We inspected BJP Home Support Limited on 27 June, 5, 6 and 20 July 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in to assist us. At our last inspection of the service in March 2015 we rated the service as Good. At this inspection we rated the service as Outstanding.

The service is registered to provide personal care to people living in their own homes. The service provides care and support to older people, people with mental health conditions, people with a learning disability, physical disability or those people who are at end of life. At the time of the inspection 147 people were receiving personal care.

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.

There was a clear management structure in place and oversight from the provider. There were systems in place to monitor the safety and drive the continuous improvement of the quality of the service provided. A comprehensive programme of audits and checks were in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety and medicines. Audits resulted in clear action plans to address shortfalls or areas of improvement.

The manager displayed good leadership qualities, drive and enthusiasm. They empowered staff to provide care that was tailored to people's individual needs. Without exception people, their relatives and professionals told us they experienced and we observed compassionate care from staff who strove for excellence. This ensured the service was run in the best interest of people who used the service.

People received care and support in a personalised way. Staff knew people well, understood their needs and the way they communicated. Care was focused on people's wishes and preferences. This meant people were able to maintain their independence and achieve a good sense of self-worth and wellbeing. The impact this had on people was outstanding and had resulted in them being settled, content and helped them to lead as full and active lives as they wanted to.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to people in a compassionate way. People told us their privacy and dignity was maintained at all times.

People and their relatives told us the service kept them safe. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Policies and procedures were in place to safeguard people from abuse. People’s medicines were managed safely. The provider and manager monitored staffing to ensure enough staff employed to support people safely. The provider’s recruitment process minimised the risk of unsuitable staff being employed.

People told us staff had the skills needed to support them effectively. Staff were supported with regular training, supervision and appraisal. People’s rights under the Mental Capacity Act 2005 were protected.

Some people received support with their food and nutrition. Where this was the case their nutritional needs and preferences were recorded in their care records. The service worked with external professionals to maintain and promote people's health and wellbeing.

Care plans were personalised and reviewed regularly to ensure they reflected people’s current support needs and preferences. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and also spoke positively about the manager. People said the manage

We received feedback from people using the service and their relatives by speaking to them on the telephone. The people we spoke with were positive about the care they received. One person said, “I am definitely satisfied with the service from BJP. I would recommend them; I couldn’t get a better service.” Another person told us, “They do what they say they’ll do and provide the care that’s needed.”

We found that people had their needs assessed and support plans were in place. The staff we spoke with were knowledgeable about the needs of the people they supported.

We saw evidence that staff communicated well with other health and social care professionals involved in peoples care.

We found that there was a recruitment policy and procedure in place and staff had undergone appropriate checks before being employed.

People were confident about the care, support and therapy provided within the service and had no concerns, but would raise them if they did.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies, paying particular regard to how people’s dignity was upheld and how they could make choices about their care. The inspection team was led by a CQC (Care Quality Commission) inspector joined by an Expert by Experience this is a person who has experience of using this type of service.

As part of this review, we visited four people in their own homes and spoke with them about their experiences of the support they had received from this service. At the time of our visit to the service, we spoke with the manager, two senior care workers and two care workers. We spoke over the telephone with a further 20 people who used the service. We also considered information provided within postal surveys returned to us from people who used this service, and their relatives.

We inspected BJP Home Support Limited on 5 and 10 March 2015. This was an announced inspection. We informed the provider at short notice (48 hours before) that we would be visiting to inspect. We did this because we wanted the registered manager to be present at the service on the day of the inspection to provide us with the information that we needed.

The service is registered to provide personal care to people living in their own homes. The service provides care and support to older people, who have a learning disability, mental health conditions, physical disability or those people who are at end of life. Every third week BJP Home Support Limited provides a rapid response service and is on call during this time. The aim of the rapid response is to provide care and support to those people in their own homes whose informal care and support package has broken down unexpectedly and who may have had to go into a hospital or care home because they were unable to manage at home. This service is also provided to people who are discharged from hospital. This service is provided to people for up to six weeks and then the person is reassessed and their ongoing needs determined.

The home 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.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

Prior to the commencement of the service staff from BJP completed environmental risk assessments of the person’s home. We saw that individual safety checks had been carried out in each home setting. Safety checks looked at the gas supply, electricity points, where the stop cock was, equipment to be used, fire risk, smoke alarms and all areas of the person’s home. We saw that equipment such as hoists was checked to ensure that they had been serviced and was fit for use. This meant that the provider took steps to ensure the safety of people and staff.

There were risk assessments in place for people who used the service. The risk assessments and care plans had been reviewed and updated on a regular basis. Risk assessments covered areas such as scalds and moving and handling. Risk assessments required further development as they were not individual to the person. This meant that staff did not always have the written guidance they needed to help people to remain safe.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However some records needed further detail to ensure care and support was delivered in a way that they wanted it to be.

Staff told us that the registered manager was supportive. Staff had received supervision. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. The registered manager had undertaken appraisals with staff.

Staff had received training which had provided them with the knowledge and skills to provide care and support. Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. The registered manager told us that staff had been on training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

There were enough staff employed to provide support and ensure that people’s needs were met.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Care plans we reviewed contained lists of people’s medicines and also information about where people kept the medicines, how they should be administered and what time they should be taken. We recommend that the service consider National Institute for Health and Care Excellence (NICE) guidance to ensure that all information on current medication list is up to date and accurate and take action to update their practice accordingly.

People and relatives told us that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People were provided with their choice of food and drinks which helped to ensure that their nutritional needs were met.

Staff at the service worked with other healthcare professionals to support the people. Staff worked and communicated with social workers, occupational therapists, hospital staff as part of the assessment process and others.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.