This inspection started with a visit to the office location on 8 November 2017 and was announced. We gave the provider 48 hours’ notice of the inspection to ensure that the people we needed to speak with were available. On 9 November we made calls to people who use the service and staff to gain their views and experiences. This was the first inspection of the service since they registered with CQC in February 2016.

The inspection was carried out by one adult social care inspector. At the time of this inspection the service was providing the regulated activity of personal care to 27 people who lived in their own homes. These services were managed by the agency from an office in Bristol. People using the service, their families and the staff used the term ‘caregivers’ when referring to care staff. Therefore, we will refer to individual staff members as caregivers in the report and staff when we refer to them collectively.

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. The provider had a very ‘hands on’, active approach and presence within the service, with clients, the local public and staff. He was constantly referred to us with praise and always by his first name. For the purpose of the report we will refer to him as the provider.

The feedback we received from people was extremely positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff and services provided. One person told us, “The whole experience has been first class, I couldn’t have wished for more”.

The safety of people who used the service was taken seriously and the registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

The whole staff team were highly motivated and proud of the service. The registered manager told us, “We have recruited the most incredible and special people who share our values of compassion, joy, empathy, creativity, intuition and who recognize that dignity, respect and integrity are at the heart of what we do. Without our incredible caregivers the service we deliver would be compromised and pretty meaningless”.

All staff were fully supported by the management team and a programme of training and supervision enabled them to provide a good quality service to people. One caregiver wrote in the CQC survey, “This is a fantastic company, the training and the quality of care provided is highest on their list. I truly love my job and enjoy giving support to clients in their homes”.

The registered manager, provider and all staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected.

The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from caregivers who knew them well. People had positive, caring relationships with their carer giver and were confident in the service. There was a strong emphasis on key principles of care such as compassion, respect and dignity and promoting independence. People who used the service felt they were treated with ‘extreme’ kindness and said their privacy and dignity was always respected.

People received a service that was individualised and based on their personal needs, preferences and wishes. One social care professional told us, “Home Instead in North Bristol is a well-respected care agency who take the person centred approach very seriously”. Changes in people’s needs were quickly identified