This inspection took place on 22 November and was announced.

Following the last inspection on 10 November 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Well-led to at least good.

This service is a domiciliary care agency. It provides personal care to 29 people living in their own houses and flats in the community. It provides a service to older adults and people who are living with a learning disability.

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.

At our last comprehensive inspection on 10 November 2016 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for good governance and notification of other incidents under the Care Quality Commission (Registration) Regulations 2009. At this inspection we found the provider had taken action to ensure they were compliant with the Registration regulations. We found that whilst some improvements had been made with the governance of the service, there were still concerns about the assessment and monitoring of the safety and quality of the service. The provider was still in breach of this regulation.

The quality assurance system that was in place was not effective at identifying areas for improvement within the service. This was because there was a lack of any in depth examination of the service. Satisfaction surveys were sent to people but the responses were not collated to gain an overall picture of the service.

There was clear and visible leadership in place and staff felt supported by the registered manager. The registered manager was able to be contacted by people and their relatives and made time to listen to people.

Regular staff meetings took place and there was frequent communication in the form of newsletters, phone calls and texts between the provider, management team and the staff.

Working relationship had been fostered and maintained with other services such as local hospitals and the local authority to ensure continuity of care for people.

People’s medicines were not always managed in the safest way possible. There were no protocols in place for ‘as required’ medicines and staff did not have a good understanding of this type of medicine.

Staff had received training in the safe management of medicines and documentation relating to people’s medicines was completed fully.

Individual risks to people had been identified but there was little information to guide staff about how to mitigate them. Risk assessments for people’s homes had been completed to help ensure the safety of people using the service and the staff visiting them.

There were enough staff to safely meet people’s care needs and staff arrived to people’s houses on time. Staff had received training in safeguarding and knew how to report any concerns of abuse. There were safe recruitment practices in place and the necessary background checks had been carried out before staff started working in the service.

Accidents and incidents were recorded and these were looked at regularly to identify any patterns or trends.

Processes were in place to prevent and control infection. Staff had received training in infection control and food hygiene and knew their responsibilities in relation to these areas.

People’s care and support needs were not always holistically assessed. Whilst there was information in people’s care plans relating to their physical health, there was little detail about any mental health needs that people may require support with.

The CQC is required to moni

This inspection took place on 10 November 2016 and was announced. Norvic Healthcare Anglia is a domiciliary care agency providing personal care to people living in their own homes. At the time of our visit, 37 people were using the service.

There was a registered manager in place, who had been the registered manager since October 2010. 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 provider had a system to monitor the quality of the service, although this did not always identify where care and staffing records were missing information.

Notifications to provide information about important events, which the provider is required to send us by law, had not been completed.

You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to safeguard people from the risk of abuse and how to report concerns to the relevant agencies. Individual risks to people’s safety had been assessed by staff and actions had been taken to reduce or remove these risks.

People felt safe using the agency and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs. Most recruitment checks for new staff members were obtained before new staff members started work, although information about previous employment and gaps in employment histories were not always checked.

Medicines records were not always completed to show people received their medicines as prescribed. Staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA). The service was meeting the requirements of the MCA. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, clearer information was needed to guide staff.

Staff supported people to eat and drink. Staff members helped people to access the advice of health professionals in the community if this was required.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted their care to be provided. Staff responded well to people’s needs and support was available for staff. Care plans contained a varied level of detail in the information to support people with their needs, which did not always provide enough guidance to staff. Staff members knew how to care for people when this information was not recorded but there was a risk that new staff would not have this knowledge.

Most people knew how to make a complaint and these were responded to appropriately by staff. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

The majority of Norvic Healthcare Anglia’s service provides nurses and carers to hospitals and care homes. This part of their service does not require registration with the Care Quality Commission. However, they have a domiciliary service in its infancy that is registered with the Commission. At the time of our inspection one person living in their own home was receiving direct support from Norvic Healthcare Anglia.

We found detailed care notes that described what care and support was required, how the person’s needs were met and how the support provided was carried out as safely as possible.

We received complimentary comments about the service such as how this was ‘the best agency ever’. We were told how supportive the service was and how well trained staff were. A relative told us that they were transferring all the care needs to this agency as they were, ‘the best’.

We saw evidence of how staff were supported with training, supervision and appraisals. This ensured staff were skilled and able to carry out the work required safely and suitably.

The manager told us the method of monitoring the quality of the service through questionnaires had been on hold since October 2012. However the one person receiving the care and support was visited and spoken with regularly to ensure the service was what was expected. This was confirmed by their relative.

As this is a staffing agency providing carers and nurses to homes and hospitals we did not gather evidence directly from the people receiving the service. However, we did talk to staff employed by the agency and to the managers of services using the agency staff.

The comments were mainly positive with many of the agency staff remaining in the homes and hospitals for long periods of time due to the quality of those staff members.