We undertook this announced inspection on 22 November 2018. Standard Nursing Agency and Care Services Limited –Wembley is registered to provide Personal Care services to people in their own homes. The services they provide include personal care, nursing care, housework and assistance with medicines. At this inspection the service was providing care for a total of about 52 people including children and adults. The service also provided nurses for NHS community and hospital services. Their nurses working as temporary staff carry out tasks under the direction of nurse managers either in the community or in hospitals. The agency received feedback on the performance of these nurses via comments made in the time sheets completed by nurse managers. The feedback form received by the agency indicated that the nurses were capable. This was also confirmed by managers of NHS services we contacted.

CQC only inspect the service received by people provided with 'personal care' and nursing care; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At our last inspection on 3 May 2016 the service met all the regulations we looked at and was rated as overall Good.

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

People who used the service and their relatives informed us that they were satisfied with the care and services provided. They informed us that people had been treated with respect and they felt safe when cared for by care workers. There were safeguarding children and adult’s policy and arrangements for protecting children and adults from abuse. The policies had however, not been updated to include guidance to care workers on ensuring that allegations of abuse were promptly reported to the CQC. These were done soon after the inspection.

The service operated under a set of seven core principles of care, which are reflective of the Principles for Good Homecare as outlined by the Equality and Human Rights Commission. These are privacy, dignity, independence, security, rights, choice and diversity and formed a key part of their staff induction training.

People and their relatives informed us that they felt safe with their care workers. Most of the required risk assessments were in place. The care records of two people did not contain appropriate risk assessments in respect of certain aspects of their care. These were prepared soon after the inspection.

There were suitable arrangements for ensuring that people received their medicines as prescribed. Audit arrangements were in place and the no gaps were noted in the Medicine administration records (MAR) we examined.

The service had an infection control policy and people and their relatives stated that care workers observed hygienic practices.

Care workers had been carefully recruited and the required pre-employment checks had been carried out. The service endeavoured to recruit a wide range of care workers from backgrounds that matched the diversity of people who use the service. Where possible, they had responded to requests for care workers who could meet the specific preferences of people. New care workers received a comprehensive induction and training programme to enable them to care effectively for people. Support, supervision and appraisals had been provided by senior staff. There were enough care workers to meet people's needs. Teamwork and communication within the service was good.

People’s healthcare needs were monitored when it was part of the care agreement. Care workers worked well with social and healthcare professionals.

Care workers were helpful and caring in their appr

We undertook this announced inspection on 3 May 2016. Standard Nursing Agency and Care Services Limited –Wembley is registered to provide Personal and Nursing Care services to people in their own homes. The services they provide include nursing care, personal care, housework and assistance with medicines. At the time of this inspection the service provided care for approximately fifty people.

At our last inspection on 19 August 2014 the service met the regulation we looked at.

The service has 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 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 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 of people 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. Where applicable, healthcare needs were monitored and care workers assisted people attend appointments with healthcare professionals. 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 telephone monitoring of care provided had been carried out and this had been recorded. This was also confirmed by people we spoke with.

People knew how to complain. The complaints procedure was included in the service user brochure. Complaints recorded had been promptly responded to. This was also confirmed by people we spoke with.

There were arrangements for the recording and administration of medicines. Care workers had been provided with training in the administration of medicines.

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 the registered manager. 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 with a few rare exceptions care workers communicated well with them and their relatives. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity and providing a good quality of care.

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 although there was room for improvement. 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 audits of care documentation. A recent survey indicated that there was a high level of satisfaction and people and their representatives made positive comments regarding the service.

Our inspection team was made up of a single inspector. There were 15 people receiving the regulated activity of personal care at the time of our visit, the majority of which were children. We spoke with three relatives of people who used the service. We spoke with the provider and three members of staff. We reviewed care records for people who used the service and records relating to the management of the home, which included five staff files.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us and the records we looked at.

Is the service safe?

The staff employed were suitably trained and experienced. All staff had been trained in first aid and had attended safeguarding vulnerable adults and children training in the past year. Staff were observed by care managers whilst caring for people who used the service every four months in order to assess their attention to safety and care delivery.

There were up to date care plans in place for each person and there was evidence potential or actual risks had been assessed and plans put in place to manage such risks. Care plans included details of health professionals involved in the delivery of each person’s care.

Is the service effective?

