This announced inspection was carried out on 17 August 2016. Extra Hands of Heacham Limited - Broadland Office provides support and personal care to people in their own homes in Norwich, Holt, Sheringham, Broadlands and surrounding villages . On the day of the inspection there were approximately 300 people using the service who received personal care.

The service had a registered manager in place at the time of our inspection. 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 supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

People were supported by a regular staff member or group of staff who they knew. People who required support to take their medicines received assistance to do so when this was needed.

People were provided with the care and support they required by staff who were trained and supported to do so. People’s human right to make decisions for themselves were respected and they provided consent to their care when needed.

People were supported to consume a sufficient amount of food and fluids that promoted their wellbeing. People received support from staff who understood their health needs.

People were treated with respect by staff who demonstrated kindness and understanding. People were involved in determining their care and support. They were shown respect and treated with dignity in the way they wished to be.

People could not rely on their plan of care containing all the required information to ensure their care and support was delivered as needed. People were informed on how to express any issues or concerns they had so these could be investigated and acted upon.

The management team provided leadership that gained the respect of care workers and motivated them as a team. When issues were indented within the service action was taken to address these. There were systems in place to monitor the quality of the service and make improvements when needed.

People we spoke with told us that staff always sought consent when necessary. They gave us examples of how staff sought permission when entering their homes. They also told us that they were involved in decisions about their care, or the care of their relative, when their needs changed. This showed us that the provider gained and reviewed consent from people appropriately.

We saw that care records had been written in a professional manner, detailing the care given at each visit and also recorded other relevant information. We looked at care plans and found that in each case the planned care matched the commissioning agency's requirements and was based on an assessment of the person by a senior staff member. One staff member said that the care plans, introduced in January 2013, enabled “a more person-centred approach to care.” People told us that they were able to read their care notes whenever they wished. This showed us that the provider had taken steps to ensure that each person received effective, safe and appropriate care.

People told us they felt safe when being cared for. One person said that staff were "more like friends than workers." Staff had up-to-date safeguarding training and policies were in place for financial transactions. We saw that the provider's recruitment process ensured that unsuitable people were not recruited and that their complaints procedure was clear.

People spoken with were positive about the support they received. We received a variety of comments about the quality of staff such as, “They’re always good and the carers carry the flag for Extra Hands.” One person commented about the care their relative received and said they thought it was, "...fantastic care. They are very kind and very thoughtful. She's exceedingly pleased with the care that she gets." People felt that staff respected their privacy and dignity.

There were systems in place to help protect people from abuse and staff knew how to raise any concerns they may have. People felt safe using the agency. Staff also had access to development and training opportunities to ensure they were able to support people safely. However, we found that guidance in individual care records about how this was to happen needed to be clearer to avoid the risk that staff may overlook aspects of care that were required or be unsure about how to deliver it safely.

There were good systems for monitoring the quality of the service and ensuring that improvements were made where necessary.