Prestige Nursing Halesworth is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults. At the time of this announced inspection of 26 and 27 November 2018 there were 89 people who used the personal care service. We gave the service notice of the inspection to make sure that someone was available to see us.

At our last inspection of 8 December 2016, this service was rated requires improvement overall and in all of the key questions. There were breaches of Regulation 18: Staffing and Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because improvements were needed in how the service was staffed and assessed and monitored. The service wrote to us to tell us how they planned to implement improvements. During this inspection of 26 November 2018, we found improvements had been made, there were no breaches of Regulation and the service was rated good overall.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were systems in place designed to provide people with safe care. Improvements had been made in the staffing in the service and the ways that people’s care visits were planned. Risks to people were managed, including risks from abuse and in their daily lives. The service had a recruitment drive in place to reduce any risks of missed and late visits. Care workers were recruited safely. Where people required support with their medicines, this was provided safely. The service learned from incidents to improve the service. There were infection control procedures in place to reduce the risks of cross infection.

People were provided with an effective service. Improvements had been made in how the service worked with the principles of the Mental Capacity Act 2005 relating to the storage of people’s medicines. People were asked for their consent before any care was provided and their choices were documented. Care workers were trained and supported to meet the needs of the people using the service. Where people required assistance with their dietary needs, this was provided. People were supported to have access to health professionals where needed. The service worked with other organisations involved in people’s care to provide a consistent service.

People received a caring service. People had positive relationships with their care workers. People’s dignity, privacy and independence were respected and promoted. People’s views were listened to and valued.

People were provided with a responsive service. People received care and support which was assessed, planned and delivered to meet their individual needs. People were provided with end of life care. The service worked in partnership with a community project to support people to die at home. A complaints procedure was in place and people’s concerns were addressed.

People were provided with a service which was well-led. There were systems in place to assess and monitor the service provided. Where improvements were identified actions were taken to address them.

Prestige Nursing Halesworth provides personal care and support to people in their own homes. They were supporting 70 people when we inspected on 8 December 2016. The provider was given 24 hours' notice of our inspection because the location provides a domiciliary care service and we needed to know that someone would be available.

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.

Prior to this inspection we received information of an incident following which a person died. The Commission made further enquiries into the circumstances leading up to the person’s death to consider whether it should take further action under its criminal enforcement powers. We concluded that there was insufficient evidence to warrant criminal action on this specific case but did identify some systemic issues about the management of instances when a person does not respond to a house call and/or the person is not at home to receive their care. Our enquiries around this incident also raised concerns about the provider’s management of complaints and application of their Duty of Candour policy and procedure.

This inspection examined the providers systems for managing those concerns. The Duty of Candour policy had been revised and records of subsequent concerns and complaints showed how this was being applied in the way in which people and their families had been involved and kept informed whilst concerns were being investigated and responded to. However there were still lessons to be learned with regard to effective communication and keeping relevant people up to date and fully informed in the interests of open and transparent communication.

During this inspection, we found that the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were not enough staff or enough travel time scheduled between calls. Ineffective scheduling of calls together with the lack of available staff meant that people could not be assured that they would receive their support in line with their assessed needs. Changes in peoples provision of care and support were not always effectively communicated,

Although care plans were written in a person centred manner, the level of detail was not consistent across the service and some had not been updated following changes in peoples care and support needs. Despite the shortfalls in the care records, people and their families told us they received personalised care which was responsive to their needs.

People told us that they felt safe whilst receiving care in their homes. Care records included risk assessments which provided staff with guidance on how the risks to people were minimised. Procedures were in place to ensure staff were aware of how to safeguard and/or report concerns to protect people from the potential risk of abuse. Concerns had been raised regarding the management of complaints. Although most people knew how to raise concerns and were confident that they would be listened and responded to improvements were needed to demonstrate how this was being proactively used it improve the quality of the service overall.

People were complimentary about the care and support they received and told us staff treated them with dignity and respect. Staff understood the importance of gaining people’s consent to the support they were providing. Although staff were generally well trained there was some inconsistencies in how quickly they were allowed to start working on their own following induction.

People were satis