The inspection took place on 11 and 12 May 2016. The last inspection took place in November 2013. There were no breaches of regulation at that time.

AH Care also known as Home Instead Care provides a personal care service for people who require support in their own home At the time of our inspection around 60 people were 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.’

Care staff spoke highly about the service provided. One said, “I love working here”. Another person said, “I am very proud to be working here”. People told us they would recommend the service to others. There was a genuine sense of fondness and respect between the staff and people. People we spoke with told us staff were caring. Relatives we spoke with informed us the staff showed a high level of compassion towards the people they supported. They used words such as “Compassionate”, “Caring”, “Excellent” and “Highly motivated” to describe the staff. All of the people we spoke with told us they felt staff went over and above what was expected of them and they couldn’t ask for more from the staff. Staff were positive about the people they supported. One member of staff stated, “I love helping the people I work for”. Another person said “It means so much to make somebody smile and their compliments mean so much to me”.

The feedback from people, their relatives and staff was a vital part of the quality assurance system. This was achieved either through annual surveys, meetings with people, complaints or reviews. They were listened to and action was taken to make improvements to their quality of life. The registered manager monitored and audited the quality of care provided striving to meet the ever changing needs of people living in the home. Staff, people and their relatives spoke highly about the registered manager. It was evident there was high level of leadership from the registered manager and this resulted in excellent staff morale. The registered manager participated in various forums and community events to ensure best practice was sustained.

Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. People were 'very happy' with the service they received. We received positive comments about their views and experiences. People told us they felt safe because the staff were "Caring and enjoyed what they did". The registered manager demonstrated their responsibilities in recognising changing circumstances within the service to help ensure that staffing levels and skill mix was effective.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role meaning staff had the knowledge and skills they needed to carry out their roles effectively. Staff informed us training was excellent and met their learning needs. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA). The registered manager had met with people to ensure their needs and preferences were recorded and they were matched with staff with similar interests. Each person had a core group of staff to ensure continuity of care.

Care plans were person centred and provided a high level of detail to provide safe, high quality care to people. Care plans were reviewed and people were involved in the planning of their care. There was a robust complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

We haven’t been able to speak with people using the service because of their complex needs. We gathered evidence of people’s experiences of the service by reviewing comment cards and the complaints log.

In respect of their care and support people had told the service, “extremely happy with the support”, “genuine care for mother’s welfare” and “pleased with your care”. One person stated, “I am kept informed when care givers are arriving”.

Comments made about the staff team included, "wonderful team of carers" and "excellent service from staff".

Feedback to the service from people included, "the quality of care that you and your team have shown to my mother has always been excellent" and "very happy with the quality of service".

The service was part of a national franchise Home Instead Senior Care. The franchise provided business support, training, policies and procedures and a care assessment and record package.

We visited people in their homes, talked with four relatives and looked at feedback people had given to the service. We talked with four members of staff about the care and support provided.

Relatives told us that they were advised about how they could legally make decisions on behalf of the person using the service where they were unable to consent about their care and support. Systems for the recording of people's consent were under review.

We found that people's care records stated their preferences about their care and support. Routines important to them, their likes and dislikes were noted. A relative said, "the assessment was comprehensive, they matched staff with my mum's needs and personality".

People were protected from the risks of exposure to health associated infection. Systems were in place to assess, prevent and control the risks of infections.

There were sufficient numbers of staff with the right skills and knowledge to ensure the health and safety of people using the service. Relatives told us,"they are all trained in the same methods so they slot together when working with a new carer".

People were asked for their feedback about the service provided. Robust quality assurance systems were in place. One relative said, "care workers are proud of their job".