This inspection took place on 28 and 30 August 2018. The inspection was announced on 24 August 2018. This is the first time this service has been inspected since they registered with the Care Quality Commission in June 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection there were a total of 21 people using the service with 4 receiving live-in care and 17 in receipt of care visits. The service mainly cares for older people living with dementia, physical disability and people living with neurological conditions such as a Stroke or Motor Neurone Disease.

The service had 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.

We found there were exceptionally well-trained staff who developed kind and caring relationships with the people they cared for. People told us the care met and exceeded their expectations. The service promoted people’s independence and provided care in a skilled and sensitive way, including people who were approaching the end of their life.

People told us they were consistently in receipt of care that made them feel very safe. Care staff demonstrated a high level of understanding of types of abuse and how to report these. The policies in place for safeguarding were detailed and had been written in collaboration with the local safeguarding authority. Risks assessments were in place and regularly reviewed.

Recruitment processes were exceptionally comprehensive. The service actively recruited staff who had shared interests and would therefore be best able to meet the needs and preferences of the people using the service. There were sufficient staff to meet people’s requirements and cover unexpected absences. Staff received detailed training and regular supervision.

Medicines were safely managed and the provider had sourced an independent expert to design and deliver the training, analyse and advise on potential medication errors and provide a telephone advice line for medication queries.

People received an outstanding level of effective care. The service sought out and worked in partnership with professional organisations that could offer valuable advice and support for people living with certain conditions. This ensured that care planning and delivery was always done to meet best practice guidelines. Information learned from professional organisations was included in training programmes and cascaded throughout the organisation. Case studies were completed in relation to specific medical conditions so that all staff were made aware of successful outcomes of excellent care.

People were supported to have maximum control over their lives and were supported in the least restrictive way possible. Policies and systems in place in the service supported staff to encourage people and their families to make choices and retain control over their lives.

The care people received was person-centred and regular reviews took place. When planning and delivering care, people’s preferences, life histories, family involvement, personal emotional and physical needs were prioritised. The service recognised the risks of social isolation and encouraged people to engage in activities within the community that were appropriate to their personalities.

The provider had detailed policies and provided training and updates for staff on respecting people’s equality, diversity and human rights (EDHR). EDHR and lifestyle needs and choices were discussed and staff were supported to respect people as individuals.

People were supported with nutritional requirements and staff promoted a healthy diet while adhering to medical recommendatio