The inspection took place on 14, 15, 16 November 2016. SPDNS is a domiciliary care agency which offers nursing care, personal care, end of life care and companionship to support people living in their own home. The service also ran a ‘hospice at home service’ and had developed a service called ‘One Response’ which is a coordinating service for people with palliative care needs. 'One Response' is a support, assessment and advice service and will visit people at home if necessary and was set up through collaborative working with a local hospice and clinical commissioning groups. This service was run in conjunction with Macmillan nurses, Marie Curie nurses and end of life specialists. At the time of our inspection the service was supporting approximately 300 people either with direct care or by telephone support.

The provider worked closely with commissioners and local authorities to develop new services in response to the needs of people in the community. This had a positive impact by helping people to remain in their own home as long as possible with the support from the ‘hospice at home team’.

The service has a registered manager. 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 systems and processes were in place to ensure people's safety. People were safeguarded from the potential of harm and their freedoms protected. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had up to date information about people’s needs which meant they were more effective in delivering appropriate care. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff supported people with their medication as required.

Staff had received a wide range of training so that they had a good understanding of how to meet people's needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides a legal framework to assess people's capacity to make certain decisions, at a certain time. Staff were clear about the importance of gaining consent from people. People told us their

wishes and decisions were respected.

The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including GPs, District nurse, Macmillan nurses, Marie Curie nurses, end of life specialist and the mental health team. People were supported with their nutrition and hydration needs.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Staff were attentive to people's needs and treated people with dignity and respect.

People were supported with activities which interested them. Management and staff understood the importance of responding to and resolving concerns quickly. People felt confident they could raise any concerns to the management.

The service was well led by a management team committed to providing an excellent service. The registered manager had a number of ways of gathering people’s views including talking with people, staff, and relatives. They carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements.

As part of our inspection we used an Expert by Experience to contact people using the service. We attempted to ring 30 people and were able to speak with six people who used the service and five relatives. People we spoke with and their relatives were generally happy with the level of care and support provided by SPDNS House.

One relative told us, “Everyone {staff} that comes here is good.” Another relative told us, ”If it wasn’t for them I wouldn’t have been able to manage as I have so far.”

We found that the provider had arrangements for assessing and recording consent and people's capacity to consent.

We saw that people's care and treatment was planned and reviewed with their and their relative’s involvement, wherever possible. Risks to people's health, welfare and safety were identified and well managed. Our inspection and discussions with people afterwards showed us that the service was generally safe, responsive and caring.

We found that there were systems in place to ensure that cleanliness and infection control practices were good.

Staff were selected and recruited in a way that ensured they were suitably qualified and fit for the job.

We found that there were systems in place to assess and improve the quality of service provision.

We saw that records relating to people using the service, staff and day to day running of the service were accurate and easily found.

We completed this visit as part of a routine inspection, but also as we had received information of concern regarding the service we incorporated those concerns into the areas that we inspected on this occasion.

We spoke with four people and two relatives who use the service. One person told us that staff were, “Excellent” and, “Very caring.” Another person told us that they were very happy with staff, “Excellent, no fault in males or females.”

People and their relatives felt that when they gave feedback if appropriate it was acted on. We were told by another relative that a staff member would come and chat to the person about topics that interested the person.

People told us that occasionally staff were late but that when this happened they usually arrived within a reasonable time and/or they were contacted by the service.

People we spoke with told us they were well informed regarding the services provided by SPDNS Nurse Care. People, carers and relatives we spoke with told us that the staff were aware of their privacy and dignity requirements and that they were involved in the decision making practices regarding their care.

People we spoke with who use the service were complimentary about the staff and commented that the standards of service were good. They told us that if they raised any concerns about the care the organisation were quick to respond and make any necessary changes.