Home Instead is a domiciliary care agency. It gives personal care to people living in their own houses for 80 people. It provides a service to older adults. Not everyone using Home Instead received the regulated activity; CQC only inspects the service being received by people provided with ‘personal care;’ and help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the last inspection the service was rated Good. At this inspection we found the service was now outstanding.

Typical feedback included. “This is an excellent company you won’t have any problems. If you ring them they will send someone to you to find out your requirements.” And, “I know the person who is on the premises. If they do not come they will send a replacement. You will not get let down. My staff member very often gives me an extra 10 minutes. They do the work thoroughly.” And, “Every now and again they send someone to see you, to ask if you are happy with their service. They will ask if there is anything they can do to improve. With regards to medicines, the manager will watch the staff member, while I take the tablets. They will explain everything to you. I have no complaints.” And, “It is very well organised one of the best around. I cannot fault them at all.”

A registered manager was 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.'

The directors of the company, management team and staff continued to find ways to improve the service and remain driven by their passion for caring for people, by ‘making it personal.’ The service had built on their earlier rating and since the last inspection, had implemented a strategy which had been focused on how they were going to achieve an outstanding model of care. The pathway used to do this was referred to as 'going the extra mile team' approach. The vision and the value of the service was to become the most admired home care provider across Brentwood, Billericay, and Upminster.

Staff had an excellent understanding of people's needs and were imaginative in the way they gave person centred care. The provider put people at the heart of the service and looked to find creative ways of supporting people to have an exceptional quality of life.

People and their relatives felt confident that people were safe and secure when receiving care in their own homes. There were clear systems in place to ensure the safety of people who used the service. Staff had received training to identify if people were at risk from abuse or harm. Enough staff was deployed to ensure that people had a consistently reliable service. Recruitment procedures to appoint new staff were thorough. People were supported to take their medicines safely.

Staff spoke consistently about the service being a good place to work. The registered provider worked in partnership with other organisations and took part in several good practice initiatives, designed to further develop the service.

People received their care and support from a staff team, that had a full understanding of people's care needs and the skills and knowledge to meet them. Staff were given an induction when they started and had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently. Staff were regularly supervised and supported. People’s needs were assessed before their care and support package began. People were provided with person-centred care which considered their needs, wishes, preferences, and any cultural or religious needs. Staff supported people to meet their nutritional and health care needs.

People were supported to have maximum choice and control of their l

This inspection took place on the 11 of May 2016 and was announced. The inspection was carried out by one adult social care inspector and one expert by experience.

Home Instead Senior Care is a service which provides personal care and support to adults in their own homes. In addition to providing personal care, Home Instead also provides a companionships service which supports people with activities and help with domestic duties. This element of the service, although provided by Home Instead Senior Care would not need to be registered with the Commission if this was their sole purpose. We focussed our inspection on the people in receipt of personal care only. On the day of our inspection there were 115 people using the service, 60 of which received personal care.

There is a Registered Manager at this location. 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 kept safe by staff that had a thorough understanding of their responsibilities to protect people they were caring for from harm or abuse.

People’s needs were met and they were cared for by sufficient numbers of staff. The risks to people were identified and reviewed to ensure people remained safe.

People had positive relationships with their care workers and were confident in the service. There was a strong value base to ensure workers were caring and compassionate. People who used the service felt they were treated with kindness and said their privacy and dignity was respected.

Medicines were managed safely and staff members understood their responsibilities.

The registered manager conducted regular audits and improvements were carried out when these had been identified. The quality of the service was monitored and assessed consistently. People who used the service, family members and staff were regularly consulted about the quality of the service they received.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service, family members and visitors were made aware of how to make a complaint and there was an effective complaints policy and procedure in place.

The service regularly used community services and facilities and had links with the local community.

People who used the service told us that freedom of choice had been available all the way through their care experience. They said they had been consulted about their care provision and had the opportunity to ask questions of care givers and the management team at any time and were always provided with thorough explanations.

People’s needs were assessed and care was planned and delivered in line with their individual care plan. We spoke with three people who used the service and with two relatives. They all confirmed there were personal care plans in place that covered the support and assistance people required.

People told us they were satisfied with the care givers who provided their care. We saw that usually care givers supported a particular group of people. This provided consistency in thesupport provided and allowed caregivers to get to know individuals and their specific needs well. One relative told us, "Most have quite a lot of experience and are very good at what they do."

People who used the service, their representatives and care givers were asked for their views about their care and that these were acted on.

There was a system in place to ensure that people had their comments and complaints listened to and acted on. One person told us, "I would be happy to contact the office if I had any concerns but I would probably talk directly to the care givers, I know they would listen to me and do as I ask."

During the course of this review we received comments from several people who had used the agency, including friends and relatives of people receiving support. We asked for their views on the quality of the service and care given. There was a clear appreciation of the openness and clarity in the preparation and offering of care, one person told us: "I have the same carer nearly all the time; it is so comforting to know that.”

People using the service and their relatives told us that a representative from the management team maintained regular contact with them to ensure they continued to be satisfied with the service provided.

We were told that the staff conducted themselves in a professional and respectful manner, taking into account and maintaining peoples' dignity. People said they were involved in reviewing the care and support provided to them on a regular basis and that they felt supported to express their wishes and preferences.

People felt that staff listened to them and took into account their views in planning care and that they felt able to feedback directly to the staff or the manager about the care and support delivered. They also told us that if they had experienced any concerns about their care, that they would raise these and be confident that the issues would be dealt with.