This inspection took place on 18 October 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location office when we visited.

Flexicare at Home is a domiciliary care agency that provides support to people who live in their own home, both older people and some younger adults with disabilities. They provide a service in the West Yorkshire area to people who have a service commissioned via the local authority and to people who are privately funded. The office is situated at Calder Park in Wakefield. At the time of our inspection 66 people were receiving support from the service, including two people who received live in care.

The service is required to have a registered manager, and at the time of our inspection there was 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.

We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. These were regularly reviewed to ensure they were reflective of people’s current needs.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse. Staff understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

The provider had a safe system for the recruitment of staff and took appropriate steps to ensure the suitability of workers. People that we spoke with told us that staff usually arrived on time and there was a system in place to ensure cover in the event of staff sickness or absence.

There were systems in place to ensure people received their medication safely. Where staff supported people with their medicines, this was accurately recorded on medication administration records. Staff had received training in administering medication and the registered provider regularly observed staff competency in this area.

Staff completed an excellent range of training, which enabled them to provide a highly effective service. Training was refreshed annually. Additional specialist training was provided in relation to people’s individual needs where this was required, such as catheter care. Staff received regular supervision and support and were very regularly observed delivering care, to check their competence.

People were well supported with their nutritional needs and food preparation, where this was part of their care plan. People told us they were very satisfied with the support provided in this area. Staff were highly skilled and proactive in encouraging those who had difficulty with eating, and we found examples of where this had led to significant improvements in people’s well-being.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with other healthcare services, such as district nurses and GPs.

Staff had completed training on the Mental Capacity Act (2005) and were able to demonstrate an understanding of the importance of gaining consent before providing care to someone.

People told us that the staff who supported them were caring. People received support from a small team of people who they knew and with whom they had good relationships. People told us they felt in control of decisions about their care and also reported that their privacy and dignity were respected. Staff demonstrated a caring and empathic approach towards the people they supported, and we saw examples where staff went beyond the core tasks in the care package, where they felt the person may enjoy or benefit from something. Comments from peop

We found the service carried out a range of assessments which identified what support was needed for clients in their care. We saw care plans were in place to meet client's needs; we found evidence which showed care plans were frequently reviewed so that any changes to a client's needs could be met. This meant appropriate steps had been taken to protect clients from the risks associated with receiving unsafe and inappropriate care.

We spoke with a sample of clients regarding their views of the service; we received consistently positive feedback. One client, for example, told us the service they received was "excellent" and "first class" whilst a second client described the service as being "brilliant".

We received positive feedback from relatives of clients regarding the service which had been provided. One relative, for instance, said the service had been "excellent" and another said: "I'm so pleased to have an agency like this".

We found policies and processes were in place to help ensure only appropriate staff, of good character, were employed by the service. Staff we spoke with confirmed a range of checks, such as seeking references and criminal record checks, were carried out when they were employed.

All staff we spoke with felt supported by means of an induction, on-going training and back up from management. We found supervision of staff was carried out on both an informal and formal basis. One staff member told us they received "outstanding support" from managers whilst another said: "Managers are always there".

We found a range of systems were in place to check a quality service was being delivered.

We saw that the service had an up-to-date policy regarding handling complaints, suggestions and compliments. We saw evidence which showed how feedback had been appropriately acted on by the service. Clients we spoke with had confidence in the service and felt that if any problems arose they would be dealt with promptly. One person, for example, said: "[It only takes] one phone call to sort it out".