The inspection took place on 15 and 17 August 2016 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was registered with CQC on 21 December 2012 and was last inspected on 11 July 2014, at which time the service was compliant with all regulatory standards.

Home Instead Senior Care is a domiciliary care provider based in Uppermill, Oldham, providing personal care and support to people in their own homes in the Oldham and Saddleworth area. There were 110 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

We found the provider delivered outstanding levels of care that put the person’s needs at the forefront of care planning and decision making, and ensured extremely high levels of continuity and familiarity. People who used the service, relatives and healthcare professionals were unanimous in their descriptions of staff who went out of their way to ensure people were cared for well.

Staff were consistently described as compassionate, caring and having built positive relationships with the people they cared for and we found a range of evidence to support these opinions. People who used the service, relatives and staff felt having care calls of a minimum of one hour enabled these relationships to develop.

Staff were consistent in their extremely positive feedback about the levels of support they received from the registered manager and provider, both of whom were regularly on site. The registered manager displayed a sound understanding of the service and the needs of people who used the service, whilst the registered provider demonstrated both effective leadership of the service, as well as a passionate, innovative and varied approach to community engagement and involvement.

People who used the service, relatives and healthcare professionals we spoke with were consistent in their praise of the leadership of the service. The provider, registered manager and all staff we spoke with were consistent in their understanding of the principles of the service, as set out in the Statement of Purpose, and were passionate about caring for people.

The provider, registered manager and other staff developed and maintained a range of excellent community links to raise awareness of dementia, the risks to vulnerable adults, but also to celebrate and support people’s independence.

Recent responses from annual surveys demonstrated improvements against already extremely positive scores from the previous year. We found staff at all levels were aware of, and contributed to, a culture focussed on meeting people’s individual needs.

We saw that sufficient numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks to ensure they were suitable for the role.

We saw that no medicines errors had been made on the Medication Administration Records (MAR) we sampled and that the provider regularly checked staff competence to administer medicines.

We saw evidence that concerns regarding people’s safety had been appropriately managed and staff displayed a good knowledge of safeguarding principles. We found that risks were managed and reduced through pre-assessment and ongoing assessment of individual needs. People using the service felt safe and there was an out-of-hours phone line for people who used the service and staff in case of unforeseen circumstances.

We found evidence of consistent and prompt liaison with external healthcare professionals and other agencies in ord

Home Instead is a domiciliary care organisation providing care, support and companionship to people in their own homes. The service was predominantly provided to people who paid privately.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

The summary is based on a visit to the service’s office where we looked at records and talked to the registered manager, the assistant care manager and the training manager. We also spoke to the service provider. Following the visit we contacted, by telephone, a sample of people who used the service and relatives of people using the service. We also talked to some care staff.

The full report contains the evidence to support this summary.

Is the service safe?

Staff had received training in safeguarding which meant they understood what to look out for and what they should do if they had any concerns about poor practice or people's safety. Members of the management team maintained regular contact with the people who used the service to monitor the quality of the service and help ensure the people using the service were safe.

Health and safety assessments were undertaken as part of the care planning process. This helped to ensure the physical safety of people using the service and staff. Personal Protective Equipment was provided to staff.

People who used the service told us they felt safe and had good relationships with the carers who supported them. People knew how to contact office staff if they needed to. Managers were described as approachable and helpful. This means that any concerns about someone could be easily communicated.

Comments about the staff from people who used the service or their relatives included: “[staff are] friendly but don’t take advantage” and “[the manager] would not send anyone she didn’t trust”.

Staff who we asked, were confident that people who used the service were safe. They also told us they understood the need to report any poor or concerning practice and their responsibility to ‘blow the whistle’ if necessary.

Everybody who we asked were confident that anyone could complain if they were unhappy with any aspect of the service. People also told us they believed any complaint would be listened to and acted on.

Is the service effective?

The service was provided on the basis of an assessment of the individual’s needs, undertaken by a senior member of staff and a written plan of care. People using the service, and when appropriate their representatives, were involved in discussing the best way for identified needs to be met.

Care and support plans were regularly reviewed and updated when necessary.

Staff were appropriately trained. They told us that the service provider encouraged them to pursue training opportunities. Staff also told us they were not asked to undertake any tasks which they were not trained to do effectively.

Regular spot checks were undertaken with people using the service to monitor the quality of the service. Other audit processes were in place, including checking on the relevance of the visit records. These actions would help to ensure that any weaknesses in the effectiveness of the service would be identified and rectified.

Is the service caring?

All the people using the service and their relatives who we spoke to were positive about the attitude of the staff and the management. Comments included: “They {staff] are [like] part of the family and I can turn to them”; “they have employed thoughtful caring women who have an interest in the job” and “[staff] are very thoughtful and we get on well together”.

Staff spoke positively about the people they supported. One person said “I am passionate about looking after people how I would want to be looked after.” Another staff member, when asked what the best thing about the service was, said it “put the patients first”.

Is the service responsive?

Care and support plans were regularly reviewed and updated if necessary. Staff were encouraged to notify managers of any changes to a person’s circumstances so that a reassessment could be undertaken.

The service had a written complaints procedure. This included advice about how to pursue a complaint if dissatisfied with the outcome of the initial investigation. Staff, people who used the service and their relatives, who we asked, were confident that any complaint would be dealt with appropriately. One person said “I could complain. I know the management team”. Other comments included “they would listen and put it right” and “I know that if I ring up I would get a response”.

Comprehensive quality monitoring and assurance systems were in place. These would help to enable the identification of any modifications to the service which may be beneficial.

Is the service well led?

There were clear lines of accountability within the service. Managers were described as approachable, supportive and responsive. People using the service and their relatives told us they were listened to and that their opinions were valued.

Communication within the service was good. Staff told us they felt well supported by managers who made themselves available for them. Comments from staff included: “there is always someone on call. If you ring up they will give you support 24 hours a day”: “[the manager and service provider are] the best people I have worked for … the owner cares about the service” and “[I can] always pop in to the office”.

People told us the service was reliable.

Quality monitoring and assurance was well developed.