Almost Family is a small domiciliary care service providing the regulated activity of personal care to ten people in their own homes in the Dorking, Leatherhead and surrounding rural areas. Other people use the service to support them with activities such as shopping or social activities, but these are not regulated activities so did not form a part of this inspection. Packages of care varied from providing 24 hour live in support, to people who received a few hours a week. The service had a policy that their minimum care visit would be for an hour’s duration. They did not provide a service to children.

This inspection took place on 8 November 2016. The provider was given short notice of the inspection date as the service provides care to a small number of people and we needed to ensure that people would be available for us to speak to at the service office.

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. On the inspection we met with the nominated individual from the registered company which operates the service. They told us the registered manager would be making application to remove themselves from the registration of Almost Family. The service had already appointed a new manager who we met on this inspection. They told us they would be making an application to register, but as they were not yet registered are referred to throughout this report as the manager.

As part of this inspection we received positive feedback from people receiving a service and staff working for the agency. All of the people we spoke with told us that they had a regular small team of carers that knew them well, staff arrived on time, and they never had any missed visits.

People were supported by sufficient staff who had the skills and knowledge to meet their needs. There were clear training programmes for both individual staff and the service as a whole. Although these were not yet completed for all staff, staff were working to complete these in a short time framework. Staff were supported through regular supervision, spot checks and appraisals of their work, and told us they felt the management were approachable and they had the skills they needed.

People were protected from the risks associated with poor staff recruitment. A full recruitment procedure was followed for new staff. This included disclosure and barring (police) checks, references and checks on people’s identity.

People were protected from risks associated with their care because the service carried out regular assessments of the risks and mitigated these where possible. People’s care plans included assessments of people’s skin, falls risks, nutrition, mobility, moving and positioning. They also covered any concerns about their home such as access issues.

People received their medicines safely where this was a part of their care plan. One person told us about how staff were very careful when dealing with their medicines which gave them confidence. Other people were able to maintain their independence with medicines as staff would guide and prompt them to take them when needed.

People’s healthcare was supported because the agency liaised with community healthcare professionals where there were concerns over people’s wellbeing. We heard of how staff had for example contacted community nursing teams in response to concerns over a person’s well being, and in another recent incident had contacted the paramedic service as a person had ben found on the floor. They waited with the person until the person was taken to hospital.

People were supported to eat regular healthy meals where this was a part of their care plan. This included being supported and encouraged

We found people were treated with dignity and respect and their independence promoted. One person told us that it was 'a good agency and care workers were very caring'. Another person told us 'the carers were very kind and they were very happy with the care'.

We looked at a sample of care plans which showed people were involved in the decisions about their care, how they wanted their care provided and their preferences regarding times of care visits and care workers.

We found that people were provided with appropriate information about their care plans and given support in relation to these. We found evidence the provider, with agreement of people liaised with other professionals involved in their care including Local Authority social care staff and healthcare professionals.

We found evidence the provider worked with people to enable people, where able, to retain their own self care skills and management of their own care, and that the provider promoted people's autonomy, independence and community involvement.

We found people were respected and treated with dignity; their independence and involvement was promoted. One person told us, “I feel they are respectful, treat me with dignity. They are always very good at helping me with my personal care in a way which respects my privacy.”

People told us they received care in a way which met their needs. One person commented, “I have regular staff. They have been flexible to my needs and have accommodated extra shifts. I don’t have to struggle to be in charge of the household anymore. If I am ill I know I can stay in bed.”

We found people felt the service was delivered safely and people felt protected from harm. A relative commented to us, “I feel perfectly confident (my relative) is safe.” A person using the service said, “I feel safe with the carers; if there is a hold up they will call me, I have never been left without a service, they even got to me in the snow. I have been very impressed.”

People were recruited safely and checks were undertaken to make sure they were suitable to work with vulnerable people.

None of the people we spoke with said they had needed to raise any formal complaints. They said whenever they had made comments about the service they had been responded to and issues had been resolved to their satisfaction. One person commented, “I feel I can speak to the office staff at any time. The staff are all lovely people. They listen to us, respond to concerns and try and resolve them.”