This was an announced inspection that took place on 23 February 2018.

This service is a domiciliary care agency. It provides live in personal care to people living in their own houses and flats. It is located in the Kingston area and supports people in the Kingston, Richmond, Wandsworth and Wimbledon areas of South London and some areas of Surrey.

At the last inspection on 25 January 2017, we asked the provider to take action to make improvements regarding risks to people, and this action has been completed. In addition we asked the provider to make improvements to service quality audits and this action has been completed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good.

At this inspection all the key questions were rated good with an overall rating of good.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People said they were satisfied with the care and support that the agency supplied.

The agency records were up to date and covered each aspect of the care and support people received, the support choices they had made and identified that they were being met. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties well.

Staff were aware of their responsibilities to the people they supported, regarding the tasks they performed and the way that people liked to be supported. Staff provided care and support in a professional, friendly and kind way that was focussed on the individual as a person.

Staff knew that they must treat people equally and respect their diversity and human rights. People said they felt treated fairly. Staff had received appropriate training, were knowledgeable and made themselves accessible to people and their relatives. Staff said the organisation was a good place to work and they enjoyed their work.

Staff encouraged people and their relatives to discuss health and other needs with them and passed on agreed information to GP’s and other community based health professionals, as required. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s likes, dislikes and preferences were met.

The agency was aware of the Mental Capacity Act (MCA) and their responsibilities regarding it.

The registered manager was approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

This inspection took place on 25 January 2017 and was announced. We gave the registered manager 48 hours to make sure someone was available in the office to meet with us. When we last visited the service on 5 August 2014 the service was rated Good overall and in all five key questions.

Trueblue Nurses is a domiciliary care agency that provides personal care and support to older people living in their own homes, some of whom may be living with dementia. Some people received ‘live-in’ care with support from staff who remained with them day and night. Other people received care from staff at certain times of the day. There were five people receiving services from Trueblue Nurses at the time of our inspection, two of whom received personal care. The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Risks to people, including risks relating to people’s medical and health needs, were not always properly assessed with suitable risk management plans in place to guide staff in caring for people safely. In addition the provider had not carried out risk assessments when they accepted criminal records checks from other organisations for staff. This meant the provider could not be sure staff were suitable to work with people who used the service. This was a breach of the regulation relating to safe care and treatment. You can see the action we told the provider to take at the back of the full version of the report.

Although the provider had audits in place to assess the quality of service, these were not always effective. They had not identified the issues we identified relating to the risk assessment processes.

People felt safe and staff understood how to respond if they suspected anyone was being abused to keep them safe. There were enough staff to meet people’s need and medicines management was safe.

The provider supported staff through a suitable training programme as well as staff supervision. People were satisfied with the support staff gave them around eating and drinking and people had access to the healthcare services they needed. Staff understood the Mental Capacity Act 2005 and how this was important in the way they cared for people each day.

Staff understood the needs of the people they were caring for as well as their backgrounds, interests and preferences. Staff treated people with dignity and respect. People were involved in planning their own care.

The provider supported people to do activities they were interested in, including arranging group activity sessions for people using the service to meet together to reduce the risk of social isolation. A suitable complaints policy was in place and the provider encouraged people to feed back on the service.

The registered manager, deputy and staff understood their roles and responsibilities well. They registered manager had open and inclusive ways of communicating with people and staff.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service. This was an announced inspection. We told the provider 48 hours before our inspection that we would be coming.

At the last inspection in January 2014 the provider was meeting the regulations.

Trueblue Nurses is a domiciliary care agency that provides personal care and support to older people living in their own homes in and around South West London who may be living with dementia or experiencing memory loss. People are either visited at various times of the day or care is provided over a full 24-hour period. There were five people receiving services from the domiciliary care agency when we visited. 

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt happy and safe receiving services from the care agency. They also told us staff were kind and caring, and treated them with dignity and respect. Our discussion with a relative supported this.   

Staff were familiar with people’s individual needs and preferences and knew how to meet them. There were also enough properly trained and well supported staff working for the care agency to effectively meet people’s needs and wishes.   

People or their representatives were involved in developing and reviewing care plans. We saw people were supported to make decisions about their care and support. The manager demonstrated a good understanding of Mental Capacity Act (2005) and issues relating to consent. People were supported by staff to maintain and develop their independent living skills.

The care agency had a clear management structure. People who received services, relatives and staff felt comfortable about sharing their views and talking to the owner/managers if they had any concerns or ideas to improve the service provided. Staff demonstrated a good understanding of their roles and responsibilities, and staff told us they were always supportive and fair.

There were systems in place to routinely monitor the safety and quality of the service provided to people.

We spoke with two people who use the service, three members of staff and the registered manager during this visit to Trueblue Nurses.

People told us that they "like the organisation and staff" saying "all very good". They told us they were "more than content with the care provided", "very well looked after", "staff come at the time they are supposed to" and "I usually have the same carers". People said the agency was 'caring', "made a big difference to my life", "staff are supportive" and "the managers keep in touch".

Staff were happy to be working for the agency, they told us that they had the required checks before they started work and received the training and support they needed to carry out their role. Staff said that they provided a personal touch and continuity of carers to people who used the service.

We found that records were up to date, staff recruitment practices were in line with requirements and quality assurance systems were in place to give people opportunities to comment about the care and support they received.