This inspection took place on 13 November 2017 and was announced. We gave the provider seven days’ notice to become available for the inspection. This was because when we first contacted the provider to give 48 hours’ notice we found the director would be unavailable. At our previous inspection in September 2015 we rated the service ‘good’ overall and found the service was meeting the fundamental standards.

Home Instead Senior Care provides personal care and support to older people in their own homes. There were 34 people receiving the regulated activity, personal care, and 77 people using the service overall. Most people funded their care privately.

At the time of our inspection the service did not have a registered manager. However, the manager had almost completed the registration process and became registered a few days after our inspection. 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 received care from a service which was extremely caring. All people and relatives without exception told us how caring the staff who supported them were and staff went the extra mile in providing care to people.

Staff knew the people they supported very well and build very good relationships with them. People received consistency of care from the same staff members and people received companionship at every visit.

Staff were compassionate towards people and treated people with dignity and respect. People were involved in decisions relating to their care and were supported to maintain their independence.

People were carefully matched to the staff who supported them in relation to compatible personalities, hobbies, interests and backgrounds.

The provider supported relatives to understand the dementia related needs of their family members by providing training to them. This helped people maintain relationships with those who were important to them.

People were central in developing their care plans and care was delivered to a high standard in the ways people preferred.

People were involved in reviewing their care. People and relatives were encouraged to feedback to the provider on their care and a suitable complaints system was in place.

An excellent induction package was in place which helped staff to understand the experiences of people using the service. Staff experienced some of the physical difficulties older people live with through a person using the service who gave feedback on how it felt to receive care. Staff were provided an opportunity to complete a specialist qualification in dementia to help them understand the best ways to care for people living with dementia.

Staff received suitable training on-going and the provider was reviewing their training package to include the mental capacity act (MCA) to increase staff understanding in this important area. People received care in line with the MCA.

People were supported to live healthier lives and received the right support in relation to eating and drinking. The provider helped people receive coordinated care when they moved between services.

People felt very safe with the staff who supported them and were safeguarded from abuse and improper treatment. Staff received training in how to recognise if people were being abused or neglected and how to report this.

Risks relating to people’s care were reduced because the provider had systems to manage risks.

People’s medicines were managed safely by the provider. Records showed people received medicines as prescribed. The provider had systems to identify and investigate any omissions in recording, and the manager told us they would improve further by checking medicines records more frequently.

People were supported by staf

This inspection took place on 9 September 2015 and was announced. At the last inspection of the service in November 2013 we found the service was meeting the regulations we looked at.

Home Instead Senior Care is an independently owned franchise of a large national home care provider, also known as Home Instead Senior Care. This service provides companionship, home help and support for people who need help with their personal care. They specialise in providing care and support to people living with dementia. At the time of our inspection there were 17 people receiving personal care from this service, all of whom were privately funding this support.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People and their relatives told us they felt safe with the care and support provided by the service. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse. Risks to people’s health, safety and wellbeing had been assessed by senior staff. Staff were given guidance on how to minimise any identified risks to keep people safe from harm or injury.

There were enough staff available to meet the needs of people using the service. Senior staff matched people with staff who were able to meet their specific needs and preferences. The provider ensured staff were suitable to work by carrying out employment and criminal records checks before they could start work.

Staff received appropriate training and support to meet people’s needs. The registered manager and provider monitored training to ensure staff skills and knowledge were kept up to date. Staff were well supported by the registered manager and other senior staff to discuss any issues or concerns they had. People and their relatives said staff had a good understanding and awareness of people’s needs and how these should be met.

People’s consent to care was sought by staff prior to care and support being provided. Where people were unable to make decisions about their care and support because they lacked capacity to do so, people's primary carers and other professionals were involved in making these, in their best interests. People’s care plans were individualised and reflective of their specific needs and preferences for how they wished to be cared for and supported. People and their relatives said they felt able to express their views and were listened to. Staff ensured people’s care and support needs were reviewed regularly to ensure staff had up to date information about people’s current care and support needs.

People were encouraged to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. They received their medicines as prescribed. Staff monitored people’s general health and wellbeing. Where they had any issues or concerns about this they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

People and their relatives told us staff looked after people in a way which was kind, caring and respectful. People’s right to privacy and dignity were respected and maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence. People were supported, where the service was responsible for this, to take part in activities at home or out in the community.

