Dunster Lodge Domiciliary Care provides personal care and support to people living in their own homes in the West Somerset area. At the time of this inspection the agency was providing care to approximately 90 people. Packages of care varied from a small number of weekly visits to supporting people with all care at the end of their lives.

At the last inspection in July 2015, the service was rated Good, with an outstanding rating for caring.

At this inspection we found the service had improved to Outstanding.

Why the service is rated Outstanding

The agency had a record of providing good quality care and continually improving the service provided to people. A number of people said they originally used the agency because it had been recommended to them. One person said, “They came highly recommended and have certainly lived up to their reputation.”

The provider took steps to make sure people received a safe service. They had policies and procedures which minimised risks of abuse and worked with other professionals to support people who may have been abused. One person said, “I feel absolutely safe with them [staff]” A relative commented, “I feel very safe, very safe indeed. If I have any problem I can just contact the office and they help me.”

People received effective care and support because staff were well trained and organised. One person told us, “I just can’t fault them. They are well trained and competent.” Staff supported people with routine healthcare needs and responded appropriately to emergency situations. One person told us, “I had a fall and they found me. They did everything and stayed with me until someone else got here. They stayed much longer than they should have but they just kept saying that it didn’t matter and they weren’t leaving. So kind.”

People were cared for by staff who were always kind and went over and above their job role to make sure people were happy and comfortable. People gave us a number of examples of where staff had ‘gone the extra mile.’ The agency ensured each person was supported by a small team of care workers which enabled people to build trusting relationships with the staff. This aspect of the service was very much appreciated by the people we spoke with. One person said, “I feel completely comfortable and secure with all my little team.” Another person said, “I’ve had other agencies where you have never known who is coming but that never happens with this one.”

People received extremely personalised care which was delivered in accordance with their wishes and lifestyle. The registered manager and a senior member of staff carried out assessments which looked at people’s interests and lifestyle choices as well as their needs. This enabled them to match people to staff who shared their values and therefore helped them to build relationships. This had proved valuable when working with people who found it hard to accept help. People were extremely complimentary about the timing of visits which meant they were able to plan their lives. One person said, “They have never been late. They are brilliant.”

The agency was extremely well led by the provider and registered manager. There was a commitment to listening to people’s views and continually improving the service to meet people’s needs. They were open when things went wrong and took action to address any shortfalls identified by complaints, incidents and their quality assurance systems. A relative said, “The company is amazing, so different to previous people that we used. They are absolutely amazing. I cannot fault them. They do everything we need them to do and they do it very well.”

Further information is in the detailed findings below

This inspection was carried out as part of the schedule of inspections and to check compliance because an area for improvement was found at the last inspection visit in November 2012. This was in regard to the outcome, Requirements relating to workers. We found that the service was now compliant and had a robust process in place to check that staff were suitable to work with the people who used the service.

We spoke with one person who used the service; three relatives and four staff. We looked at three care records, two staff recruitment records and records for the management and administration of the service. We also used information from the services own quality assurance survey of service users and relatives that was carried out in March 2013.

People and their relatives told us that they were very happy with the care and support they had from the service. Comments from people included “Excellent” and “Going really well. X has really taken to it even though X was reluctant to have support in the first place.” People and their relatives had found that the service provided by the provider was, “Much more personal. Staff had a good understanding of old age care.”Other people told us “Fabulous continuity of staff.” And ” Staff care about the person.”

We found people experienced care and support that met their needs and expectations. Improvements had been made in the systems the service had for monitoring the quality of the services it provided.

This was the first inspection visit since the service was registered in March 2012. We visited the service office where we reviewed records and spoke with two staff including the registered manager. We contacted three of the 17 people who used the service or their relatives following the visit to the service. We spoke with two of the 13 care workers employed by the service. We also obtained feedback from a social worker who was involved in purchasing services from the agency.

People made comments about the quality of the support, such as, “Very good,” and “I am very pleased with the service, always excellent!” People also told us about their experiences of the staff. We were told by a relative that staff were “very patient and understanding and XXXXX always enjoys their company.” They had added that they had always found them to be “nice and kind.”

We found that the service had provided to people the support they needed and met their expectations. We found there were areas where further development was needed such as for record keeping in the office so that the information reflected the support people were actually receiving. We also found the processes for monitoring the quality of the services provided to people needed expanding. We made one compliance action and this was in regard to ensuring that the recruitment processes for new staff were robust.

This inspection was announced and took place on 27 & 28 July 2015.

Dunster Lodge Domiciliary Care provides personal care and support to people living in their own homes in the West Somerset area. At the time of this inspection the agency was providing care to approximately 90 people. Packages of care varied from a small number of visits a week to 24 hour care to people receiving support at the end of their lives.

The last inspection of the service was carried out in May 2013. No concerns were identified with the care being provided to people at that inspection.

There is 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 were extremely complimentary about the agency and the staff who supported them. Many people commented they thought staff went the extra mile to make sure they were comfortable and content. Comments included; “I have had the carers since October. They are certainly the tops, I can’t speak highly enough of them,” “Anything extra you want they are always happy to do” and “They are the best carers I have had in 30 years. Always on time and always treat you with dignity.”

People had consistent staff who they were able to build trusting relationships with. This ensured people received care from a small number of staff who they got to know well. This aspect of the service was very much valued by people. We heard examples of how a consistent staff group, working with patience and understanding, had enabled the agency to provide care to people who had previously been unwilling to accept support. This led to improvements in people’s well being.

Care staff demonstrated extreme kindness and compassion for the people they visited. In addition to people receiving care, they also supported informal carers to enable them to continue their caring roles.

Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and liaised with other professionals to make sure people received effective treatment and pain relief. Where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.

Staff knew people well and respected the things that were important to them. A health and social care professional told us they felt the agency respected people’s choices about how they wished to live their lives.

Staff were well trained and people were confident they had the skills to meet their needs. Staff were well supported which led to high morale and a happy workforce. Many people commented that staff were always cheerful.

The agency had a robust recruitment procedure that ensured staff were thoroughly checked before they began work. Staff knew how to recognise signs of abuse and all said they were confident that any issues raised would be appropriately addressed by the registered manager or provider. People felt safe with the staff who supported them.

There were systems in place to monitor the quality of the service and plan on-going improvements. People using the service and staff felt involved and able to make suggestions or raise concerns.

People felt well supported by staff and knew how to contact the registered manager or community team supervisor if they wished to discuss any aspect of their care. A number of people told us they would recommend the service to other people.