This inspection took place on 3 August 2017 and 8 November 2017 and was announced. We gave the service a short period of notice that we would be attending as we needed to ensure that senior personnel would be available during the inspection. This was the service’s first inspection since newly registering with us in September 2015.

Better Care at Home is registered to provide personal care to people who wish to remain living in their own homes. At the time of this inspection, the agency was providing a service to 12 people.

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.

Everyone spoke positively about the management of the service and felt that the registered manager was available and approachable. There was a strong ethos of delivering high quality, person centred care and this was a culture which was embedded with the staff team.

There were strong support systems in place for staff which enabled them to feel valued and motivated to provide high quality support to people.

Oversight of the service and staff was both formal and informal and enabled the management team to continually monitor and develop support to be responsive to people’s changing needs.

People, relatives and professionals consistently told us that staff were exceptionally kind and caring and gave examples where staff had gone the extra mile to provide high quality, person centred care for people.

Support from staff was appreciated by carers of people receiving support and we were told what a difference the additional consideration for their role as main carers had on their lives.

People were supported to receive high quality end of life care by staff who were flexible in their approach and supportive of people’s families.

Staff were aware of their responsibilities in protecting people from harm and knew how to report any concerns about people's safety or wellbeing. People had individual risk assessments giving staff the guidance and information they needed to support people safely.

People were supported by staff who were recruited safely and were familiar to them. People and relatives felt that staff had the sufficient skills and knowledge to support them and we saw that staff had access to relevant training for their role. Staff received regular supervision and appraisals and we saw that they also had competency checks to monitor their practice and drive improvements.

Staff understood what support people needed to manage their medicines safely and these were given as prescribed. There were processes in place to audit the accuracy of recording medicines.

Staff understood the principles of the Mental Capacity Act and were able to explain how they considered capacity and consent when they supported people.

Where people received support from staff to eat and drink sufficiently, we saw that staff offered choices and prepared foods in the way people liked. People were supported to access a range of professionals where needed.

Care plans were person centred and provide details about what was important to people and were regularly reviewed when people’s needs changed.

People and relatives knew how to complain if they needed to and where a complaint had been received, this had been recorded and responded to.

Staff respected people’s privacy and information was stored confidentially. Staff encouraged people to be as independent as possible and there was a strong focus on enabling people to remain independent in their own homes.