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Inspection carried out on 5 September 2018

During a routine inspection

This announced comprehensive inspection took place on 5 and 6 September 2018.

Nurseplus UK is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults. Not everyone using Nurseplus received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of this inspection 45 people were receiving personal care from the service. People who used the service lived in Newton Abbot and the surrounding areas.

The service had a registered manager. The registered manager for the service was also the registered manager of another branch of Nurseplus and was planning to de-register as registered manager of Nurseplus Newton Abbot. A new manager had recently been appointed to manage Nurseplus UK in Newton Abbot. The new manager told us they would be submitting and application to be the registered manager of this service. The new manager took the lead role during the inspection and was supported by the 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.

Our last inspection of this service was on the 21 December 2015 and we rated the service good.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were very positive about the care they received from Nurseplus. People were supported in a kind and compassionate manner. They complimented the caring attitudes of staff. One person told us, “Definitely happy, I’ve been with other care companies for years and with Nurseplus for two years now and I would say they [carers] go over and beyond all the others.”

People felt safe when staff supported them in their own homes. Systems were in place for staff to follow which protected people and kept them safe. People were supported by staff who had received training in and understood how to protect them from any harm and abuse. Staff knew how to, and were confident in, reporting any concerns they may have about a person's safety.

People had received an assessment of their needs to ensure they were suitable for the service. Care plans were used to provide guidance to staff on how to safely meet people's needs. However, some care plans lacked person-centred detail. We made a recommendation to the provider about seeking advice and guidance in developing more person-centred care plans.

Associated risks for staff attending people's homes and for providing care and support to people, were assessed and managed through individual risk assessments. These provided staff with information to help keep both people and themselves safe from avoidable harm with minimal restrictions in place. However, specific risks related to complex health needs were not always in place. We made a recommendation to the provider about this.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training and staff were also supported in their roles from managers and colleagues.

People were supported by staff who were familiar to them. People knew in advance which staff member would attend their care visits which gave them reassurance. Care visits were monitored to make sure staff turned up and stayed for the agreed amount of time.

Inspection carried out on 21 December 2015

During a routine inspection

Nurse Plus and Carer Plus UK Ltd provide care and support to mostly older people, who live in their own homes. The services provided include personal care, and domestic work in Newton Abbot, Teignmouth, Shaldon, Dawlish, Bishopsteignton and the surrounding areas. The service also provides registered nurses to care homes, to support end of life care; this is not regulated by the Care Quality Commission.

The service had 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.

We visited the office on 21 December 2015. At the time of this announced inspection 150 people were using the service. The service moved offices and was re-registered with the CQC in December 2014. Therefore, this was the first inspection to be carried out at this office.

People and their relatives were positive about the way staff treated them. Each person we spoke with told us their care workers were kind and compassionate. Comments included “They’re kind, sweet staff, and make jokes” and “We discuss what we want done and they always meet those needs”. People told us staff were respectful and polite. One person told us “Staff are respectful and all care staff have a nice manner”. We saw staff and people interact in a friendly way. They obviously knew each other very well and care staff knew what people needed. The staff knew people’s interests and chatted with them about these.

People and their relatives told us they felt safe when staff were in their home and when they received care. People told us “I feel 100% safe” and “I have a small team that I know and trust”. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service’s safeguarding policy.

People told us they were happy that staff knew how to meet their needs. People said “They’re brilliant, they’ll do anything to help me” and “Staff work in a unhurried way, going above and beyond”. Staff told us they were happy with the training they received. The service employed a training officer who provided face to face training. New staff completed training before going out to visit people. People told us they had a regular team of staff who had the appropriate skills to meet their needs. Another person said “I know my carers and they are flexible to my needs”. People told us staff were usually on time. They said “On the whole they are pretty good”. People told us if staff were going to be late, the office phoned them to let them know. Staff told us they were usually able to get to their visits on time. The office co-ordinator told us they tried to plan visits close together so travel time was reduced.

Care plans were developed with the person. They described in detail the support the person needed to manage their day to day health needs. Staff knew people well and were able to tell us how they supported people. During a home visit, we saw staff responded to people’s requests, met their needs appropriately, and knew how they liked things to be done. In one house, we were unable to find the care plan. The daily update book was available and well completed. The registered manager put new copies in the person’s home to make sure staff had access to them.

Safe staff recruitment procedures were in place. Each staff file had a list to ensure all checks had been completed before staff started work in people’s homes. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people.

Risk assessments had been undertaken and included information about action to be taken to minimise the chance of harm occurring to people. For example, where one person had experienced a number of falls, staff told us they had discussed this with the person. The person had agreed that staff could remove a rug at the bottom of the stairs. This had reduced the risk and the number of falls. Where people were supported to have their medicines this was done safely. People had received their medicines as they had been prescribed by their doctor to promote good health. The service reviewed incidents and accidents to minimise the risk of them happening again. For example, one person was given the wrong medicines on one occasion. Staff contacted the person’s GP, and stayed with the person to make sure they were safe. Staff completed further training to prevent this happening again.

The registered manager sought regular feedback from people who used the service. For example, through questionnaires, telephone calls, and meetings. People and their relatives felt able to raise concerns or make a complaint. People said “I can’t complain at all” and “I’m perfectly happy, nothing could be better”. Where complaints had been received, these had been dealt with appropriately. One person told us the registered manager had listened to their concerns, “She sorted it out. I phoned and thanked her”.

Health care professionals told us about their experience of the service. Comments included “I have found them to have a professional and friendly approach” and “They are easy to contact and respond quickly”. Staff told us the registered manager and co-ordinators were approachable. Comments included “They’re really understanding” and “I can talk to them about anything”.

A comprehensive audit system was in place to monitor the quality of the service. The organisation employed auditors. They carried out audits every three months over three or four days. A health and safety panel met every month to look at incidents and identify any trends. The provider had reached quality standards to receive accreditation from two independent organisations. The registered manager attended regular meetings at the organisation’s head office. They met up with other managers and shared learning and good practice.