This inspection was announced and took place on 20 January 2017. We gave the provider short notice of the inspection as we needed to make sure we were able to meet with the registered manager, access records and gain permission from people using the service to telephone them or their representatives.

The last inspection of the service was carried out in November 2013. No concerns were identified with the care being provided to people at that inspection.

The service is a homecare agency based in Egham, Surrey that provides for the local community around that area. It is an independently-run franchise of the national Home Instead brand. At the time of this inspection, they were providing a regulated care service to 34 people living in their own homes.

The service had a registered manager, which 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 company director also took a hands-on approach to the running of the service, having set it up five years ago.

People using the service, their representatives, and community health and social care professionals all provided positive feedback about the service. Everyone said they would recommend it to others.

We found that the service provided to people was very caring and responsive to their individual needs; in their own words, to be ‘companionship-led.’ It strived to match care staff to people based on shared interests, cultures and life histories, and to provide people with the same care staff. People were listened to and their care adjusted accordingly. The service’s approach was to enable people’s well-being to be enhanced.

Staff were encouraged to go ‘the extra-mile’ for people in terms of companionship and engagement, not just to provide care. The service’s one hour minimum visit time benefitted individuals in terms of improved engagement and quality of life. People were treated respectfully by staff, and were encouraged to be as independent as they wanted to be.

The provider placed a lot of emphasis on the promotion of positive images of dementia in the community. They ran regular Memory Cafés to help local people engage and avoid social isolation. Workshops and gatherings were also provided to local people’s family members, to help them understand dementia.

Staff were employed for their ability to show compassion and go ‘the extra mile’ in their care visits. They were intensively trained on understanding the different ways individuals experienced dementia and physical conditions of old age. This helped staff to empathise and engage well with people so as to support them to experience a better quality of life.

Staff were also vetted and trained to ensure that they were safe to work in people’s homes. Their competency was checked on for key processes such as hoisting and providing medicines support. People’s care packages were assessed for safety concerns and were kept under review.

The service ensured that there were enough staff to provide a safe service and that staff arrived punctually at people’s homes. People were provided with good support for health and nutritional matters. The service worked well with community health and social care professionals to help meet people’s needs.

The service listened to people and their relatives, and adjusted people’s care packages accordingly. Action was taken to stop concerns developing into formal complaints.

The service was well-led. The management team was passionate about providing people with high quality, individualised care. Staff were recognised and valued as part of this, and were provided with good support for meeting people’s care needs and preferences.

The service audited how effectively it was providing individualised care, including through

We visited Home Instead Senior Care and looked at the care and welfare of people who used the service. We looked at four care plans held in the office and talked with the manager and nominated individual. We also spoke with four other members of staff and five people who used the service or their family members.

People told us that the staff were very kind and helpful. One person said “They are very friendly people. We have a set of six carers that we know very well.” Another told us “The staff are really good to us. They turn up on time and are a really good support to us.”

Staff talked to us about they how they gained consent from people. One staff member told us “All people have a form that they have signed to agree their care. We always check with them that everything is still the same before we deliver care to them.”

Care plans and risk assessments were in place and the registered manager, or a named person from the office, carried out the assessments. Staff confirmed they looked at each person’s folder in order to carry out the correct care for the individual.

Staff told us they had received safeguarding vulnerable adults training. They were able to tell us the types of abuse they may see and knew how to report any incidents.

We saw that the provider had carried out appropriate checks when they employed staff. This ensured staff were of good character.

Regular audits took place to ensure the quality of the care and service provided by the agency.

As part of the inspection we spoke with five relatives of people who used the service. They all told us that they felt that the care their relative received was good and that they had been involved in their care plans. One relative told us “Yes, absolutely fully involved in the care plan.”

Relatives told us that they felt (their relative) was safe in the staff’s care and that they were treated with dignity and respect. One relative told us “We are very happy, we can’t speak too highly of the carer.”

We found that appropriate checks were undertaken before any member of staff started work at the service. We looked at staff files and spoke to staff who confirmed this.

The service had systems in place to monitor the quality of the service and to identify when things needed to be improved. We saw that this included sending questionnaires to people and relatives and to gather their views of the service.

People were very happy with the service they received, expressing many complementary comments related to staff availability, continuity of care, their skills and enthusiasm.

People said they felt involved in discussions and decisions about the services they required, stating that they could express their preferences and make choices. We were told that the staff were respectful and treated them with dignity.