be met.

Procedures for raising complaints were in place and people and relatives said they would be confident to raise any concerns so they could be addressed.

People and relatives could contact the service easily when necessary and care staff said the registered manager and senior staff were supportive and approachable.

The registered manager accessed good practice guidance to enhance the service provision and keep up to date with the care sector.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with five people using the service or their representatives, four care workers and the agency’s registered manager, field coordinator and business development manager.

Most of the people using the service told us they were happy with the care and support they received. Their comments included “they are very well trained and really know what they’re doing” and “they give me the help I need, they are very good.” However, one person did comment “it didn’t start well but it has got better. The carer was often late but the last couple of weeks have been OK. The carer is excellent with my [relative], it was just the punctuality.”

We looked at the care plans for four people using the service. We saw people’s care plans detailed their health, social and personal care needs and the support care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse.

We looked at the recruitment records for four care workers and saw the provider carried out pre-employment checks to make sure new staff were suitable to work with people using the service.

There were procedures in place to monitor the quality of services provided. The provider carried out regular audits and people using the service were asked for their views on the care and support they received.