Network Healthcare Professionals is registered to provide the regulated activity of personal care and treatment of disease, disorder and injury. The service is a domiciliary care service, providing care and support to people in their own homes. It provides services to older people, younger physically disabled adults with complex care needs and those requiring palliative and end of life care. Care and support was delivered to people from three separate teams within the service – the domiciliary care team, the palliative care team and the complex care team.

Domiciliary care and palliative care was currently provided to people in the south area of Bristol. At the time of this inspection the complex care team were supporting people in Bristol and Gloucestershire.

There were two registered managers in post. One registered manager was responsible for the domiciliary and palliative care teams and the other was responsible for the complex care team. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 inspection was announced. We gave the registered manager 24 hours’ notice of the inspection. We did this to ensure key staff were available for the inspection. At the time of the inspection the service were supporting eight people with complex care needs, six people who were near the end of their life and 53 people with personal care. The service employed in total 115 staff.

The service people received was safe. There were effective safeguarding systems in place. Staff knew what to do if safeguarding concerns were suspected or witnessed or a disclosure had been made to them. Safeguarding training was part of the provider’s essential training programme. Any risks to people’s health and welfare were assessed and management plans put in place to reduce or eliminate that risk. There were sufficient numbers of care staff employed to meet people’s needs. Each person supported by the complex care team had their own team of staff who had received person-specific training to ensure they could look after the person safely. There were safe recruitment procedures in place, pre-employment checks were robust and ensured only suitable workers were employed.

Where people were supported with their medicines this was done safely. Staff received safe administration of medicines training and their competency to support people properly was reviewed. The staff took appropriate measures to prevent and control any spread of infections.

The service people received was effective in meeting their needs. People’s needs were assessed prior to a service being delivered. This was to ensure the service had the capacity to meet their specific care needs. For those people with complex care needs, a staff team was recruited and led by a care manager (qualified nurse) and team leaders. Staff in all three teams were well trained and well supported by the management teams.

People were supported with meal preparation where this had been identified as one of their care and support needs. Care staff monitored those people where the risk of malnutrition and dehydration had been identified. People were supported to access any health care services they required.

People’s capacity to make decisions for themselves regarding their care and support was assessed and kept under review. The staff were aware of the principles of the Mental Capacity Act 2005 and understood their roles and responsibilities in supporting people to make their own choices and decisions.

People received a caring service and the staff treated them with kindness. The feedback we received fro

We undertook an inspection on 12 and 13 April 2017. The inspection was announced, which meant the provider knew we would be visiting. This is because we wanted to make sure the provider, or someone who could act on their behalf, would be available to support the inspection. The last full inspection took place on 15 March 2016. We found one breach of the regulations of the Health and Social Care Act 2008 relating to staffing. We also found one breach of the CQC (Registration) Regulations 2009 relating to their statutory duty to notify CQC of incidents. These breaches were followed up as part of our inspection.

Network Healthcare Professionals Limited provides personal care to people living in their own homes in the Bristol, Bath and North East Somerset areas. At the time of our inspection the service was providing personal care and support to approximately 155 people.

A registered manager was not in post at the time of 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. A manager has recently been appointed and they confirmed that they intend to submit their registered manager’s application to CQC for consideration.

In March 2016 we found that the provider had not ensured that staff had knowledge and training required on the Mental Capacity Act (MCA) 2005. Staff had not received appropriate support in terms of supervision and appraisal to be effective in their roles. We found sufficient improvements had made.

In March 2016 the provider did not notify CQC of all relevant incidents that affect the health, safety and welfare of people who use the service, as required. We found sufficient improvements had been made.

The provider operated safe recruitment procedures and ensured all pre-employment requirements were completed. Staff had received appropriate training to identify and respond to suspected abuse.

People’s rights were in the main upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

People felt they received good care from staff and that staff were confident and knowledgeable when providing their care.

Records showed that staff liaised with other healthcare professionals when it was appropriate to do so. This helped to ensure that there was good communication and sharing of information about the person’s care needs.

People generally spoke positively about the staff and told us they were caring.

People told us the service was responsive to their needs. Before people commenced a care package with the agency, a full assessment of their needs was carried out by a care quality assessor. This included gathering full information about the person’s needs and their views on the kind of support they wished to receive.

