This was a comprehensive inspection which took place on 23 January 2018 and was announced. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office to assist us.

Carewell Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, younger adults, people living with dementia and people with physical or learning disabilities. At the time of the inspection the service was providing personal care and support to 13 people.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 registered manager was present and assisted us during the inspection.

At the last inspection the service was rated Good in all domains. At this inspection we found the service remained Good in Safe, Effective, Caring and Well-led. They were outstanding in Responsive.

People received safe care from the service. Staff were trained to safeguard and protect people. They reported concerns promptly when necessary and the registered manager took appropriate action. People received their medicines safely and when they required them. Risks to people were assessed and actions taken to minimise risks without restricting their freedom. A robust recruitment procedure was followed to ensure as far as possible only suitable staff were employed.

People continued to receive effective care from staff who were trained and had the necessary skills to fulfil their role. Staff were very well supported by the registered manager. Regular one to one meetings and appraisals provided time to seek advice, discuss and review their work. They had opportunities to develop their skills and knowledge as well as gain relevant qualifications.

People were supported with nutrition and hydration when this was part of their care and support plan. People’s healthcare needs were monitored and advice was sought from healthcare professionals when necessary. 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.

The service remained caring and people reported staff were extremely kind and patient. They told us staff were willing to go above and beyond their duties to provide excellent care and support. People’s privacy and dignity was protected, they and their relatives told us staff treated them with respect. People and when appropriate relatives were fully involved in making decisions about their care.

The service was extremely responsive to people’s individual needs. Staff knew people very well and paid particular attention to finding out about people’s interests, past lives and their personal preferences. Individual care plans were person-centred and detailed. They focused on the diverse needs of each person, taking into account any protected characteristics. The service worked toward achieving people’s desired outcomes and providing flexible and outstanding care. People knew how to raise concerns or make a complaint but had not needed to do so. They felt confident they would be listened to if concerns were raised. The service was working to the accessible information standard.

The service was very well-led and had strong leadership from the registered manager. Records were complete, accurate and reviewed regularly to reflect current information. The registered manager was experienced and skilled. They promoted an open, empowering, person centred culture and demonstrated by example the provision of excellent care. The values of the service wer

This inspection took place on 9 December 2015 and was announced. Carewell Limited is a small domiciliary care service and at the time of the inspection was providing personal care to eight people living in their own homes.

At the time of the inspection 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.

People and their relatives were happy with the service they received from Carewell. They told us they felt safe using the service. Risks to people and staff were assessed and managed effectively. Staff had good knowledge and showed awareness of how to keep people safe. They understood the policies and procedures used to safeguard people.

Recruitment procedures were effective and helped to ensure people were cared for by suitable staff. Staff received training to ensure they had the skills to care for people safely and effectively. People received their medicines when they required them and there was a system to manage medicines safely.

The provider had policies and procedures designed to deal with emergency situations. Staff showed knowledge and understanding of how to deal with emergencies.

People’s right to make decisions was protected. Staff understood their responsibilities in relation to gaining consent before providing support and care. People and where appropriate their relatives had been involved in making decisions about their care. Their decisions were respected and they felt they had been listened to.

People were treated with kindness, dignity and respect and they were supported to remain as independent as they wished.

Staff were kept up to date with information concerning people or changes to their care. Where concerns were identified regarding a person’s well-being, staff contacted healthcare professionals to seek advice. People were supported to have enough to eat and drink when this was part of their identified care needs.

There was an open culture in the service and staff were comfortable to approach the registered manager for advice and guidance. Staff felt well supported, they said they were listened to and action was taken promptly to manage any concerns raised.

Regular feedback was obtained from people using the service. This helped the registered manager to monitor the quality of the service. A complaints policy was available, no complaints had been received in the last year.

We spoke with people who use the service. One person told us the staff were "really helpful" and were "chatty and companionable". Another told us the staff were "always very pleasant and very caring".

Care was planned with the involvement of the people who use the service and reflected people's individual needs.

There were arrangements in place to protect people from the risk of infection. Staff were supported to deliver care as they received mandatory training in a range of topics and regular management supervision. All staff received an annual appraisal.

There were systems in place for the provider to monitor the quality of the service provided and for recording complaints and incidents. The people we spoke with were aware of who they could speak to if they had any complaints.

We spoke to people who use the service. One person told us the staff were "very good" another told us the staff combined "professionalism with good nature and making you feel comfortable"

Care was planned with the involvement of the people who use the service and reflected people's individual needs.

Although there was an informal system of staff supervision and training in place staff training was not always complete and appraisals had not been carried out for several years.

There were systems in place for the provider to monitor the quality of the service provided and for recording complaints. The people we spoke with were aware of who they would speak to if they had any complaints.