This inspection took place on 21 and 22 November 2017 and was announced. We told the provider 48 hours before our visit that we would be coming. At the last inspection we found the provider was meeting the regulations and we rated the service Outstanding in Responsive and Well Led and Good in Safe, Effective and Caring and Outstanding overall.

Home Instead Senior Care provides domiciliary care and support to 185 people living in Wimbledon, Kingston and the surrounding areas. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This includes personal care such as assistance with bathing, dressing, eating and assistance with medicines. Other help provided covers all aspects of day-to-day housework, shopping, meal preparation and household duties as well as companionship services such as escorting people on visits or appointments, simple conversation and company. When we visited the provider 185 people were in receipt of a service; 85 received personal care and the remainder received help in their home or companionship. We only looked at the service for people receiving personal care during this inspection as this is the service that is registered with Care Quality Commission. The staff who support people are known as ‘caregivers,’ we have called them this in the report and office personnel are referred to as office staff.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 service continued to provide outstanding support to people and was very responsive to people’s needs. The service also provided outstanding support to staff.

One person said “This is as good a service as it can be. I would be very happy to recommend it to anyone” and a relative commented “My relative now has a regular core of carers who know her very well. They treat her very kindly and speak to her with great respect, upholding her dignity and they are always very polite to other relatives in the house.”

People continued to be extremely well supported by caregivers to engage in activities to stimulate and promote their overall wellbeing. The provider had continued to recognise and respond to people’s needs by starting up several new not for profit clubs, as well as continuing to support clubs previously started. A new coffee and culture club had started at the Wimbledon Tennis club, a men only lunch club, a supper club and a new memory café at Kingston Hospital. Home Instead had also continued to sponsor the Alzheimer’s Singing for the Brain service. An observer at one of the clubs told us “Without exception the clients are enjoying the session and being encouraged and supported by the carer with them.” The caregivers gave many examples of where the positive feel of the activities had stayed with people throughout the week.

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered manager had developed a new structure to the office team which enabled the service to develop and grow. Staff support had been enhanced through a buddy system, effective training, systems to keep staff safe and recognition of staff’s dedication to the care of people. One person commented “Staff are very, very well trained. If my regular caregiver is away the caregiver who replaces her knows exactly what to do.” A caregiver said “The company supports its staff to care for clients to a high standard through a good support structure and training.”

The registered manager was an excellent role model who actively sought and acted on the views of people. Staff said Home Instead was ‘like being part of a family and we all really like one a

This inspection took place on 8 and 9 December 2015 and was announced. We told the provider one day before our visit that we would be coming. At the last inspection on 21 February 2014 the service was meeting the regulations we checked.

Home Instead Senior Care provides domiciliary care and support to 130 people living in Kingston and the surrounding area. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This includes personal care such as assistance with bathing, dressing, eating and medicines; home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties; and companionship services such as escorting people on visits or appointments, simple conversation and company. Of those 130 people 60 received personal care and the remainder receive help in their home or companionship. We only looked at the service for people receiving personal care during this inspection as this is the service that is registered with Care Quality Commission. The staff who support people are known as ‘caregivers,’ we have called them this in the report and office personnel are referred to as office staff.

The service had a registered manager in post who was also the owner of the company. A registered manager is a person who has registered with the CQC 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 service provided outstanding support to people and was very responsive to people’s needs.

One person said “The caregivers are super; they always go two steps further to help me.” A relative said “When I am struggling the caregiver just says ‘leave it to me, I’ll deal with it,’ and the problem is solved.” People were extremely well supported by caregivers to engage in activities to stimulate and promote their overall wellbeing. The provider had recognised and responded to people’s needs by starting up several not for profit clubs. A lunch club, an afternoon tea club, three memory cafes and sponsoring the Alzheimer’s Singing for the Brain service. Caregivers said these clubs gave people the ‘feel good factor’ which remained with people throughout the week.

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Their ethos was “To change the face of ageing and it is with extreme passion and commitment that we are here in your local community doing just that. Just because you are an older person doesn't mean your quality of life should diminish.” Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

The registered manager was an excellent role model who actively sought and acted on the views of people. People and their relatives without exception told us they thought the service was extremely well managed. We found all staff were very positive in their attitude to the company and their role and said they were committed to the support and care of the people. Staff said Home Instead was different because the manager genuinely cared about all people and wanted to make it the best service.

People told us they felt safe with the support they received from the caregivers. There were arrangements in place to help safeguard people from the risk of abuse. Caregivers and office staff we spoke with understood what constituted abuse and were aware of the steps to take to protect people. Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely. The provider had a thorough and comprehensive selection process when employing people. This helped protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Caregivers told us they felt well supported by the registered manager and all the office staff and had appropriate training to carry out their roles. This training enabled staff to support people effectively. All staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Records showed people were involved in making decisions about their care and support and their consent was sought and documented.

Positive, caring relationships had been developed with people. People and their relatives were consistently positive about the caring attitude of the staff. One word that was used by several people when asked about the care they received was ‘Excellent.’

People were involved and consulted about the type of care they wished to receive and how they wished to receive it. Everyone we spoke with confirmed that they had been involved in developing and deciding their care plans and that their views were listened to and respected. Caregivers supported people according to their personalised care plans and respected people’s privacy and treated them with respect and dignity. The people we spoke with were positive with their views and experiences of the service and the ability of caregivers to respond to their changing needs.

The provider had up to date complaints and whistleblowing policies and procedures which gave processes to follow and time scales to adhere to. This helped to assure people and staff that their concerns were taken seriously and addressed quickly.

The registered manager told us they encouraged a positive and open culture by being supportive to staff and by making themselves approachable with a clear sense of direction for the service. People were regularly asked for their opinion on whether their objectives for the service they were receiving were being met. Staff regularly monitored the quality of the service by speaking with people who received a service.

The provider had quality assurance systems in place to monitor the quality of service people received. The provider had audits systems for staff training and supervision and the national office conducted an annual standards renewal audit; this included scrutinising all aspects of the business. The last audit in January 2015 was positive, with no actions to be taken.