The inspection took place on 5, 12 and 13 October 2017. The inspection was announced. The agency was last inspected in July 2015 and was found to be outstanding in caring and good overall. At this inspection we found that the service had maintained its good rating and continued to be outstanding in caring.

Ross Nursing Agency provides personal care to peoples in their own homes. At the time of the inspection they were supporting 70 people. This was a family run business and there was a registered manager in post who was the daughter of the previous manager and the provider. 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.

We found this to be a well run service. There was a good organisation and deployment of staff which meant that people received care from a consistent team who were reliable. There were sufficient staff to respond to people’s changing needs and any emergencies. There were robust systems in place to ensure that staff were properly recruited. Once in post staff were trained and their practice observed to check that they were working to the required standards. Specialist training was provided to ensure that staff had the skills to meet peoples individual health needs. Staff monitored people’s needs and sought advice from health professionals appropriately.

People were supported to have maximum choice and control of their lives. Staff knew people well and the care provided was person centred. Staff were kind and compassionate and provided people with care and companionship. People told us that care staff went beyond what would normally be expected and provided a highly individualised service.

Support was underpinned by detailed and informative care plans which were regularly reviewed. The agency communicated well with individuals and their relatives to ensure that the support was responsive to people’s needs. There was a complaints procedure and any concerns raised were dealt with in an open and transparent way.

The registered manager provided clear leadership and was well known to and assessable to people using the service and staff. People told us that the office team were helpful and proactive in responding to issues. There were quality assurance systems in place to monitor the quality of care which included seeking the views of people who used the service. Since the last inspection there had been a number of new initiatives and the registered manager had a plan to drive continued improvement at the service.

During our inspection we visited two people who received a service from this agency and spoke on the telephone with nine further people and eight people's relatives. We also spoke with eight members of staff and a health care professional who had regular contact with the agency's staff.

The people and relatives we spoke with made mainly positive comments about the care provided. One person described the care provided as, “Acceptable.” Other people told us the care was, “Very good.” A relative told us, “I’ve found it to be an excellent service. They keep us going. They are what keeps my [relative] at home.” Another person said they were “…very, very satisfied [with their care]. Ten out of ten. I can’t fault them.”

We saw that people’s needs were assessed before care was provided to ensure that the agency was able to meet each person’s needs safely. Each person had a care plan that provided clear guidance to the staff on the care people required.

We found that appropriate arrangements were not in place to ensure that medicines were administered to people safely.

We saw the provider took steps to ensure there were sufficient staff on duty to provide care at the agreed time and for the agreed duration. People told us that staff were generally well trained and competent.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. We saw that comments and complaints were responded to appropriately.

We visited the office on 22 May 2012 and spoke with three people using the service on the phone and they told us that they were happy with the service and that they received, “excellent care.” They stated that carers were coming and staying for the agreed time. One person said: “If they are ever late, they let us know. I can’t remember last time they were late.”

They stated that carers were good and knew what was expected of them. People felt safe and protected and said that they could contact the office if they were unhappy with anything. One person explained: “ I would press the red button”, referring to emergency pendant they wore all the time.

Two people confirmed that they knew about their care plans and were consulted when care plans were reviewed. One person added: “They write the notes every day and they tell me what they write.”

We reviewed quality monitoring surveys carried out by the provider and were given a copy of the summarised results. Seventeen people had returned their questionnaires up to the date of the visit, 22 May 2012. 82% of people felt always respected and the remaining 18% marked “nearly always”. 59% marked the service as “excellent” and the remaining 41% as “good”.

A person stated in the questionnaire under “Any additional comments”: “Thank you very much for staying beyond the agreed time and going with me to hospital when I needed someone with me.”

This inspection took place on the 30 June and the 1 July 2025 and was announced.

The agency was last inspected on the 6 September 2013. It was found to be meeting all of the standards required other than the regulation with regards to the management of people’s medicines. The registered manager sent CQC a detailed action plan telling us what action they would take to achieve compliance. At this inspection we found that the action had been taken and the improvements had been made.

The agency provides personal care to people in their own home over a 24 hour period where required. It is a limited company and the registered manager is also the Director. 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 service had recently had a change in manager. We met a number of senior staff who had been working at the agency for many years and staff retention was good.

We found it was a well-led service. There were robust systems in place to ensure staff had the necessary skills to deliver care safely. We looked at systems in place to help ensure people received their medicines safety and saw these were sufficiently robust.

Staff knew how to report any concerns affecting the wellbeing and, or safety of people using the service and worked closely with other health care agencies to ensure people’s needs were met. Risks to people’s safety were clearly documented and people’s needs were kept under constant review to ensure the care provided was safe and appropriate.

There was a good organisation of staff to ensure there were enough staff to cover calls and do this flexibly to take into account changing needs and dealing with emergency situations. A tracking device helped the management team know where staff were and if they were staying the allocated period of time.

Robust staff recruitment processes helped to determine a person’s ‘fitness’ before employment. Once employed staff were supported through induction, training and supervision. We saw that staff had the necessary skills to meet people’s individual and sometimes complex needs. Staff were able to do this by working closely with other health care agencies to ensure people’s health was maintained and ‘health conditions’ carefully managed.

Staff monitored people food and fluid to ensure people did not become dehydrated or lose unnecessary amounts of weight.

Staff supported people lawfully and sought people’s consent and permission before providing care. Where a person lacked capacity to make certain decisions staff worked with family and other agencies to ensure the persons best interest was upheld.

Staff were kind, caring and worked flexibly to support people and provide them with comfort, reassurance and companionship. People’s dignity and confidentiality was promoted and care plans focussed on what people needed help with.

Staff were well trained to provide good palliative care when required.

People were involved in their care and all had access to information about the service. People were familiar with all the staff and management and felt comfortable to raise concerns and said it was an effective service.

The agency were responsive, people’s needs were assessed and a detailed plan of care was put in place. This enabled staff to know how they should support people and provide support consistently. The plan was actively reviewed and monitoring systems enabled changes to be quickly identified and show what actions had been taken to address any changes to people’s need.

There was a robust complaints procedure which people were familiar with. Regular monitoring of staff and close management contact with people using the service enabled concerns to quickly be identified and rectified.

The service was open, transparent and accountable to people. There were systems in place to record the service delivery and identify any occurrences which had an adverse effect. Actions showed how the agency responded and learnt from mistakes.

The agencies quality assurance processes ensured they engaged with people and asked them for their views of the service. This enabled them to influence the service.

Joint working with other agencies enabled the agency to respond more appropriately to the needs of people and manage risk.