The inspection of Nurse Plus and Carer Plus UK Limited domiciliary care agency took place on 16 and 17 November 2016 and was announced. We gave the provider 48 hours’ notice because they were sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that they would be in. The inspection involved a visit to the agency’s office and telephone conversations with people who used the service and healthcare professionals.

Nurse Plus and Carer Plus is a domiciliary care agency based in Eastbourne. They are registered to provide personal care and nursing care. At the time of this inspection the regulated activity nursing care was not being provided. The service provides care and support for adults living in their own homes at key times of the day and includes support for people with physical disabilities, learning disabilities and dementia type conditions. At the time of the inspection there were 59 people who received personal care from the service.

The service had a registered manager although an acting manager was in place at the time of the inspection while the registered manager was on a period of leave. 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 receiving the care and support provided by the service. Staff understood and could recognise the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.

Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. There were sufficient levels of staff to protect people’s health, safety and welfare consistently and reliably.

People said staff were caring and kind and their individual needs were met. One person told us, “All the carers are very nice and very caring.” Another person said, “The staff are very attentive to my needs.” Staff knew people well and had a good understanding of their needs and choices.

Care plans and risk assessments reflected people’s assessed level of care needs. People were encouraged to be as independent as possible. One person told us, “They always involve me with any changes to my care needs.”

Staff felt supported by management, said they were well trained and understood what was expected of them. Staff were encouraged to provide feedback and report concerns to improve the service. A member of staff told us, “The managers are really supportive and always available if I need to raise concerns.”

There was a complaints policy and information regarding the complaints procedure was available. Complaints were listened to and investigated in a timely manner and used to improve the service.

Regular audits were in place to measure and monitor the quality of care and service provided.

People and staff surveys were positive about Nurse Plus and Carer Plus. One person commented, “All staff we have are all good, no complaints.” A member of staff told us, “I enjoy getting up and coming to work. What we do makes a difference. You have a purpose. I like working here.”

During our inspection we looked at care documentation. We saw that people had been involved in decisions about their care, and had signed to confirm they had read and consented to care decisions.

We spoke with people who used the service. One person told us “I could not be more satisfied, staff really could not be any nicer.”

Care needs had been reviewed and updated regularly if changes occurred. Staff had attended safeguarding training, and displayed knowledge of how to recognise and report concerns.

Staff records showed that appropriate checks had taken place before people commenced employment, and the provider had systems in place to assess and monitor the quality of the service provided.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We visited four people in their own homes as part of this inspection and spoke with them and their relatives about their experiences of the support they had received. We spoke with the manager, two care coordinators and four care workers as well as with an external trainer.

We spoke with four people who received a service from this agency over the telephone, as well as with nine relatives. Everyone we spoke with told us that they felt respected by the care workers from the agency. One person said the care workers were “so polite and respectful I don’t mind them being in my home at all”. People told us that staff always asked how they would like to be addressed.

People told us that care was provided in line with their needs, choices and preferences. We were told of one missed call the previous week; another relative expressed concern regarding an overdue review of the person's care plan. Other people said that their needs were reviewed regularly.

People felt that most staff were well trained and understood their needs when providing personal care. People told us that the agency responded to any comments or concerns raised with them. People told us that they felt safe, and if they had concerns they would speak with somebody from the agency.