About the service: Prestige Nursing Ipswich is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection it was providing care to 46 people.

People’s experience of using this service:

People were supported to be safe in their home and there were sufficient staff employed to fulfil people’s arranged care visits.

Risks to people’s health were assessed and clearly documented in the care plan.

People received their medicines as they were prescribed.

Staff understood their responsibilities to prevent the spread of infection whilst working between people's homes.

Incidents and accidents were monitored to inform practice and make improvements to the service.

People’s personal needs were assessed and care was provided to them with their consent.

Staff continued to receive the training and support they needed to carry out their roles.

People were supported to access health care services when they needed to.

Staff continued to support people by providing food and drinks to them of their choice.

Staff informed us they had positive working relationships with health care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff helped people to remain independent and promoted their dignity.

People's privacy was respected and their personal information was kept securely.

Each person had an individual care plan including an assessment of their needs, risk assessment and detailed information about how to achieve agreed goals.

The service had a complaints policy of which people were aware.

There were on-call arrangements so that senior staff were always available to support as needed.

Senior staff sought the views of the people using the service through surveys.

Governance arrangements were in practice. Regular audits identified any shortfalls in provision of care.

Rating at last inspection: At our last inspection on 13 September 2016 the service was rated overall Good. The key question of Responsive was rated Requires Improvement. The report was published on 5 November 2016.

Why we inspected: We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.

Follow up: We will continue to monitor the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Prestige Nursing provides personal care to adults in their own home. It also provides a recruitment service, supplying staff to the adult social care sector. This element of the service, although provided by Prestige Nursing would not need to be registered with the Commission. We focussed our inspection on the people in receipt of personal care only. On the day of our inspection there were 34 people using the service.

Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives, and staff told us.

There is a Registered Manager at this location. A Registered Manager is a person who has registered with the Care Quality Commission to manage the service. Like registered services, 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 and secure when staff visited them, and staff understood the process they should follow to keep people safe. Staff could describe the different ways people may experience abuse and the correct steps they would take if they were concerned that abuse had taken place.

We inspected staff rotas, which showed there was a sufficient number of staff available to meet people’s needs. The registered manager told us the service needed to improve the way it managed missed and late visits and explained to us how they were planning to improve this area. Recruitment processes were rigorous and procedures for dealing with emergencies were in place.

When staff supported people to take their medicines, this was managed safely by trained staff who understood their responsibilities. The service and staff understood their responsibilities under the Mental Capacity Act 2005 and people had given their consent to the care provided.

Staff told us they had completed training and was encouraged by the service to continue to learn, by completing further qualifications in Health and Social care.

Staff told us they had supervision meetings with the registered manager. We inspected staff records and found these were not always recorded. We have recommended meetings should be consistently recorded in the future.

Everybody told us they had positive relationships with their care workers and were supported by staff that showed patience when supporting people. People told us they were treated with kindness and said their privacy and dignity was respected.

People had an individual care plan which set out their individual care needs. Assessments included needs for mobility aids, specialist diets, medication, allergies, and information relating to health needs.

People told us they were made aware of how to make a complaint and there was a complaints policy and procedure in place. The service worked well with other agencies and professionals to make sure people received the care they needed.

A notification is information about important events the service is required to send to us by law. We found when a safeguarding incident had occurred the service had not notified us of this event.

A new registered manager was recruited and started in post three weeks before the inspection took place. Staff told us they were approachable and supportive.

We inspected the way the service audited the service and found they had a system to assure the quality of the service provided. A service development plan was provided which showed how the service planned to improve the service over the next six months.

People were asked for their consent before an assessment of their needs was undertaken. We spoke with one person who said, "They asked me all about myself, and did nothing I didn't want them to.” This showed that people’s views were acted upon by the provider.

We saw that people had their needs assessed and had care plans in place so that staff knew what people’s individual support needs were. One person said, “I need help and I get it. I couldn’t manage without the agency.”

We looked at recruitment records for four members of staff. We saw that the provider had effective recruitment and selection procedures in place.

We saw evidence that the provider obtained the views of people who used the service and an independent organisation had sent a quality assurance questionnaire for people to complete. When we asked people what they thought about the quality of care they received one person said, "I’m very happy, they always manage to fill my requests."

The provider made people aware of the complaints policy and people we spoke with confirmed this. The registered manager said, "If there is an issue then I will try and resolve it."

We had the opportunity to talk with three of the people who use the service. All of the people we spoke with were happy with the care they received. They told us that they were supported in the way they wanted to be, had their privacy and dignity maintained and that they were able to express their views and individuality.

People were complimentary about the staff who supported them.

People we spoke with told us that the staff knew how they wanted to be supported and that they made sure they got what they needed. One person who we asked what they thought of the quality of care said, “I am always left comfortable.”

People told us that they were included when their care plans were written and were given a chance to read them before they were finalised.