The inspection took place on 5 and 12 February 2019. The registered provider was given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies.

At our previous inspection in June 2016 the service was given an overall rating of ‘Good’. At this inspection we found it remained good.

This service is a domiciliary care agency. The service provides care and support to older people, younger adults and children. It provides personal care to people living in their own houses and flats in the community. It also provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of our inspection there were 40 people who used the service. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’. Where they do we also take into account any wider social care provided.

The service was managed by the 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 were safe. Staff understood their responsibilities in relation to protecting people from the risk of harm. Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe. People received their medicines as prescribed. Infection, prevention and control procedures were in place and staff followed these.

Staffing levels were predominately maintained to ensure that people's care and support needs continued to be met safely and there were safe recruitment processes in place. However, there was a shortage of staff to support people and at times this impacted on people’s families.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People’s needs and choices were assessed and mental capacity assessments were undertaken.

People and the relatives we spoke with were very happy with the care and support provided. However, some said they did not always receive the care and support arranged due to staffing difficulties. The management were aware of the issues and had put a new management structure in place to manage calls and ensure better communication.

The provider had a complaints procedure that was given to everyone who used the service in the statement of purpose. People we spoke with said they were listened to and any complaints received were dealt with following the providers complaints policy and procedure.

All staff we spoke with told us they enjoyed their work and received regular supervision, appraisals and training. However, some staff told us there were staffing issue and more staff were required.

A system was in place for checking the quality of the service using audits, satisfaction surveys and meetings. People made their views known through direct discussion with the service manager and staff or through the complaint and quality monitoring systems. People's privacy and confidentiality were maintained as records were held securely.

This inspection was carried out between the 04 and 06 June 2016. The inspection was announced, and we gave the provider 48 hours’ notice to ensure there was a manager available to assist with the inspection process.

Buxton Home support provides personal care for 35 people in their own homes. This includes children and young people with complex needs, people living with dementia, people with physical disabilities.

The service should have a registered manager. At the time of the inspection visit there was not a registered manager at the service. 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. The current manager had applied to CQC to become a registered manager.

People and relations of children using the service said they felt safe and secure using the service. There were systems and procedures in place which were followed to ensure appropriate pre-employment checks were made on staff prior to them working with the people who used the service. Staff understood how to protect people from potential harm and how to report any concerns.

The provider ensured staff received training relevant to their roles and responsibilities. New staff completed a period of shadowing and induction training prior to them supporting people with their care needs.

Staff treated people and children with dignity and respect. People felt the staff understood their individual needs. The management team ensured people were involved in their own care and decision making. Staff understood the key principles of the Mental Capacity Act (2005).

Care plans contained information to assist staff in providing personalised care. People were given information on what to do if they had any concerns or complaints. Staff felt confident if they had any concerns or complaints the registered manager and management team would take them seriously and endeavour to resolve them.

People and children had their individual care plans reviewed to ensure they received the care and service they required. People were listened to and felt their individual needs were understood by the staff. Staff reported any changes to people’s health conditions to ensure continuity of care.

The manager endeavoured to provide people and children with their care support at the time they needed it. People understood there were times when staff may be late due to unforeseen circumstances, but felt confident that they would be contacted and alternative arrangements made.

People’s and children’s independence was promoted and encouraged by staff who understood individual needs. Staff were aware of people’s needs and wishes and supported them in a personalised manner. When needed, staff assisted and supported people with their nutritional needs and meal preparation.

The provider had processes in place to monitor the quality of the service people received. There were clear arrangements for the day to day running of the service. The service was managed by a team who understood their roles and responsibilities in providing a good service to people.

The Buxton Home Support Service is a domiciliary agency based in north Derbyshire. We visited the agency at their offices in the centre of Buxton, which they share with the Buxton Volunteer Centre.

We also spoke with two people who receive a service from the agency and asked them about the service that they received. Both said they were very happy with the service and made the following comments. One person said: “The staff are marvellous, really helpful and caring. I don’t know how I would manage without them.” A second person said: “I have no problems with the staff at all, they are very good, and they meet my needs. It is usually the same carers so there is consistency, and they work very well as a team.”

We also spoke to one member of the care staff as well as two members of the management team. Staff said they were happy working for the agency, and felt well supported.

We found the agency to be well run, very organised and responsive to people’s needs. Management staff in the offices knew the people who were receiving care, and understood their needs.

We used the services of an ‘expert by experience’ to talk with people who use the service.

The expert spoke with seven people who receive care from Buxton Home Support Service. Everyone provided positive feedback regarding their experiences. One person summed up their feelings with the comment: “A very happy arrangement.”

None of the people who were spoken with thought that they were in anyway at risk whilst being cared for by the staff from Buxton Home Support Service. Among the comments made were: “They are brilliant.” “I couldn’t manage without them.” “They are kind, caring and compassionate.”

Everyone spoken with said that they felt they or their relative were treated with respect and were always spoken to in an appropriate manner. One person explained how their relative had had a stroke, as their rehabilitation had allowed development and more independence; the care plan had been changed accordingly.

Among the other comments that people made were: “They are always happy to help.” “If there were any problems I would tell you, but there are not.” “If there is a change in the plan, for example if the carer is going to be late, or maybe a change to the carer, they always ring and let me know so we can decide if we are happy with this.”