About the service: Home Instead Senior Care is a domiciliary care agency (DCA) registered to provide personal care and support to people in their own homes. At the time of our inspection, 84 people were using the service. Of those 84 people, 39 received personal care and the remainder received help in the home or companionship services. We only looked at the service for people receiving personal care as this is the activity that is registered with the Care Quality Commission (CQC).

People’s experience of using this service:

• People received an outstanding service. People, relatives and health and social care professionals were extremely positive about the service people received.

• There was an exceptional open and inclusive culture. The service was extremely well led by a strong and supportive management team. All staff fully embraced the registered provider’s visions and values to deliver a high quality person centred service, helping people to continue living in their own home, maintain their independence and lead happy and fulfilled lives.

• Staff were highly motivated, felt valued and enjoyed working at the service. The culture of the service was fully embraced by all staff. The management team actively encouraged staff to be involved in the continuous improvement of the service.

• People told us they were extremely happy with the care they received from staff. Staff were exceptionally kind and caring, often going the ‘extra mile’ to meet people’s individual care and support needs.

• Positive relationships had been formed between staff and people using the service. Staff knew people well and were kind and sensitive to their needs, ensuring people's privacy and dignity was respected at all times.

• People received a person centred service. A holistic approach was taken to assessing, planning and delivering care and support. Staff had access to up to date information and care and support was provided in line with people’s preferences and needs.

• People and their relatives felt safe using the service. There were sufficient numbers of staff who had been safely recruited to meet people’s needs. People were supported by a consistent care team who had been matched to people who shared the same interests. There had been no missed call visits and people did not receive visits from care staff who had not previously been introduced to them.

• Risks to people had been assessed and staff knew what to do to keep people safe from avoidable harm. Where required, people were supported to take their medicines in a safe way by staff who had been trained and assessed as competent.

• On-going training, supervision and observations of staff competence was undertaken to support staff and check they had the skills and knowledge to be competent in their job role and support people safely and effectively.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• People's health was well managed. Staff had built positive links with professionals which promoted people’s wellbeing.

• Systems were in place to respond to complaints and concerns which were managed appropriately and in a timely manner.

• Effective quality assurance systems were in place to monitor the quality of the service and understand the experiences of people using it.

• The service had forged strong links with the community. The senior management team were committed to promoting a culture of continuous improvement, both within the service and to others in the local community.

Rating at last inspection:

GOOD (the date last report published was 23 June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has improved to Outstanding.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those ser

The inspection took place on the 17 and 23 May 2016.

Home Instead Senior Care is a domiciliary care agency (DCA) registered to provide personal care and support to people in their own homes. At the time of our inspection 53 people were using the service. Of those 53 people, 19 received personal care and the remainder received help in their home or companionship services. We only looked at the service for people receiving personal care as this is the activity that is registered with the Care Quality Commission (CQC).

A manager was in post and was going through the process to become a registered manager with the Care Quality Commission. 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. The manager was supported by a deputy manager to ensure the daily management of the service.

People who used the service provided us with very positive feedback. They told us they received a reliable service and received a good standard of care from a consistent staff team who were matched to people who shared the same interests; this helped to build positive relationships. Staff were caring and kind and knew the people they cared for well.

People and their relatives told us they felt safe. Staff were aware of their responsibilities to keep people safe and to protect them from harm and abuse. Risks to people were well managed and assessments were undertaken to keep people safe. The provider had effective recruitment processes in place which ensured people were protected from the risk of avoidable harm. Medication management, where required, was good and people received their medication as prescribed.

Staff received regular training and were knowledgeable about their roles and responsibilities. Care plans were person centred and included people's preferences and routines. Care plans were regularly reviewed and people, and the people that mattered to them, were involved in the planning and review of their care. Care plans contained sufficient information to enable staff to care for people safely. People told us they were very happy with the care and support they received and that they were treated with dignity and respect. People were supported, where required, to have sufficient amounts to eat and drink and to access health and social care professionals and services.

The manager and staff demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

There was an effective complaints system in place and people told us that they were confident that any concerns would be listened to and acted upon.

The service had a number of ways of gathering people’s views which included talking with people, staff, and relatives. There were quality assurance systems in place to monitor the quality of the service and to help ensure the service was running effectively, meeting people’s individual needs and working towards continuous improvement.

Staff told us they felt valued and enjoyed working for the service. They were committed to providing a high quality service to people.

We have used the word caregivers when referring to staff because this is the terminology used in all of the agency’s documents. People told us that they were treated with dignity and respect and that they had been fully involved in their care and treatment. One person said, “I am very satisfied with the service I am receiving, the caregivers (staff) that come to my home are all very respectful.” We saw that people had been fully assessed, taking into account their cultural, religious and individual needs. One relative said to us, “I found out about the service from the Alzheimer’s society and the manager of the agency came and assessed my partner, they explained in detail the support they could offer and this has turned out to be excellent.”

People told us that they felt safe when being cared for by caregivers who came to their homes. Caregivers had been trained and they showed a good knowledge of how to safeguard people. People received their care and treatment from staff that had been properly trained, supported and supervised. One person spoken with said, “In my opinion the caregivers are well trained.” Another person said, “The caregivers are all brilliant.”

We saw that there was an effective quality assurance system. People told us that they were very happy with their caregivers and that the manager regularly sought their views. People received safe, effective and compassionate care from a well led service that responds quickly to their changing needs.