This inspection was announced and took place on 9 and 25 October 2018.

There has been a change to the way the service is delivered since our last inspection. The service used to be called Project Smile and Care at Home. Since our last inspection a decision was made to stop providing support to children and adults living within the local community and the service was renamed Care at Home.

This service is a domiciliary care agency. It provides personal care to people living in their own flats. It provides a service to older and younger adults.

Care at Home staff provide personal care and support to people that live in their own homes on Moorview, which is sited within The Heathlands Village. At the time of our inspection visit 31 people were living on Moorview, 18 of whom were receiving personal care and support from the Care at Home staff team. People who used the service who received support had a wide range of diverse needs.

People were able to access all the facilities available on The Heathlands Village site and many of the systems and processes used by the Care at Home staff were the same as The Heathlands Village and are therefore shared in this report.

At our last inspection in November 2015 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service did not have a manager who was registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of this inspection a new manager had recently been appointed and their application to register was submitted after the inspection.

Staff we spoke with praised the outgoing manager for the work they had done in promoting good teamwork and raising confidence which had a positive impact on morale.

Recruitment procedures were satisfactory. However, improvements were needed to the registered providers application form to ensure a full employment history was maintained. This was addressed by the provider during our inspection.

Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the managers of the service.

Our observations and discussions with staff and people who lived at the home confirmed sufficient staff were available to support people.

Risk assessments had been put in place and were individual to the person assessed. This was to minimise potential risk of harm to people during the delivery of their care and support. These had been reviewed on a regular basis and were relevant to care provided.

We found medication procedures at the service were safe. People were supported to maintain good physical and mental health through regular monitoring by staff and support to attendance at external appointments.

People were supported to have maximum choice and control of their lives with staff support where necessary. People who used the service were responsible for cleaning their own flats, with support.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively. Improvements had been made in staff training and more support was being offered to staff from human resources

Project Smile and Care at Home provide personal care and support to children and adults who live in their own homes within the local community. This was the first inspection of this service.

Project Smile is an established service providing care and support for children and young people. Care at Home is a new and developing service for adults. The service was less than a year old at the time of our visit and provides services to older people and continuity for young people transitioning from children to adult services.

This report relates only to children, young people and adults who receive personal care from both services. At the time of our visit Project Care was providing personal care to 11 children and young people and Care at Home was providing personal care to five adults.

The services had a manager who was registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager for the service was available at the time of our visit.

Staff we spoke with told us about the importance of keeping people safe and they were in no doubt that the registered manager would take the right action to deal with any safeguarding or whistleblowing allegations.

We saw there were recruitment and selection procedures in place to help protect people who used the service from coming into contact with staff who were unsuitable to work with vulnerable people.

The organisations code of conduct made it clear what behaviours the organisation expected from staff and what behaviours they did not expect. This included the prevention of abuse of people who use the service, staff appearing unapproachable; imposing personal beliefs, ignoring something they know is wrong, bullying and criticising colleagues.

We found that people received support from regular staff who knew them well. Photographs were available on care files so people using the service could recognise staff providing support to them. Feedback on documents we saw and from people we visited were highly complementary about the support they received from staff.

We saw that there were risk assessments in place and staff had received training in administration of medicines and infection prevention and control.

Staff confirmed that they had completed an induction when they started to work for the service and received regular supervision from their line manager. They also commented that they would recommend the care agency to a member of their own family. The staff undertook a wide range of training.

We saw that staff received training in Jewish awareness so that they understood people’s cultural needs, which included kosher arrangements. We saw that staff received training in food hygiene as well as nutrition and diet. A hydration risk assessment was carried out to help ensure people received plenty of fluids to keep well.

People who used the services commented that, "Project Smile has provided outstanding care for my child. My child is looked after with compassion and a consideration of their needs. The service they are providing is outstanding in comparison to other care providers we have used." and "The service is very thorough, there is a lot of paperwork involved. The staff are amazing and the managers are very helpful. I have known them for a long time and they always have time for me. They always show and interest and what is best for us."

We were given examples of staff going, ‘the extra mile’ for people such as temporarily moving into a person’s home to enable the rest of family to go away and attend a family event. This gave the person continuity of care and support whilst they were aware and reduced the impact of disruption to their daily life.

We saw that there was