This announced inspection was carried out on 15 September 2016. Home Instead Senior Care provides support and personal care to people living in their own home in West Norfolk. On the day of the inspection there were 30 people using the service who received personal care.

The service did not have a registered manager in place at the time of our inspection and has not had one since July 2013. However a manager had been recruited who had made an application to become the registered manager. 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 were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent and risks were mitigated in the least restrictive way possible.

People were supported by a regular staff member or group of staff who they knew. People who required support to take their medicines received assistance to do so when this was needed.

People were provided with the care and support they wanted by staff who were trained and supported to do so. People’s human right to make decisions for themselves was respected and there were systems for people to show their involvement in planning and agreement with their care.

People were supported by staff who understood their health conditions and ensured they had sufficient to eat and drink to maintain their wellbeing.

People were treated with respect by staff who demonstrated compassion and understanding. People were involved in determining their care and support and were treated in the way they wished to be.

People could not rely on their plan of care containing all the required information to ensure their care and support was delivered as needed. People felt able to express any issues of concern and these were responded to.

People who used the service and care workers were able to express their views about the service which were acted upon. Changes to the management team were enabling a better allocation of work and fulfilment of management duties.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:-

Is the service safe?

In the care records we reviewed we saw that risk assessments regarding people’s individual needs were carried out and measures were in place to minimise or eliminate any risk.

Lawful requirements under the Mental Health Act (2005) were recognised and staff expressed a full knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLs). Staff had regular training in these areas to ensure their knowledge remained up to date and appropriate.

Staff were trained to recognise abuse and knew what actions to take if any incidents of abuse were suspected. People using the service told us that they felt safe and cared for. Two family members told us that if they had any concerns they felt certain that Home Instead would deal with these appropriately.

Is the service effective?

Staff expressed a thorough understanding about the needs of people they supported. We saw that care plans reflected the choices that each person had made. Care plans had been updated regularly and people using the service told us that they had discussed their wishes and preferences with staff.

People who used the service told us that staff always knew what support and care was needed and asked before they undertook any care. This ensured that each individual was able to make decisions on a daily basis and be in control of their care at all times.

Is the service caring?

When we spoke with people who used the service they told us that staff were caring. Everyone we spoke with said they felt their dignity was promoted by staff.

One family member told us that staff always treated their relative appropriately and were, "Always very kind and good at their job."

People using the service told us that they could talk with staff about any matters relating to their care and support. They were confident that any issues would be dealt with quickly and efficiently.

Is the service responsive?

Regular spot checks and audits were undertaken to ensure the quality and efficiency of the service was monitored and improved where needed. People using the service and their family members confirmed this did happen regularly.

Two people using the service and one family member explained to us that when some adjustments or changes were needed, Home Instead had taken action to address issues to their satisfaction.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates that showed when training was due to be updated. This meant that people were supported by a staff team who knew how to provide people's support in a safe and appropriate way.

Quality assurance systems were in place and regular monitoring of records and staff practices was carried out and recorded. Staff and people who used the service told us that they felt supported and able to discuss any matters with the manager.