We undertook this announced inspection on 26 May 2017. Priory Nursing Agency & Homecare Limited is an agency that is registered to provide Personal and Nursing Care services. The services they provide include personal care, housework and assistance with medication. The service provided care for approximately fifty five people.

At our last comprehensive inspection on 6 April 2016 we rated the service as “Requires Improvement”. We found three breaches of The Health and Social care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. We noted that in five out of the seven records of people there were unexplained gaps in their medicine administration records. During this inspection on 26 May 2017, the provider demonstrated that they had taken action to comply with the requirement made. With one exception, we found no gaps in the medicine administration records we examined. The registered manager stated that the gap noted in one of the records was an error and the care worker concerned had administered the medicine and the record was rectified accordingly.

The second breach was in respect of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Person-centred care. The service was unable to provide us with information that people had received regular reviews of their care so that the care provided met their changing needs. During this inspection the provider demonstrated that they had taken action to comply with the requirement made. We saw evidence of regular reviews being carried out. This ensured that the care provided met the needs of people.

The third breach was in respect of Regulation 17 relating to good governance. The service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. This meant that deficiencies in the service provided may not be promptly identified and rectified. During this inspection the provider had the necessary checks and audits for ensuring quality care. These included reviews of care and regular spot checks on care workers.

People who used the service and their representatives informed us that they were satisfied with the care and services provided for people. They informed us that people had been treated with respect and dignity. They stated that people were safe when cared for by the service. There was a safeguarding adults policy and suitable arrangements for safeguarding people from abuse.

There were arrangements for the administration of medicines. Medicine Administration charts were regularly checked by senior staff to ensure that people received their medicines as agreed. The service had an infection control policy. Gloves, aprons and shoe covers were available in the office for use by care workers. People and their representatives informed us that care workers observed hygienic practices.

Care workers had been carefully recruited. The necessary checks had been undertaken prior to them starting work. New care workers had been provided with a comprehensive induction and training programme to enable them to care effectively for people. They had the necessary support and supervision from the deputy manager and the registered manager. Teamwork and communication within the service was good. There were sufficient care workers to meet people's needs.

Care workers were caring in their approach and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them had been assessed. There were appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were monitored where this was part of the care agreement.

There were arrangements for encouraging people and their representatives to express their views and make sugge

We undertook this announced inspection on 6 April 2016. Priory Nursing Agency & Homecare Ltd is registered to provide Personal Care services to people in their own homes. The services they provide include personal care, housework and assistance with medicines.

At our last inspection on 7 August 2014 the service met the regulation we looked at.

The service has two registered managers. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People and their representatives informed us that they were mostly satisfied with the care and services provided. They informed us that people had been treated with respect and they were safe when cared for by the service. There was a safeguarding adults policy and suitable arrangements for safeguarding people from abuse.

Care workers were caring in their approach and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and guidance provided to care workers on how to care for people. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People’s healthcare needs were monitored and care workers arranged for them to have appointments with healthcare professionals when needed. Care workers worked well with social and healthcare professionals to bring about improvements in people’s care. This was confirmed by professionals we contacted.

There were arrangements for encouraging people and their representatives to express their views and make suggestions regarding the care provided and the management of the service. Reviews and evaluations of care had been carried out. We however, noted that reviews of care and assessments had not been carried out for some people to ensure that the care provided meet their changing needs when needed.

People knew how to complain. Complaints recorded had been promptly responded to. Two people were dissatisfied and made complaints regarding the services provided. This was relayed to the registered manager with the permission of the people concerned. The registered manager agreed to investigate the complaints.

There were arrangements for the recording, storage, administration and disposal of medicines. We however, noted that there were unexplained gaps in the medicine administration records of people. This omission may put people at risk and we found a breach of regulations in respect of this.

Care workers had been carefully recruited and provided with a comprehensive induction and training programme to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. Care workers were able to attend to people's care needs. Teamwork and communication within the service was good.

People and their representatives expressed confidence in the management of the service. They stated that care workers communicated well with them and kept them informed if they were held up or running late. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity, providing high quality care and promoting people’s independence.

Two social care professionals provided positive feedback regarding the management of the service. They indicated that they had no concerns regarding the management of the service. Audits and checks of the service had been carried out by the registered manager and senior care workers of the service. These included spot checks on care workers and telephone monitoring to obtain feedback from people who used the service. These were not sufficiently comprehensive as they failed to identify and rectify the deficiencies we noted.

During our previous inspection of 21 January 2014, we found that people's privacy, dignity and independence were respected. However, people's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

There was no evidence that people who used the service were being involved in the development of their care plan. Care plans had not been signed by people who used the service or their relatives and where a person was unable to sign their care plan, there was no information about the attempts that had been made to involve them or their representatives in the assessment of their needs and care planning. We noted that care plans did not always contain information about people's ability to make decisions about their care.

We carried out an inspection on the 7 August 2014 and found improvements had been made. Care plans had been reviewed and there was evidence of people’s or their relative’s involvement with their care.

We carried out this unannounced inspection to check if the provider had complied with a compliance action from a previous inspection of the service. We spoke with some care staff of the service and checked staff records to make a judgement as to whether the provider was meeting Outcome14 :Supporting Workers and was compliant with Regulation 23 (HSCA 2008 Regulated Activities) Regulations 2010.

At this inspection we found that the provider had taken proper steps to ensure that appropriate staff supervision and support were in place to ensure that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People who use the service and their representatives were satisfied with the services provided. They said their carers carried out their duties well and treated them with respect and dignity. They also indicated that their carers were kind and did what was agreed in their care plans.

People who use the service indicated that they had no concerns regarding their carers and they felt safe with them. They were aware of who to complain to if they felt unhappy with staff or the care provided. Staff we spoke with were aware of the procedure to follow when responding to allegations or incidents of abuse.

People who use the service indicated that they had been consulted regarding their care. Monitoring visits and spot checks had been carried out by the agency and they were able to express their views regarding the service provided.

We were supported by an expert-by-experience during the inspection process. An expert-by-experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. They sent us a report of their calls to a sample of people who use services, which we have used as part of our evidence.

People told us that care workers generally treated them with respect and as individuals. Most people agreed that they were consulted about the care and changes to their care plan. As one person put it, “Every aspect of my care plan has always been met with flexibility, care and consideration for my individual needs.”

There was, however, mixed feedback about having regular reviews of care and there being care plans in place. Some people’s care and support may not have been reviewed and updated regularly so as to best meet their needs. We have suggested that improvements are made in this area.

People told us that they felt safe with their regular care workers. However, new care workers did not show their identification, one person adding that they did not feel safe with new care workers. We have suggested that improvements are made in this area.

People told us that their regular care workers were fully trained but new care workers needed much more time and with greater focus on manual handling. We found that improvements were needed in this area, to ensure that competent staff were provided to people in their homes.

Despite these specific issues, people told us that they generally received care and support that met their needs. This matched people’s general perception of the agency reported in the agency’s July 2011 surveys. For instance, the vast majority of people stated that they were satisfied with the service received, and that they would recommend the agency to others.

We spoke with thirteen people and their relatives. When asked about the service, one person told us “I am very satisfied with them. My care worker is very pleasant, courteous and respectful. I have no complaints in regards to the care I receive”.

People’s privacy and dignity were respected; however there were no regular reviews of people’s care and support.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the services’ procedures.

People were cared for and supported by suitably skilled and experienced care support workers.

Records kept were accurate and held securely.