People and their relatives said they were comfortable raising any issues or concerns they had directly with staff and knew how to make a complaint if needed. People were confident that any complaints they made would be dealt with appropriately.

People’s views and experiences were sought by senior staff in order to improve the service. People and their relatives said the service was managed well and senior staff were open and welcoming of comments and feedback. The provider was committed to improving the quality of care people experienced. This was embedded in the vision and values for the service. Senior staff ensured all staff were clear about their duties and responsibilities to the people they cared for and accountable for how they were meeting their needs.

There was a quality assurance programme which checked care was being provided to an acceptable standard. Where improvements were needed, the registered manager took action to ensure these were made. Although independent, the provider of this service had access to advice, support and resources from the national office. This enabled them to use learning and best practice from other similar types of services to drive continuous improvement.

We visited the agency’s office. We spoke with the registered manager, director, the Recruitment and Training coordinator and three members of staff who are known as care givers. We spoke on the telephone with eight people who used the service and a relative of a person who used the service. The feedback we received was very positive. Comments included “I am very happy with the care”, “excellent care”, “I am very impressed with this service and I am glad I chose them”, “the staff are lovely" "very caring” and "the staff ooze friendliness". People we spoke with told us that they were consulted with about their care, they were asked for their views and they felt all their needs were met.

We found that the agency employed sufficient numbers of care givers to meet the needs of people who used the service. People we spoke with told us they always received their visits at the right time and they were visited by regular staff who were familiar to them. A person who spoke with us said “The staff are very efficient and they always arrive on time”. Another person said "I always receive a good one hour support".

People were supported by care givers who were appropriately trained. Staff's practice was monitored when they cared for people in their home. People we spoke with told us they thought their care givers had the right skills to support them. Comments included “The staff are well trained" and "the staff are competent".

At the time of our inspection, there were approximately 40 people using the service and 36 staff employed. We visited the agency office and met with the new care manager, office manager and director. We also spoke on the telephone with three people who used the service, one relative and one member of staff. The reader should note that the term ‘caregiver’ is used in this report and refers to staff who work for this agency.

People using the service told us that the agency was meeting their care and support needs properly. Their comments included, “they feel like my friends” “I am extremely happy, delighted with it,” “very pleased, my X enjoys the company” and “I’m really very satisfied, no complaints”. People we spoke to said they had regular caregivers and were kept informed if there was a change. Comments included, “punctuality is good”, “my carer is always on time” and “they don’t mix staff around, we know who is coming.”

All the people using the service complimented the staff and described them as “very nice people, very helpful and friendly”, and “they are not just here as a worker, they stop and have a chat.” People felt staff were caring and treated them with dignity and respect. One person said, "They are caring and sensitive."

People told us that the agency kept in touch with them on a regular basis and they had confidence that any problems would be dealt with appropriately. All the people we spoke to knew how to complain but said they had never needed to.

We asked the provider to complete a self assessment for six of the outcomes prior to the visit. This information is used to help us reach a decision about whether the service is meeting the essential standards. The returned Provider Compliance Assessment (PCA) was informative and included good information about how the agency complies with the standards. It also told us about how the agency intends to make some improvements. We have included statements taken from the PCA within the main body of the report.

The reader should note that the term “caregiver” is used in this report and refers to staff who work for this agency.

We spoke on the telephone to a selection of people who use the service and their relatives or representatives. The overall feedback was highly complimentary about the care and services provided and told us that people benefit from a well-organised and reliable service.

One person said, “Very happy, the service is excellent. 100%!”

Another told us, “The carer turns up on time and sometimes stays an extra 5 or 10 minutes if I need her.”

People told us they always had the same caregivers and described them as “excellent”, “reliable and always on time”, “very, very good” and “friendly and we get on very well with our carer”.

A relative commented said the carer was “very patient and proactive with my X and she uses her initiative. “

Other responses from people’s relatives or representatives included:

“The agency rings me and keeps me updated if there’s a change to my X’s needs.”

“X had a slight fall once and when the carer arrived they checked X for injury and made sure everything was ok.”

People told us that the agency keeps in touch with them on a regular basis. They said they can voice their concerns and felt they could make a complaint if it was required.

Written comments held on the agency’s compliments file included, “excellent service provided by yourself” and “how impressed I am with the swift and efficient service that you and your organisation have provided, to give help and companionship to my X.”

All those who took part in this inspection are thanked for their time and contribution to share their views about the agency.