There were systems in place to respond to complaints and this was set out in a written policy. We saw that the concerns outlined in the complaints had been responded to comprehensively. They were dealt openness and transparency, with apologies made where appropriate when the service had not performed as expected .

There were systems in place to monitor the quality of the service provided by the agency. There were quality audits in place reviewing spot checks, supervisions, training, Mental Capacity Act register, appraisals and falls management. Where improvements could be made action plans were implemented.

People were given the opportunity to feedback their experience of the service through care planning reviews and surveys.

We undertook an inspection of Network Healthcare Professionals Limited on 15 March 2016. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection. When the service was last inspected in May 2014 no breaches of the legal requirements were identified.

Network Healthcare Professionals Limited provides personal care and support to people in their own homes in Bristol and Bath and North East Somerset. Network Healthcare Professionals Limited provides care and support to older people and to people who are living with dementia. At the time of our inspection there were 149 people receiving personal care and support.

A registered manager was in post 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.

The service had undergone a period of change, stable management was now in place. The provider was aware there were areas that required improvement. They were making changes to address these shortfalls.

Staff had not always received training on the Mental Capacity Act 2005 (MCA). They were not always knowledgeable about this legislation or understood how it impacted on their role. Training for staff had not been kept up to date. Staff had not received regular supervision and therefore were not fully supported in their role. Feedback from staff was not sought by the provider in order to identify areas of improvement.

A new induction programme was underway in line with the Care Certificate. Staff knew how to respond to suspected abuse and follow safeguarding procedures.

People spoke positively about the quality of care and support given. They said care was delivered on time and in accordance with their wishes. Staff were kind and caring and treated with people with respect. Staff were observed during spot checks to ensure the care they gave was at the expected standard.

People’s needs were assessed and support was reviewed to ensure it continued to meet people’s requirements. Care records and risk assessments were detailed and informative. Clear guidance was in place to ensure people were supported in line with their preferences.

The service was not consistently well-led. People and staff were unclear about the management structure of the organisation. Statutory notifications in reference to safeguarding referrals had not always been sent to the Commission. The provider had identified areas that required development and had produced plans to deal with shortcomings.

We found three breaches of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of this report.

This inspection was undertaken by an Adult Social Care Inspector and a Pharmacist Inspector. We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the office, feedback questionnaires sent to people who use the service and their relatives and discussions with the staff and management team. Please read the full report if you want to see the evidence supporting our summary.

Is the service caring?

We received positive feedback from people who used the service and their relatives. People told us that they were cared for in ways which encouraged their independence and met their individual needs. We received comments such as 'I have nothing but praise' and 'the carers are very friendly and always take time to interact with my mother which she enjoys'.

We were told about instances where staff had reported health concerns about a person they supported and this had led to them accessing the right treatment swiftly.

Is the service responsive?

People that used the service told us that they knew how to raise concerns or complaints if they needed to. There was a system in place for a senior staff member in the office to respond to situations where a member of staff was running late for a visit. We were told that if this was the case, the person waiting for their care worker would be informed. People who responded to our questionnaire confirmed that this was the case most of the time.

Is the service safe?

People who used the service told us that they felt safe in the presence of staff and they were treated with respect.

Staff understood their responsibilities to safeguard vulnerable adults and had received training to support them in this. There was a safeguarding policy in place to guide staff and ensure that they responded to safeguarding issues in a consistent manner.

Risk assessments were in place to guide staff in how to support people safely. Any accident and incidents were recorded and there was a member of staff responsible in the organisation for identifying any common themes or concerns arising from these.

Staff were monitored to ensure that they were delivering care in a safe and appropriate way. This was achieved through regular supervision and 'spot checks'.

People were supported safely when they required assistance with their medication. The systems in place for supporting medication had recently been reviewed with a view to improving this aspect of the service and reducing the possibility of errors occurring.

Is the service effective?

People had clear support plans in place and these were reviewed regularly to ensure that they were up to date and reflective of people's needs.

Staff that supported people received good training and supervision to ensure that they provided effective care for people who used the service. People told us that staff had the skills and training to be able to support them.

Is the service well led?

There was a registered manager in place at the time of our inspection. Staff told us that they felt well supported by senior staff and able to raise any issues or concerns.

There were systems in place to monitor the quality of the service provided and these systems were being developed further at the time of our inspection.