This comprehensive inspection took place on 8 and 18 January 2019 and was announced.

We last inspected the service on 6 September 2016 and we rated the service overall Good. At this inspection we rated the service requires improvement in well-led and overall Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults in the borough of Redhill in Surrey. At the time of the inspection the service was providing personal care to 25 people.

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.

The systems and processes in place to oversee the service was not always effective. Audits undertaken did not always identify issues and action taken was not always clearly documented. We shared our concerns with the registered manager who on the second day of the inspection had implemented compliance processes to address our concerns. We will review this at our next inspection.

People received their medicines as intended by the prescribing Pharmacist. Medicine records were not always completed in line with good practice. Action taken to address these issues was not always documented.

People continued to be protected against the risk of avoidable harm, as risk management plans in place were regularly reviewed and gave staff clear guidance on how to keep people safe in their own homes.

People were protected against the risk of abuse as staff were aware of how to identify, report and escalate suspected abuse. Staff were aware of the provider’s safeguarding policy and were confident in whistleblowing.

People continued to be protected against the risk of cross contamination as the provider had clear infection control guidelines for staff to follow. Staff received adequate amounts of personal protective equipment to minimise the spread of infection.

Sufficient numbers of staff were deployed to keep people safe. The provider had a robust pre-employment procedure to ensure only suitable staff were employed. Newly employed staff underwent a comprehensive induction process to familiarise themselves with people and the service.

Staff received on-going training to enhance their skills and knowledge. Training provided ensured people’s needs were met by staff equipped with the skills to effectively support them. Staff reflected on their working practices through regularly one-to-one meetings with management and goals were set for the coming months.

Consent to care and treatment was sought prior to being delivered. The service was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People's consent to care and treatment was sought prior to being delivered. 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.

Where agreed in people’s care packages, staff members supported people to access food and drink that met their preferences and dietary requirements. People were also supported to make contact with and attend healthcare professional appointments as and when required.

The service had an embedded culture of treating people with dignity and respect. People’s privacy was maintained and people were treated equally, taking into consideration any cultural or religious needs.

The service monitored people’s dependency levels to ensure appropriate support was given, that enabled people to m

Prestige Nursing and Care Agency is a domiciliary care agency that provides personal care to people in their own homes who live in the East Surrey area. The agency provides care for people living with physical frailty, dementia, mental health needs and people who require rehabilitation following hospital discharge. The service can also provide nurses to independent providers such as care homes or private clients. At the time of our inspection the agency was supporting 33 people with personal care in their own homes.

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 and associated Regulations about how the service is run. The registered manager was present for the duration of the inspection.

Care workers knew how to keep people safe. They understood their responsibilities under safeguarding procedures and told us they would report anything that looked like abuse to the registered manager who they said would deal with issues immediately.

Staff recruitment procedures were safe and ensured care was provided by staff who were vetted and suitable to support people in their own home. Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported to undertake their roles.

The agency had procedures in place to manage medicines safely and ensured only suitably qualified staff administered medicines to people.

Risks to people had been identified, assessed and well managed. Information was provided to staff on how to care for people in order to reduce any risks.

The registered manager logged any accidents and incidents that occurred and put measures in place for staff to follow to mitigate any further accidents or incidents.

People’s consent to care and treatment was considered. Staff understood the Mental Capacity Act (2005) and about people’s capacity to make decisions.

Staff were caring to people and respected their privacy and dignity. People and relatives told us staff were polite and staff said they were always mindful that they were a visitor in people’s homes.

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were addressed by the registered manager to drive improvement and provide better services for people.

If an emergency occurred for example adverse weather conditions or an outbreak of staff sickness people’s care would not be interrupted as there were procedures in place to manage this.

A complaints procedure was available for any concerns. This was included in the information pack people were given when they engaged the services of the agency. People knew how to make a complaint but said they never used the formal process and issues got addressed immediately.

We looked at records in the agency’s office relating to the care of people and the management of the service. These included care plans, risk assessments, medicine records, staff recruitment and training files and a range of policies and procedures. These were well maintained and regularly monitored by the registered manager to ensure the quality of record keeping was appropriate.