About the service: Professional Nursing Services Limited is registered to provide nursing and personal care to people who live in their own homes. At the time of our inspection nursing care was not provided and four people received support with personal care in their own homes.

People’s experience of using this service:

• We were unable to speak directly with people who received support due to the complex conditions people lived with and the circumstances in which they were supported.

• We obtained feedback about the services provided from people’s relatives and the staff team that provided people’s care.

• We received positive feedback about the care and support received.

• Everyone we spoke with during this inspection told us they were happy with the care and support provided by Professional Nursing Services Limited.

• Staff promoted people`s privacy and dignity and their choices were respected.

• Care and support was delivered in a personalised way by staff who knew people`s likes, dislikes and preferences.

• Risks to people`s well-being and health were assessed and reviewed to ensure they were safe and protected from the risk of harm.

• Staff received training and had their competencies assessed to ensure they had the skills and knowledge required to meet people`s needs effectively.

Relatives told us staff were always on time. They felt staff were well trained and met people`s needs.

• Staff used effective infection control measures to protect people from the risk of infections. appropriate equipment was in place where needed for people to receive support in a safe way.

• People had opportunities to access the community where possible and pursue interests.

• Relatives we spoke with and staff confirmed the registered manager was approachable, supportive and placed people at the centre of the care and support delivered.

• Complaints were responded to appropriately.

• Feedback received from people and relatives was used in a constructive way and lessons were learned to ensure improvements were made.

• The registered manager who was also the provider used effective audits and governance systems to check the quality and safety of the care people received.

Rating at last inspection: Good (report published 27 January 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit.

We undertook an announced inspection of professional Nursing Services on 27 January 2016. We told the provider two working days before our visit that we would be coming to ensure we could access the information we needed.

Professional Nursing Services Limited is registered to provide nursing and personal care to people who live in their own homes. At the time of our inspection nursing care was not provided and three people received support with personal care in their own homes.

We were unable to speak directly with people who received support due to the complex conditions some of them lived with and the circumstances in which they were supported. However, we obtained feedback about the services provided from people’s relatives and the staff team that provided people’s care.

We last inspected the service on 16 July 2013 and found the service was meeting the required standards at that time.

The service had a registered manager. 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.

People’s relatives told us that they felt confident that people were safe and secure when receiving care. Staff were knowledgeable in recognising signs of potential abuse and understood how to report concerns both within the organisation and to outside agencies. Assessments were undertaken to assess any risks to people who received a service and to the staff who supported them. There were sufficient numbers of staff available to meet people’s individual support and care needs at all times, including during the night and at weekends. People received appropriate support from staff to enable them to take their medicines.

People received their care and support from a staff team that had a full understanding of people’s care needs and the skills and knowledge to meet them. People who used the service were treated with kindness and respect and their privacy and dignity was respected.

People received care and support that was based on their individual needs and preferences. People’s care and support plan was amended as necessary and in consultation with their relatives to meet their changing needs. Relatives of people who used the service felt confident raise any concerns and were in no doubt that they would be managed appropriately.

Staff were supported by the registered manager and received the training and supervision necessary to empower them to provide safe and effective support for people. People’s views about the service provision were gathered regularly to help the provider and registered manager assure themselves that the service they provided was safe and was meeting people’s needs.

Both of the people who receive a service from this agency had complex needs which meant they were not able to tell us their experiences. However, we spoke with a relative of each person, both of whom were closely involved with their care. Both relatives were complimentary about the service and the care provided by this agency. They told us they felt the agency met the needs of their relatives.

We found there were appropriate arrangements in place to manage people’s medicines safely.

We saw that people were cared for and supported by, suitably qualified, skilled and experienced staff. We found that the provider had carried out appropriate checks as part of the staff recruitment process. The relatives we spoke with told us that staff were, “Very good.” One relative told us they thought the manager selected staff, “very carefully”. They also said, “I’m very happy that [the staff] can be trusted to keep [relative] safe and care for [them].”

We found the provider had an effective system in place to regularly assess and monitor the quality of service that people received. This included formal processes, such as surveys. It also included informal processes, such as discussions with staff and the relatives of the people who received a service from the agency.

Since our last inspection in January 2013 we found the provider had made improvements in their record keeping. We found records were accurate and fit for purpose.

During our inspection we found the people using the service had complex needs which meant they were not able to tell us their experiences. However, we spoke with three people’s family members, all of whom were closely involved with their care. All were complimentary about the service and the care their relatives received.

People’s relatives told us they were asked for their views about the service and felt listened to by staff and the manager. They said issues were addressed quickly and in a satisfactory manner.

We were informed by people we spoke with that staff understood and met their relatives’ needs. Two of the three care plans that we looked at were very detailed and provided comprehensive guidance on how staff should assist those people. However, the third care plan was brief and did not cover all areas of the person’s need. Although we were satisfied the person’s needs were being met, we were concerned that should staff change, they would not know how to meet the person’s needs.

The relatives we spoke with all said they trusted the staff. We found that staff were trained to carry out their roles and received regular support from the manager.