People who used the service or their relative were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A member of staff told us, "I ask what they would like." They went on to say they never forced people to do anything.

Is the service caring?

Relatives we spoke with told us the majority of staff were caring for their family member well. Staff told us how they cared for the people who used the service, working to meet the needs of people as individuals. People who used the service told us, "They are nice to my son," and "They are good to us."

Is the service responsive?

People’s individual needs had been assessed by suitably experienced staff. The staff we spoke with were aware of the needs of people who used the service. The relatives we spoke with told us they were aware of how to make a complaint. One person told us they had made a complaint recently, which was on going at the time of the inspection.

Is the service well-led?

Staff told us they were able to raise concerns during spot checks and supervisions and they felt able to speak to care managers over the phone if they had a concern. People who used the service had been consulted recently for their feedback, and feedback was positive in the majority of cases.

We found the service to be well organised with a detailed and consistent system of records both for those that used the service and for the staff that worked for the agency. All relevant policies and procedures that would be expected of a domiciliary care agency were well documented and readily available, including information on safeguarding, whistle blowing, complaints and recruitment policy.

The people we spoke with told us that they were happy with the standard and continuity of care that was provided and considered that their individual needs and wishes were taken into account. They felt that the care provided was reliable, and that there was a good collaborative working relationship with staff.

People were aware of a complaints procedure and were confident that they could relay any concerns about the service if they needed to do so.

Staff felt well supported and suitably trained and there was a clear and rigorous selection process in operation.

Records were managed securely and we were shown evidence of robust systems in place to monitor the quality of the service by the management team.

The agency is registered to provide the regulated activities nursing care and personal care. At the time of our inspection the director informed us that the organisation acted as an employment agency with regard to the nursing part of the agency. In view of that we did not inspect the part of the service related to the regulated activity nursing care, but we inspected the domiciliary service with regard to the regulated activity personal care.

At the time of the inspection the agency provided a small domiciliary care service mainly to children. We spoke to relatives of children and to an adult who was using the service. People knew how to contact the agency and had received information about the service it provided. They confirmed the agency asked them for feedback about the service that they received.

People told us they were happy with the care and support they or their child received, and said that staff were skilled, approachable and reliable. They told us they had regular care workers and were happy with that consistency of care and confirmed that staff respected their privacy and cultural needs. Comments from people included; “I am happy and have no complaints, I was really impressed with the service.”

Staff told us that they felt well supported and received appropriate training to ensure they could meet people’s needs and provide a quality service.

Records were accurate and up to date.

We inspected this service on the 10th January 2012. Standard Nursing Agency and Care Services Limited-Wembley is registered to provide the regulated activities nursing care and personal care. At the time of our inspection the director informed us that the agency did not provide a service by nurses that involved the planning, supervision or delegation of the provision of care and that the nurse agency part of the organisation acts as an employment agency. This means that this part of the agency is not required to register under Health and Social Care Act 2008. In view of that we did not inspect the service concerning the regulated activity nursing care, but we inspected the domiciliary service with regard to the regulated activity personal care.

As part of our review of Standard Nursing Agency and Care Services Limited-Wembley we visited the agency and we conducted telephone interviews with care workers, people who use the service and their relatives or significant others.

People told us they knew how to contact the agency, and had received information about the service it provided. They confirmed the agency asked them for feedback about the service that they received. People told us they were kept informed of changes to the service such as the substitution of staff due to staff holidays and staff sickness.

People informed us they were happy with the care and support they or their relative received from the agency and felt involved in decisions about their care. People told us that staff listened to them, asked them about their needs and how they wanted to be supported. They told us staff were skilled, approachable, reliable, and understood their needs. They told us they had regular care workers that provided the care and support they needed, and were happy with this consistency of care. People confirmed that staff stayed their allocated time and respected their privacy needs.

When we asked people if they felt safe and well supported by staff, people answered “Yes”. Comments from people using the service included; “I chose the agency,” I am very happy with the agency,” “I am very happy with the care,” “I have a care plan,” “I know how to contact the agency,” “I get the same staff,” “The staff know what I want,” “The staff are fabulous,” “There is stability of staff, stability is everything,” and “I am very happy.”

Staff told us they enjoyed their job. They confirmed they felt well supported and received appropriate training to ensure they could carry out their role and responsibilities in caring and supporting people using the service.