This inspection took place on 9 and 17 October 2017 and was announced. Flexicare Home Services UK provides domiciliary care services to a range of people who live in their own home. The service often provides complex care including 24 hour care or care contracted through continuing healthcare. At the time of our inspection there were 68 people with a variety of care needs using the service, including older people, people living with physical disabilities and younger adults.

We last inspected on the 4 and 5 December 2014. At the December 2014 inspection the service was meeting all of the requirements of the regulations and was rated as “Good” with caring rating as “Outstanding”, due to extremely positive feedback from people and their relatives.

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.

People and their relatives spoke extremely positive about the outstanding care they or their relatives received. The service often went above and beyond their contractual obligations to ensure people had a good quality of care. People were placed at the centre of their care and were supported to develop their independence, their lives to the fullest and make choices around their care including who cares for them.

People and their relatives were heavily involved in their care and spoke extremely positively about the professional relationships they had with all staff employed by the provider. The service had strong links with healthcare professionals and was focused on improving and developing care and the care staff role nationally as well as within the service.

People were cared for by committed care staff who were supported by a dedicated management team. People’s relatives were involved in providing training to care staff which enabled them to provide exceptional person centred care. Relatives spoke positively about the support they received to provide this training.

There was a strong structure of leadership within the service. Staff were supported to professionally develop and be responsible for additional duties. Staff felt valued by the service. The registered manager and provider knew and anticipated the needs of staff and had systems to ensure staff had access to the training and support they needed.

Staff and other professionals spoke very highly of the registered manager and gave positive feedback about their approach to caring for people. The service was passionate about providing high quality person centred care for people. All staff understood the providers and registered managers caring values.

Our inspection of 13 August 2013 found that there were shortfalls in the provider’s recruitment processes because appropriate checks had not been completed before staff began work. This was because gaps in employment history were not identified or asked about at interview. Where applicants had previously worked in a care role references had not taken up from the care employer.

The provider wrote to us and told us that recruitment processes would be changed so that applicants would be asked for dates of their previous employment. They told us that this would enable them identify when applicants had previously worked for a care employer and references could be obtained from these employers. The provider told us that these changes would be implemented by 20 September 2013.

We looked at the personnel files for two staff who had been employed since our visit in August 2013. We found that dates of applicants’ previous employment were obtained. Where applicants had previously worked in a care role references were sought from that care employer. We found that the compliant action set on 13 August was met because the revised recruitment processes that the provider had put in place were appropriate.

The inspection was announced. We gave the provider 48 hours’ notice that we were starting our inspection because we wanted key people to be available.

Flexicare Home Services UK provides care and support to people in their own homes in Gloucester, Cheltenham and the surrounding areas. The service was provided to 60 - 65 people at the time of our inspection and there was a team of 51 staff who delivered the care and support. Some people were supported on a weekly basis, others on a daily basis and three people received a 24 hour/7 days a week service.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were safe. The care staff who visited them had safeguarding training, were aware of safeguarding issues and knew to report any concerns they had to the registered manager, the local authority or the Care Quality Commission. They received training in moving and handling and used hoisting equipment competently. Staff were recruited using safe recruitment procedures to ensure unsuitable staff would not be employed. Management plans were put in place where risks had been identified in order to reduce or eliminate that risk.

People were looked after by care staff who were well trained and received appropriate support and supervision from senior staff and managers. They were equipped to undertake their roles effectively and were monitored regularly to ensure they provided a service that met people’s needs. Where possible people were involved in the decision making process when setting up the service and had a say in how their care and support was delivered. Care staff were given sufficient information about the people they visited and spoke about them respectfully. People were provided with the support they needed with food and drink and were supported to access health care services when needed.

People were looked after by the least number of care staff possible. This ensured people were cared for by staff who knew them well”. Those that needed to be supported by two carers each visit were visited by at least member of staff who knew them well each visit. The team leaders and care staff had good working relationships with the people they supported and this was particularly prevalent in the palliative care team. People were treated with kindness and respect.

Assessment and care planning processes ensured each person received the service they needed and met their individual needs. Their preferences and choices were respected. People were provided with a copy of their care plan. People felt able to raise any concerns they may have and had been provided with a copy of the service’s complaints procedure.

The arrangements in place for assessing the quality and safety of the service enabled the registered provider and registered manager to look at where improvements could be made. Analysis of any accidents, incidents or complaints that would enable the service to identify any themes or trends and prevent reoccurrences was not routinely carried out. By the second day of our inspection the registered manager had made a decision on a system for this, which they said they would introduce immediately.