This inspection was completed on 11 and 12 January 2017 and was announced. County Carers Ltd provides domiciliary care services to people within their own homes. This can include specific hours of required support or live in carers to help promote the person’s independence and well-being. At the point of inspection 21 people using the service received personal care assistance.

The service had a 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 and their relatives advised that they had been appropriately involved in the planning and reviewing of care. They felt that the service excelled at providing exceptional responsive care to people, often going above and beyond what was expected of them. Care plans were thorough providing specific details on how to support people in the way they wanted. This allowed people to remain involved in the how they had care delivered effectively.

People told us that they felt safe. Staff were able to explain signs of abuse and what protocols they would follow if they suspected anything. The service had systems in place to ensure sufficient suitably qualified staff were employed to work with people. They were matched to meet people’s needs, in terms of language, knowledge, likes and dislikes.

People received care and support from staff who had the skills and knowledge to care for them. All staff received a comprehensive induction, training and support from experienced members of staff. Bespoke training was being delivered to meet the changing needs of people, whilst ensuring that staff remain up to date with changing legislation and guidance on best practice. Staff reported feeling supported by the registered manager and said they were listened to if they raised concerns.

People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests. Staff had an understanding of the Mental Capacity Act, and used the principles of this when working with people.

People felt the service was respectful and preserved their dignity and independence. Where possible choice was given and the person was encouraged to complete tasks independently. This promoted well-being for the person.

People were supported with their medicines by suitably trained, qualified and experienced staff. Details were provided on each person’s file on what the medicine was for and how this needed to be administered. Comprehensive protocols for PRN medicines were recorded in the files, where applicable to prevent over usage. PRN medicines are used on an as needed basis.

People told us communication with the service was good and they felt listened to. People, professionals and relatives said they thought people were treated with respect, preserving their dignity at all times. County Carers was described by a relative as “one of the best companies out there”.

The quality of the service was monitored regularly by the registered manager, who is also the nominated individual. A thorough quality assurance audit was completed bi-annually with an action plan being generated, although this was not always followed up on, or evidenced. The bi-annual audit gathered information from people, relatives and staff to better the service. The registered manager advised shorter audits were completed monthly, although a formal report was not always prepared. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments. No complaints had been received, however the registered manage