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Inspection carried out on 10 October 2017

During a routine inspection

We undertook an announced inspection of Nissi Care (DCA) on 19 October 2017. We told the registered manager two days before our visit that we would be coming. Nissi Care provides personal care services to people who are living in their own homes. At the time of our inspection 61 people were receiving personal care from the service.

At the previous inspection in October 2016 we found the provider had not taken the necessary actions to ensure that medicines were managed safely. People's Medicine administration records (MAR) did not always contain accurate information relating to the administration requirements of specific medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

People were not always supported in line with the principles of Mental Capacity Act 2005 (MCA) . This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. The provider did not have an effective system in place to monitor the ongoing management of the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the registered manager had made significant improvements to address the areas of concern and bring the service up to the required standards. Where people needed support with taking their medicines we saw that medicine records were accurately maintained and up to date. People received their medicines as prescribed.

The registered manager was knowledgeable about MCA and how to ensure the rights of people who lacked capacity were protected. People were supported in line with the principles of MCA.

Regular audits were conducted to monitor the quality of service. These were carried out by the deputy manager and then checked by the registered manager. Audits covered all aspects of care. Information was analysed and action plans created to allow the registered manager to improve the service.

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.

People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People's care records contained up to date and accurate information and guidance for staff to mitigate the risks associated with people's care.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service.

The service sought people's views and opinions. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

Inspection carried out on 18 October 2016

During a routine inspection

This inspection took place on 18 October 2016. The inspection was announced.

Nissi Care Solutions provides personal care to people with a range of conditions, living in their own homes. At the time of our inspection there were 73 people using the service.

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 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely and we could not be sure people were receiving their medicines as prescribed.

The registered manager and staff were not clear about their responsibilities in relation to supporting people in line with the Mental Capacity Act 2005.

The provider had not sent in notifications to the Care Quality Commission (CQC) of events they were required to tell us about by law.

Systems were not in place to assess, monitor and improve the service.

People were supported by staff who understood their responsibilities to identify and report safeguarding concerns. Where risks associated with the support people required were identified there were plans in place to manage the risks.

There were sufficient staff to meet people's needs and people benefited from a consistent staff group. This enabled staff to develop caring, positive relationships with people. People were positive about the support they received and the caring approach of staff. Staff spoke respectfully when speaking about people. We heard supportive conversations between staff and relatives.

Staff had the skills and knowledge to meet people's needs. Staff were positive about the support they received and felt valued and listened to.

People were supported to access health and social care professionals when needed. Management and staff were responsive to people's changing needs.

People were confident to raise any concerns with the registered manager and felt they would be dealt with in an appropriate manner.

The registered manager was working to improve the care plan system and was aware of the need to make further improvements.

Inspection carried out on 18 September 2014

During a routine inspection

This service was inspected by an adult social care inspector. In order to answer the questions below we spoke with two people who used the service, two relatives, one member of staff and the registered manager. 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. We also reviewed two people�s care records and one staff member�s personnel records. There were eight people using the service at the time of our inspection.

Is the service safe?

The service was safe. People told us they felt safe. Staff personnel records contained all information required. Staff were confident to raise concerns to the manager and able to describe the different ways people might experience abuse. They understood the correct steps to take if they were concerned abuse had taken place.

Is the service effective?

The service was effective. Staff had a good understanding of people�s care and support needs and they knew people using the service well. Each person had a well written care plan that detailed their support needs. There was a robust procedure for recruiting staff and for making sure they had the skills and knowledge to support people using the service.

Is the service caring?

The service was caring. We saw staff demonstrated a great deal of patience when they were supporting people and gave people plenty of time to make their own decisions. One staff member told us, �We do our best all the time.� People confirmed to us they were not ever rushed.

Is the service responsive?

The service was responsive. There were audits in place to monitor the quality of the service. People�s support needs were always assessed before they used the service. Care records reflected people�s needs and ensured support was provided in accordance with their wishes.

Is the service well-led?

The service was well-led. Staff had a good understanding of the aims of the service and there were quality assurance processes in place. All staff were regularly supervised by senior staff. Care records we viewed were accurate, current and complete. The service had a robust system in place to respond to complaints and concerns.

Inspection carried out on 10 May 2013

During a routine inspection

We spoke with two relatives of people who used the service. They told us that their relatives had been given information about the service so they would know what to expect. One relative said that the agency had been very responsive to a short notice request for care. They said that the carers were very respectful of people who used the service and their families. One relative said that the agency had "been an absolute boon to us."

People's care and treatment was planned and delivered in a way that met their needs. Each person had an assessment and care plan. The relatives told us that their relatives had been involved in developing their care plans which were updated when their needs changed.

The provider had policies and procedures about safeguarding and staff had received training so that people were protected from the risk of abuse. The people we spoke with told us that the carers were trustworthy and their relatives who used the service felt safe with the staff.

We saw that the each member of staff received the training they needed to do the job. This meant that people were cared for by skilled and well trained staff.

There were systems so that people who used the service and their relatives could give feedback about the service. Any concerns were acted upon. There was a complaints procedure and people knew how to make a complaint. There were also systems to assess and manage risks so that people were kept safe.