Prestige Nursing Gloucester is a domiciliary care service which provides support to people in their own homes living in the Gloucestershire, South Gloucestershire and Wiltshire areas. At the time of our inspection, 69 people were receiving a service from Prestige Nursing Gloucester.

This inspection took place on 30 November and 1 December 2016. The service was last inspected in February 2014 and there were no breaches of regulation at that time.

There was a registered manager at the service. 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 received a service that was safe. People were safe from harm because staff were aware of their responsibilities and, knew how to report any concerns. There were enough skilled and experienced staff to safely provide care. Recruitment checks were carried out before staff worked with people to ensure they received care from suitable staff. Risks to people were assessed and action taken to manage these. Where people needed help with medicines, they were protected from risks because medicines were safely managed.

The service provided was effective. Staff received the training, supervision and support required to effectively meet people’s needs. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people’s rights were respected. Where people required, staff supported them to eat and drink. Staff ensured people received assistance from other health and social care professionals if needed .

People received a service that was caring. People received care and support from caring and compassionate staff who knew them well. Staff provided the care and support people needed and treated them with dignity and respect. People and, where appropriate, their families were actively involved in making decisions about their care and support.

The service was responsive to people’s needs. People received person centred care and support. The service listened to the views of people using the service and others and made changes as a result. People were supported to participate in a range of activities based upon their assessed needs and wishes.

The service was well-led. The registered manager and senior staff provided effective leadership and management. They had clear visions and values for the service and, had communicated these effectively to people, their relatives, staff and other health and social care professionals. Staff, people and their relatives spoke positively about the registered manager. Quality assurance checks and audits were occurring regularly and identified actions required to improve the service.

We visited the branch office and spoke with the assistant branch manager and looked at records. We spoke on the telephone with three people who used the service and two relatives. Feedback was mainly positive. People told us that care workers usually arrived when they were expected and they were informed of any delays or changes in staff. One person however told us that they had been recently let down on two occasions.

Care workers were described as “friendly”, “polite” and “caring”. People appreciated the companionship as well as the care provided. One person told us, “They have all become friends”. Family members told us they were kept well informed of their relative’s progress and they were notified of any concerns.

People told us they felt safe and comfortable in the company of their care workers. Staff demonstrated a good understanding of their responsibility to be vigilant and alert to any signs of abuse or neglect and told us they would have no hesitation in reporting concerns.

People were confident that the agency would provide suitable staff. There were stringent vetting procedures in place to ensure that people employed were of suitable character and skilled and experienced in providing care. Staff received regular supervision to ensure that they performed to the required standards.

People told us that that the agency was receptive to feedback and that their views were important to them. There were a number of systems in place to monitor quality, although we felt that the agency would benefit from further analysis of data to provide an overview of the branch’s performance.

We spoke with two people who used the service, two relatives, two live in care staff, three homecare workers, one registered nurse and the management team in the office. We saw and reviewed people’s care records which were held in their home and the office. We noted that people were given sufficient information related to the services offered by Prestige Nursing Gloucester and this information was held in peoples care records. One person told us “I was told everything about what the agency had to offer”. People’s privacy dignity and independence were respected. One person told us, "The staff practice privacy and dignity".

People were asked for their consent to care by the provider. We saw that in people’s care plans there were signed written documentation which were obtained by people; a family member confirmed their involvement with the planning of their relatives care. Another person told us, "I was consulted about my care needs".

We saw evidence that detailed assessments of people’s individual care needs had been undertaken by those who were qualified to do so. People told us, that the manager came and assessed their needs. One person commented, “You’ve (the manager) been awesome”.

The agency had policies and procedures for staff about recognising and reporting abuse and whistleblowing. The records showed that staff had received training in safeguarding adults from abuse. People told us that they felt safe with the care staff from the agency.

We noted that the agency had a longstanding staff team with appropriate experience, skills and qualifications. We noted that the provider did not have regular team meetings; such meetings provide staff with opportunity for support and to give feedback on issues of concern or share good practice. However, we found that people spoke positively about the staff team and the care and support they received.

People were given the opportunity and provided feedback related to the care they received. We saw that the results of the 2013 survey were available on the provider’s website.