About the service: The service is a domiciliary care service providing the regulated activity of personal care. At the time of our inspection there were about 160 people using the service.

People’s experience of using this service:

The service had strong leadership and a well- planned and organised workforce. This ensured people had consistency from a small team of care staff who knew their needs well and could be relied upon. Care calls were electronically monitored to ensure people received a need based service. There were emergency plans in place to ensure all calls were covered or extra ones could be provided when required. The service had a rapid response team who were not scheduled to cover calls and meant they could respond to people’s changing needs and able to avert a crisis or take some of the strain of a family member. For example, when a family member had an admission to hospital.

Staff recruitment procedures were robust and helped ensure only suitable staff were employed. The service invested heavily in its staff and ensured they were well trained, competent and shared the organisation values and upheld the rights and dignity of people they were supporting. This helped to promote staff retention and there were processes in place to support and develop staff

The service had robust systems in place to monitor the safety and quality of the service they provided. They clearly communicated their high expectations of their service and their staff and took responsibility and accountability for when things went wrong. They learnt from their mistakes and used them to embed and change procedures to ensure sufficient safeguards were in place. They considered best practice and current guidance. Care was planned to take into account new technologies and current risks within the market place.

The service contributed to new ways of working and were part of steering groups looking at policy change. They worked collaboratively with other organisations to help improve outcome for people they were supporting and be an equal contributor in the care sector.

The care was personalised and flexible according to people’s assessed needs and wishes.

Staff were kind and compassionate and this was an inclusive service which looked after people well, their extended families and the staff providing the care. Good practice was recognised and rewarded as a way of supporting and motivating care staff and helping them feel valued.

The service was seamless with staff at all levels understanding their responsibility to provide good care and safeguard people. There were systems in place to learn lessons when things went wrong and to reflect on practice to identify any shortfalls or come up with new initiatives which would help improve the service.

The service had been compliant since registration and has retained a good rating. There was an inclusive team. The service demonstrated its commitment to high quality care through its membership with investors for people, its engagement with the community and its presence at care award ceremonies. It had reached the finals consecutively over many years and contributed to raising the standards in care.

Rating at last inspection: (Good). The report was published 27 July 2016

Why we inspected: This was a scheduled inspection based on our previous rating.

Follow up: ongoing monitoring; possibly more about how we will follow up

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This announced inspection was carried out on 16 June 2016. Extra Hands of Heacham Limited - Heacham Office which provides support and personal care to people in their own homes in Kings Lynn, Dersingham, Fakenham and surrounding villages. On the day of the inspection there were 197 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 rights 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’s concerns may not be recognised 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.

There were systems in place to make sure that any person who used the service had their right to make decisions about their support and care valued and respected. People who used the service were actively consulted in decision making processes.

People who used the service and family members of other people who used the service, had positive comments to make about the standard and quality of the support and care provided. Support and care provided maintained and promoted people’s health, safety and wellbeing.

Effective systems were in place to safely support people with the management of their medication, if this was needed.

Although staff had distances to travel between call visits, people said that members of staff generally had arrived on time and when there call visit was due to start. This indicated that there were sufficient numbers of staff to meet people’s support and care needs in a timely manner.

People said that remedial action had been taken in response to their concerns or complaints. They said that this had improved the standard and quality of their support and care. Some also said that they were actively asked for their views about their support and care and action had been taken, if needed.

During our inspection on 15 May 2012 we visited three people using the service in their own homes and spoke with five others on the telephone. We also spoke with three family carers.

People told us that they received a reliable service. They were given information about who would be calling and were contacted if there were any changes. All of the people we spoke with knew how to contact the agency if there were any problems.

People were consulted about the care they needed. Most of the people we spoke with were happy with the service and said they received care that met their needs. One person told us, "They are all pretty good, they know what needs to be done and the way I like it." Another person told us, "I am very happy with the care and would not want to change." People had opportunities to be involved in reviews and changes to their care plans.

We were told that staff treated people with kindness and respect. People said that they trusted the care workers who visited them. One person told us, "I've never had anyone who was not nice."

People with whom we spoke told us that on the whole the homecare assistants who visited them were kind and caring and that they were treated with respect. People told us that the agency had involved them in the planning of their care and they were able to make their own decisions about how they wished for their care to be delivered. One person told us that the homecare assistants they were provided with were excellent. Some people told us that they are not always informed of changes to the time of the homecare visits or sometimes who the homecare assistant would be. However, all the people we spoke with said that they felt safe and knew how to raise concerns if they had any. They also said that their care needs were being met but that staff were not always aware of those needs before they visited.

Some people with whom we spoke told us that they received appropriate support with their medicines. Some other people said that their medicines were not always given to them when they should be and that they had to ask for them.

Some people told us that the agency does ask them for feedback on the quality of the service by way of a written survey. Other people told us that they had not spoken with anyone from the office for some time. They said that no one from the office had been out to visit them to review their records for over a year.