This inspection took place on 19 and 20 April 2018. At our last inspection we rated the service good. At this inspection we found evidence the service was now outstanding and because of this the report is in a shorter format.

Agincare UK - Nutfield Extra Care Scheme provides personal care to people living in their own flats across four schemes. It also provided personal care services to those people who were in prison. At the time of our inspection there were 74 people using the service.

The service was managed by 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 felt safe when using this service. Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns. Risks to people's wellbeing were assessed and action taken to reduce these. The service focused on keeping people safe whilst promoting their independence.

There were enough staff to meet people's needs and staffing levels were flexible according to people's changing needs. The registered manager followed safe recruitment practices to ensure that staff were suitable to work with people. Staff were qualified and received training that helped them to deliver a high quality service to people. The registered manager provided support and guidance to staff to ensure they were equipped to carry out their roles. Staff felt valued by the registered manager and supported in their roles.

People’s medicines were handled safely.

Where necessary people's nutritional needs were well met. Where required they supported people to access a range of health and social care professionals in the community for advice, treatment and support. Staff monitored people's health and wellbeing and responded quickly to any concerns.

Staff understood the importance of gaining consent from people and acted in accordance with the principles of the Mental Capacity Act 2005. Staff had a good understanding of people's needs and supported them effectively.

People's achievements were celebrated and their views were sought and acted on. People were supported by staff who were compassionate and treated them with dignity and respect. Without exception, people who used the service spoke highly in their praise about the staff who supported them.

People had assessments of their needs and care was planned and delivered in a person-centred way. The service had creative ways of ensuring people led fulfilling lives and they were supported to make choices and have control of their lives.

People described how their care was delivered and what they told us demonstrated the service was extremely person-centred. Staff echoed that the service was person-centred in their feedback and our own observations and evidence gathered supported this. Every element of the approach of the registered manager and staff was centred around the person who used the service, their abilities, feelings, wishes and goals.

People who used the service accessed a range of community facilities and were involved with activities which were organised by the service.

People's end of life wishes were followed with pride and staff took great comfort when they had supported people to have the end of life they had wished for.

The service had a positive, vibrant and caring culture which people, relatives and staff supported and promoted. People told us they were well supported and well cared for. Staff were exceptional in supporting people to be as independent as possible in their lives. We saw lots of examples where people were striving towards independence.

Staff were highly motivated and reflected pride in their work. They talked about people i

We carried out an inspection of this service on 12-16 September 2016 during the inspection of HMP Leyhill, which was carried out in partnership with Her Majesty's Inspectorate of Prisons. A breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. The full comprehensive inspection report of the September 2016 inspection, which was published on 25 January 2017, can be found on the HMIP website at: https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/hmp-leyhill/

This inspection took place on 24 August 2017 and was announced. We announced the inspection because we needed to be sure somebody would be present at the location. At the previous inspection we found a breach of Regulation 9 (Person-Centred Care). During this inspection we found that improvements had been made and the provider met this legal requirement.

Agincare UK - Nutfield Extra Care Scheme provides personal care to people living at the on-site 'Extra Care Scheme' as well as people who are detained at HMP Leyhill. The purpose of this inspection was to look at the care provided to people at HMP Leyhill. 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 found that people had detailed and up to date care plans in place, which they had been fully involved in creating. Care staff kept daily records which confirmed that they had provided the care people required. Care staff communicated any changes in people's needs, health and well being to the appropriate people.

We spoke with three people who all told us that they received the support that they needed. They told us that they had been asked for their views about their care and about the service that was provided. They all said that someone from the agency had asked them about their needs and what help and support they wanted. People told us that the staff always asked them what they wanted doing when they visited.

People said that they had been involved in developing their care plans and that they had consented to the care and support in their care plans. There were suitable arrangements to manage medication to keep people safe. One person told us that the staff helped them so that they had the right tablets at the right time.

The staff had had regular supervision and spot checks from a senior to make sure they were working effectively and they were supported. When they started work they had all the basic training needed to make sure that they had the skills to work with people. Staff had the opportunity to work towards qualifications in care. They received more specialised training to keep their qualifications and skills up-to-date.

Three people told us that the staff had the right skills and training to meet their needs. Two people told us that the staff were all very good. Another person said that the staff were very encouraging and helped to promote their independence. One person said that “they always know what they are doing” and the care and support from staff was “spot on.” Another person said that the staff “cannot do enough for you.” A third person said that they “could not ask for better.”

There were arrangements to monitor the quality of the service provided and people told us that they were asked for their views about the service. There were also arrangements to make sure that risks were managed and people were kept safe.

We spoke to four people who received a personal care service from Agincare UK and one person's relative. People told us that they felt respected by the staff who were polite and reliable. Care plans contained information about people’s preferences and staff understood the importance of offering people choice.

People told us that they were satisfied with the service they received. Care plans were person centred and up to date. One person told us they felt confident that care staff would arrive on time and provide the care they needed. This person told us that if they pressed their emergency alarm the staff would attend immediately.

People told us they felt safe with the care staff and knew who to talk to if they had any concerns. Staff told us they were confident the manager would take action in response to any concerns or complaints.

The service ensured that effective recruitment procedures were in place so that people were safe.

The provider had a system in place to monitor the quality of the service.

The inspection was announced. We gave the provider 48 hours’ notice of the inspection. We did this to ensure key staff would be available at the service. At the time of the inspection the service was providing personal care to 24 people living at Nutfield Extra Care Scheme. The service also ran a domiciliary care service and were providing personal care to 21 people within the local area.

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

At the time of the inspection the service employed, a registered manager, deputy manager, one care coordinator, senior care staff and 20 care staff.

People received care and support from care staff they felt safe with. People were safe because staff understood their role and responsibilities to keep them safe from harm. Staff were aware how to raise any safeguarding concerns. Risks were assessed and individual plans put in place to protect people from harm.

Staffing levels were sufficient to meet people’ needs and protect them from harm. The service carried out pre-employment checks on staff before they worked with people to assess their suitability.

People spoke highly of the staff that provided their care and people’s relatives were also complimentary of staff. Staff we spoke with demonstrated they were aware of people’s individual needs and understood their preferences.

There was training and support available to staff to ensure they had the skills and knowledge they needed to support people effectively. Staff received supervision and appraisal aimed at improving the care and support they provided. Staff understood their roles and responsibilities in supporting people to make their own choices and decisions.

People gave consent before any care was provided. Staff understood the principles of the Mental Capacity Act 2005 and gave examples of how they supported people with decisions about their care and daily lives. Where required, legal documentation was in place where others had made decisions on behalf of those people who lacked capacity to do so.

People were involved in planning their own care. They had been consulted to ensure their care records reflected their own views and opinions. Care records were reviewed with people and they had also been provided with sufficient information about the service.

People received a service that was well-led because the registered manager provided good leadership and management.  Systems were in place to check on the standards within the service. These included regular audits of care records, medicine management, health and safety, infection control, staff training and supervision.