The inspection took place on 20 December and was announced. The inspection continued on 22 December 2016.

Nurse Plus and Carer Plus (UK) Limited - 3a Mey House provided domiciliary health and social care support services and 24 hour care to people in their own homes. The agency provides care and support to a wide range of people including children, people who are elderly, people diagnosed with dementia and people with learning or physical disabilities. At the time of our inspection there were 10 people receiving personal care from the service. There was a central office base which was an open plan shared space where recruitment, care and agency consultants were based with the registered manager.

The service had a registered manager in place. 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 and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults and protection of children.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their life. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, oral suction, nebulisers and pressure area care.

Staff received regular supervisions and annual appraisals which were carried out by the registered manager. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. People’s capacity was assessed when necessary and best interest decisions made as appropriate.

People were supported to eat and drink enough whilst maintaining a healthy diet. Food and fluid intake was recorded for those who were under monitoring for this.

People were supported to access healthcare services as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. People said they felt comfortable with staff supporting them. Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected people’s needs in these. We saw that these were regularly reviewed by the nurses and case managers with people, families and other health and social care professionals.

The service had systems in place to capture and respond to people’s feedback. People were asked if they were happy with the support they are receiving and if they would like any changes made during people’s regular review meetings. General feedback from the 2016 survey was positive and actions had been completed.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. Compliments were also recorded by the service.

Staff, people and families told us that the thought the management was good at Nurse

People told us that they understood the care choices available to them, and could have their views taken into account in the way their care was delivered. A person told us, "Every time they come they ask me if it’s O.K before they do anything.” Another person told us, "They will always do what I need.”

The registered manager told us, “We only have seven service users at the moment. We are looking to expand our domiciliary care operations – We tend to support people who need longer periods of care, either during the day or at night – We can provide 24 hour support.”

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person’s relative told us, "I have a copy of their care plan, they update it regularly." We saw that people's care was regularly reviewed and their personal information was held securely.

People were protected from the risk of abuse and their human rights were respected and upheld. A person told us, “The staff are very good. They are always very polite and respectful. I have no worries about them.”

We found that staff were properly trained and supervised. We spoke with three members of the care staff who told us that the agency had offered them the opportunity to study for qualifications that were relevant to their work.

The provider had appropriate systems in place to monitor and improve the quality of care people received.

We spoke with the manager and with three staff. People who used the service were unable to express their opinions about the service due to their complex needs. We spoke with two main carers of people who used the service.

The main carers told us that staff always sought their family members consent before delivering care, they met their family members needs and were reliable. They said that staff carried out the tasks that had been agreed. One carer said, "They're fantastic. They're more like friends than carers, I would recommend the agency unreservedly". Both carers were particularly impressed by the good communication between themselves and the agency. They said that the manager and staff responded quickly to any changes in circumstances.

The agency provided support packages for three people in their own homes. Packages varied from daily support to live in care. We looked at all three care plans which contained detailed information about the care, treatment and support that was required.

Staff were appropriately trained. Training was delivered by an in-house trainer on the premises. Carers felt that staff were well trained and that they provided safe and appropriate care.

Staff were also encouraged and supported to gain further qualifications. Arrangements for supervision and appraisals were in place.

The quality of service provision was monitored in a number of ways, and improvements had been made as a result.