The inspection took place over two days on 22 & 24 January 2018 and was announced. We announced the inspection at short notice because we needed to ensure managers were available when we visited and also to arrange consent from people to carry out visits and telephone calls.

The last inspection was carried out in May 2015 and was rated as ‘Good’ at that time.

Home Instead Senior Care is a registered with the Care Quality Commission to provide ‘personal care’ to people living in their own houses and flats in the community. It provides a service to older adults. Home Instead Senior Care office base is located in Liverpool, Merseyside. The office building is modern and accessible for people who required disabled access.

At the time of our inspection the service was supporting 33 people who were located in Liverpool and Sefton.

A registered manager was 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.

All of the people we spoke with who used the service expressed great satisfaction and spoke very highly of managers and staff. They described an exceptional service which was very responsive to individual care needs.

Support was provided to people on a flexible basis and in accordance with their clearly identified needs. People who received care and support provided us with very positive feedback. They said they received a reliable service and an excellent standard of support from caring, kind and compassionate staff. There was a consistent staff team and staff were matched to people with the same interests to help build a positive relationship. This was central to the ethos of the service.

The safety of people who used the service was maintained. Staff were well 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.

Staff had a full understanding of people’s care needs and the skills and knowledge to meet them. People received consistent support from care workers [called 'Caregivers' at Home Instead] who knew them well. People felt safe and secure when receiving care. People were supported with their medicines and staff were trained and felt confident to assist people with this.

Sufficient numbers of staff were available to meet people’s needs. Thorough staff recruitment checks were in place. These checks were undertaken to make sure staff were suitable to work with vulnerable people.

Staff were very responsive to any changes in people’s health or wellbeing and liaised effectively with health professionals in a timely and proactive manner. All of the community professionals we spoke with were very complimentary about the service and reported very positive experiences when dealing with Home Instead Senior Care.

People were provided with care and support according to their assessed need. People gave consent to their plan of care and were involved in making decisions around their support. People’s plan of care was subject to review to meet their changing needs and updated promptly if required. People received effective care that met their individual needs.

Staff told us they felt well informed about people’s needs and how to meet them. Care plans were in place regarding people’s needs and the level of support required. These were highly personalised and reflected people’s individual care needs including social and psychological aspects of care. People were consulted with and felt involved and in control of their care. Care plans were regularly reviewed and people where included in the review process.

Risks to people’s safety and welfare had been assessed and information about how to support people

The inspection was carried out on 21st, 22nd and 26th May 2015. We gave the provider 48 hours’ notice of the inspection in order to ensure people we needed to speak with were available.

Home Instead Senior Care is a registered with the Care Quality Commission to provide personal care. The provider of this service is Liverpool and Sefton Homecare Limited.

Home Instead Senior Care office base is located in Liverpool, Merseyside. The office building was modern and accessible for people who required disabled access.

At the time of our inspection the service was supporting 40 people who were located in Liverpool and Sefton. The agency was providing a service for older people and this included people who may have a dementia, mental health needs, physical disability and sensory impairement.

An acting manager was in post. The acting manager had applied to the Care Quality Commission (CQC) for the position of registered manager. Following the inspection the acting manager became registered with us. 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.

Our findings showed care and support was provided to people in their own home on a flexible basis and in accordance with individual need. The amount of support provided varied and people were offered a service between several hours per day to 24 hour support, seven days per week if required.

People who received care and support from the agency provided us with very positive feedback. They said they received a reliable service and a very good standard of support from caring, kind and compassionate staff. People told us they felt safe in the way staff supported them and had confidence in the staff.

People who used the service received support from a consistent staff team and staff were matched to people with the same interests to help build a positive relationship. Sufficient numbers of staff were available to meet people’s needs.

Some of the people who used the service were supported with their medicines and staff told us they were trained and felt confident to assist people with this. People’s care plans included information about their needs with medication however the level of information varied. Staff completed handwritten medicine administration records for medicines administered.

Staff liaised with healthcare professionals at the appropriate time to help monitor and maintain people’s health and wellbeing.

People were provided with care and support according to their assessed need. People told us staff supported them with their diet and meals if they required this.

People gave consent to their plan of care and were involved in making decisions around their support. People’s plan of care was subject to review to meet their changing needs. People received effective care that met their individual needs.

Staff told us they felt well informed about people’s needs and how to meet them. Care plans were in place regarding people’s needs and the level of support required.

Risks to people’s safety and welfare had been assessed and information about how to support people to manage risks was recorded in people's plan of care.

The acting manager had a clear knowledge and understanding of the Mental Capacity Act (MCA) 2005 and their roles and responsibilities linked to this. They were able to explain the process for assessing people’s mental capacity and how they would ensure a decision was made in a person’s best interests if this was required. The service working alongside other health and social care professionals and family members. This helped to ensure decisions were made in people’s best interests.

Recruitment checks were in place. These checks were undertaken to make sure staff were suitable to work with vulnerable people.

Staff files contained training certificates and these showed staff training was up to date. The training programme provided staff with the knowledge and skills to support people. We saw systems were in place to provide staff support. This included monthly staff meetings, supervisions and an annual appraisal.

The agency had a whistleblowing policy, which was available to staff. Staff told us they would feel confident using it and that the appropriate action would be taken.

Staff we spoke with told us how much they enjoyed working for the service and were committed to providing an excellent service for people.

Systems and processes were in place to monitor the service and drive forward improvements. This included internal audits and also the provider had corporate audits which provided positive feedback about the service.

People's views had been sought through the use of questionnaires, as part of assuring ‘excellence’. The overall feedback we received about the management of the service was very positive.

With regards to monitoring the safe management of medicines we discussed with the acting manager the development of a formal medicine audit to help assure safe medicine practices.