This announced inspection took place on 7 March 2017. We gave 48 hours’ notice of our inspection to ensure that staff were available to provide the information we needed and so we could make arrangements to speak with people receiving a service. We last inspected this service in January 2016 when the service was assessed overall as good. Some improvements were needed to the system for administering medicines and at this inspection we found these had been done and people received their medicines as prescribed.

At the time of our inspection the agency was providing personal care to about 80 people in their own homes. There was a registered manager in post who was available throughout our inspection visit. 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.

Everyone we spoke with could not praise the care provided by staff from the service highly enough. People and their relatives described the staff as caring and providing very good care. People felt they were treated with kindness and their privacy and dignity were always respected. Staff had developed positive relationships with people. Staff showed that they had an understanding of the needs of the people they were supporting. Staff we spoke with told us how much they enjoyed working for the service and indicated they were committed to providing an excellent service for people.

All of the people we spoke with who were using the service told us that they felt safe with the staff who supported people. Staff understood their responsibilities to take action to protect people from the risk of abuse. In circumstances where the provider had thought people may be at risk of abuse they had made the relevant authorities aware.

There were good systems to ensure that staff were recruited appropriately and were subject to the necessary checks so that people were protected from the risks of being supported by unsuitable staff. There were enough trained staff to keep people safe and to meet their needs. Some people needed reminding or support to take their medicines and staff had received training to do this.

People and a relative told us they were supported by consistent staff members who had got to know their needs. Staff received regular training and supervision and had regular meetings to refresh their knowledge and discuss any concerns about people’s care.

When required people were supported to eat and drink in ways which supported their health and respected their choices. People were supported to access health care professionals when necessary to maintain their health.

People’s consent was appropriately obtained by staff when caring for them. People had been asked how they wanted to be supported. When necessary relatives or friends who were close to them were involved in order to help the person express their views.

Arrangements were in place to deal with any concerns or complaints. The registered provider had developed a complaints procedure. People said they knew how to raise complaints and knew who to contact if they had any concerns. All of the staff we spoke with were also confident they could raise any concerns with the managers, knowing they would be listened to and acted upon.

The provider sought feedback from people using the service and their relatives in respect of the quality of care provided. Staff we spoke with felt valued and supported and able to seek advice at any time of the day.

There were systems in place to monitor the quality and safety of the service. The registered manager ensured audits and checks were completed to ensure the service was running properly to meet people's needs and to monitor the quality of the care people received.

The announced inspection took place on 14 January 2016 we gave 48 hours’ notice of our inspection to ensure that staff were available to provide the information we needed and so we could make arrangements to speak with people receiving a service. We last inspected this service on 31 October 2013 when the service was compliant with regulations.

The service provided personal care and support to people in their own homes. There were 59 people receiving this at the time of the 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.

People and relatives told us that they felt safe with the staff who supported people. Staff understood their responsibilities to take action to protect people from the risk of abuse. The provider had investigated a previous allegation but had not informed the local authority as required in line with safeguarding procedures. However, for more recent safeguarding incidents the provider had made the local authority aware as required.

There were good systems to ensure that staff were recruited appropriately and were subject to the necessary checks so that people were protected from the risks of being supported by unsuitable staff.

People and their relatives told us they were usually supported by consistent staff members who had got to know their needs. There were enough trained staff to keep people safe and to meet their needs. Staff received regular supervision and had regular meetings to refresh their knowledge and discuss any concerns about people’s care.

Some people needed reminding or support to take their medicines and staff had received training to do this. Medication records did not follow available good practice guidance but the provider had plans in place to improve this.

People, where they needed support in this area, were supported to eat and drink in ways which supported their health and respected their choices. People were supported to access health care professionals when necessary to maintain their health.

People’s consent was appropriately obtained by staff when caring for them. People had been asked how they wanted to be supported. When necessary relatives or friends who were close to them were involved in order to help the person express their views.

People told us that the staff were caring. Staff showed that they had an understanding of the needs of the people they were supporting.

Arrangements were in place to deal with any concerns or complaints. The registered provider had developed a complaints procedure. People said they knew how to raise complaints and knew who to contact if they had any concerns. All of the staff we spoke with were confident they could raise any concerns with the managers, knowing they would be listened to and acted upon.

The provider sought feedback from people using the service and their relatives in respect of the quality of care provided. The majority of relatives and staff we spoke with were confident in how the service was led. Staff we spoke with felt valued and supported and were able to seek advice at any time of the day. There were systems in place to monitor the quality and safety of the service.

We visited the agency office and spoke with the registered manager, care co-ordinator and with two staff members that provided care to people. We spoke on the telephone with four people who used the agency and with four relatives of people who used the agency.

People or their relatives told us they were happy with the support the staff provided and that it met their needs. One relative told us, “The quality of care that they provide is very good.”

People or their relatives told us that they usually had the same care staff who arrived on time and stayed for the agreed length of time.

We found that people were protected and safe from abuse. Staff recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people.

Staff told us they felt supported to meet the care and welfare needs of the people who used the service.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.

During our review, we discussed the quality of the service provided by the agency with local authority colleagues involved in monitoring the agency. They said they had not been made aware of any concerns about the service being provided.

We spoke with six people who received personal care from the agency or their relatives.

People or their relatives told us they were happy with the support the staff provided and that it met their needs. One person told us ‘’I am completely satisfied and my standards are high.’’ People felt that staff helped them to be as independent as possible and that they provided them with the care and support agreed. One relative told us ‘’I can see the difference in her, having someone to talk with.’’

People receiving care, and their relatives, said that the care staff treated them with

kindness and respect. One person told us ‘’They are respectful of my needs’’, a relative told us ‘’They are very good at respecting privacy and dignity.’’

People or their relatives told us that they usually had the same care staff who arrived on time and stayed for the agreed length of time. One person told us ‘’They have never been late.’’ A relative told us, ‘’We have the same five carers, they always let us know if it is someone different and then they come and shadow the usual carers first.’’

During our review, we discussed the quality of the service provided by the agency with local authority colleagues involved in monitoring the agency. They said they had not been made aware of any concerns about the service being provided.

We looked at the records of four people using the service and spoke with relatives of three of them, because the people using the service had conditions that meant it was difficult for them to speak with us. We spoke about the support that Home Instead Birmingham provided from the point of view of both the people using the service and their relatives.

The relatives we spoke with were happy with the quality of care provided. They said “they’ve been very good” and “I’m really glad I found them.”

Relatives told us that the agency had carried out an assessment before the service started and that the service was “responsive” and flexible. Relatives we spoke with were confident that they could raise concerns if they were not happy with the care being provided and that they would be listened to. One relative said that occasionally the person using the service did not like a member of staff and the office were “really good” at allocating a different member of staff.

Relatives told us they were happy with the support provided and that it met the needs of the people using the service. Relatives told us that the people using the service were treated with respect and that staff maintained their privacy and dignity. They told us that staff completed the care and support required and that staff stayed longer than agreed when this was necessary.