Prestige Nursing North Manchester is a provider of nursing and domiciliary support to approximately 80 people living in their own homes. At the last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Effective safeguarding systems were in place, recruitment was robust and staffing levels appropriate to meet people’s needs.

Risk assessments were detailed and up to date. Assessments were thorough, and care and support files included appropriate information.

Health and safety measures were in place and medicines systems were appropriate and effective.

There was a comprehensive staff induction, on-going training, supervisions and appraisals. Confidentiality and data protection systems were in place. The service promoted advocacy when appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect and were encouraged to become as independent as possible. The service was committed to the principles of equality and diversity.

People told us the service was flexible and reliable. People were encouraged to pursue education, employment and leisure activities. People were fully involved in their care plans which were person-centred. Reviews of support were carried out regularly.

All information from the service could be produced in other forms, such as large print, braille, preferred language or in cassette form to make it as accessible as possible to all.

There was an up to date complaints procedure and complaints were addressed appropriately.

Health and social care professionals spoke highly of the service. The management team was stable and relatives, staff and other professionals described them as approachable.

Staff were well supported and relatives told us they could always contact someone if they needed assistance. Quality monitoring systems were robust and we saw evidence of excellent partnership working.

The service had good links with the local community and sponsored a number of local events to help raise money for and awareness of brain injuries.

Further information is in the detailed findings below

Prestige Nursing – North Manchester provides trained nursing staff and health care assistants to care homes and to individuals in their own homes. People who use the service may be funded through the NHS, the local authority or opt to pay privately. The agency provides services to children as well as adults and also nursing and personal care. At the time of our inspection there were 69 people using the service.

This was an announced inspection which took place on 26 and 27 April 2016. In line with our current methodology we contacted the service two days before our inspection and told them of our plans to carry out a comprehensive inspection. This was because the location provides a domiciliary care service and we needed to be sure that the registered manager would be at the office.

The service has a registered manager who was present on the day of our inspection. 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.

Robust recruitment procedures were in place which ensured staff had been safely recruited. Staff had received training in safeguarding adults. They were aware of the correct action to take if they witnessed or suspected any abuse. Staff were aware of the whistleblowing (reporting poor practice) policy in place in the service.

People who used the service and their relatives told us they felt safe with staff from Prestige Nursing - North Manchester. They told us staff were reliable, caring and knew them well. We found staff to be knowledgeable about people they supported and respectful in their approach.

Care records were very detailed and person centred and contained information about people’s health and social care needs. We found they contained risk assessments and care plans that were written using very respectful terms. They provided staff with sufficient detail to guide them on how best to support people and how people communicated. They contained information about people’s preferences and routines and guided staff on how to promote people’s independence. A system was in place to ensure care plans were regularly reviewed and updated. This helped to ensure they fully reflected people’s needs.

People were supported to access a wide range of activities, hobbies and places of interest to them. Some young people were supported to attend college and work placements.

Risk assessments were also completed for the general environment and activities people took part in. This helped to ensure people who used the service and the staff that supported them remained safe. Arrangements were in place to help ensure the prevention and control of infection.

Staff received training in administration of medicines and systems in place ensured people received their medicines safely.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Staff were able to tell us how they supported people to make their own decision. The managers in the service were aware of the process to follow should a person lack the capacity to consent to their care.

Staff received an induction and were provided with a wide range of training that would help them carry out their roles effectively. Training was also given about an individual’s health conditions and equipment that people used. Staff had regular supervisions and team meetings and told us they felt very well supported by the organisation and managers from the service. Staff told us they enjoyed the work they did and enjoyed working for the service.

Staff were trained in safe food hygiene and nutrition. We saw that people’s nutritional needs were recorded in their care records and any special dietary needs were noted and guidance was given for staff to follow, such as gluten fre

People who used this service and their representatives said support staff respected their rights to choice, privacy, independence and dignity. A person who used the service and a member of the support staff commented, "The girls are great. They discuss what needs doing with me and respect my wishes” and “I only help where it is needed, or if the person is struggling. It’s important to arrive at their preferred time, because they rely on us.”

The people we spoke with during our inspection spoke positively about the care and support provided by Prestige. Systems were in place to make sure people were supported safely and according to their choices and preferences. A case manager told us, "Yes, the service is provided in a flexible and responsive way."

Prestige had a policy and procedures in place to guide nursing and support staff on the tasks they would undertake to make sure people who used the service took their prescribed medication at the right time. Staff had received the appropriate training for supporting people safely with their medication needs.

Effective systems were in place to ensure Prestige recruited staff of good character, who were physically and mentally fit and who had the skills and experience to provide safe care to the people who used this service. A caseworker told us the training provided by Prestige showed in the quality of the staff.

Satisfactory and relevant records were in place to ensure people using the service received safe care.

We did not speak to any people who were using the service as part of this inspection.

At the time of inspection, there were 23 people using the service of whom most had some kind of brain injury.

Comments were requested from people who use the service including relatives, local authority commissioning teams and health and social care professionals. This was to gain feedback about their experiences and involvement with the service provided.

Information received from a relative included; ‘I have a very high opinion of Prestige Nursing for the following reasons. The quality of care my relative receives is of a high standard. We have a very competent carer. Privacy and dignity is maintained. Staff are reliable and timekeeping is adhered to. Any changes are always relayed in good time. I can phone or email the manager at any time and with any concerns and he replies straight away. The care package was agreed with my relatives consent and has been reviewed and signed. My relative is happy with the care package and she and I have a copy of the plan. I would be happy to recommend this service to other people’.

NHS Oldham also told us that ‘based on feedback from people and their respective families, we can report that Prestige Nursing have provided and continue to provide a good standard of care, this is supported by the absence of any complaints regarding the care and positive comments made by both the person and their families’.

Further comments from the commissioning team were positive about the working relationship with the service. They said that ‘communication is positive between both organisations and NHS Oldham would consider commissioning care services from Prestige Nursing in the future if it is identified they can meet the prospective patient’s needs’.

NHS Oldham also expressed that on commencement of a care package they did experience some problems with regards to high staff turnover and punctuality. However on reporting this to the provider the issues were addressed in a professional manner. They also added that ‘NHS Oldham were reassured that the matters were taken seriously and positive actions were undertaken to minimise the care package from breaking down and preventing a recurrence of the problems. Prestige Nursing demonstrated their ability to work professionally and closely with large organisations without ignoring the needs of the family concerned’.

Commissioners told us that they ‘had not received or needed to undertake any formal or informal investigations in relation to complaints since commissioning domiciliary care services from Prestige Nursing’.