This inspection took place on 8 September 2016 and was announced. Home Instead Senior Care Wolverhampton provides community support and personal care to older people, people living with dementia, people with learning and physical disabilities, and people with sensory impairments, in their own homes. At the time of the inspection 108 people were receiving a service from the provider and of those, 52 people were receiving personal care. At the last inspection in September 2014 we found the provider was meeting all of the requirements of the regulations we reviewed.

The registered manager had left the service in May 2016, however there was a new manager in post who had submitted an application to become registered. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe. Staff were knowledgeable about different aspects of abuse and knew how to report any concerns to people’s safety. Risks had been assessed, managed and reviewed in order to protected people from avoidable harm. The provider had systems in place to ensure only suitable staff were recruited to work with people. People received their medicines as prescribed with support from trained staff.

People told us staff had the skills and knowledge required to support them. Staff had received training relevant to their role. People were asked for their consent before care and support was provided and, where appropriate, decisions were made in people’s best interests. People who received support to maintain their diet were happy with the shopping and meal provided. People were supported to access relevant healthcare services when required.

People told us the staff who supported them were kind and caring. Staff shared examples with us of the things they did that were above and beyond their expected duties. People were supported by staff who understood their needs and preferences. Staff supported people in a way that upheld their privacy, dignity and independence.

People were involved in the planning, assessment and review of their care. People were supported to follow their interests by staff who encouraged them to share their experiences and hobbies. People knew who to contact is they were unhappy about any aspect of their care. The provider had systems in place to manage complaints which included details of actions to ensure the complainant was satisfied with the outcome.

People and staff were complimentary about the service and told us they felt it was ‘good’. Staff felt supported by the manager and provider and were able to share their views and concerns. There were systems in place to monitor the quality of the service provided and people had been asked to give feedback about the service they received.

We inspected this service so we could consider our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? One inspector carried out this inspection.

There were 27 people using the service for personal care at the time of our inspection. Other people were using the service for companionship or housekeeping but these services were not regulated by the commission. Following our last inspection in April 2014 we had received information of concern about the service. We inspected the service to consider the concerns that had been raised. Below is a summary of what we found. The summary is based on speaking with four people who used the service, seven relatives and six members of care staff supporting them. We also spoke with the manager of the service, two office staff, the nominated individual and two health / social care professionals.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People or their relatives confirmed that they believed that the service was safe. Their comments included: "I was unwell at the weekend they did everything that was needed and got a doctor to visit me" and "I have felt that all the care staff are trustworthy," All of the people were happy about how care staff accessed the property where they lived and received care.

Staff told us about us about their training in health and safety and the support they received from the office staff if they were worried about a person's safety. Risk assessments had been written to ensure that people were moved safely and that their health needs were met. People confirmed that a copy of these records were kept on their property for staff to look at.

There were enough staff available to ensure that people received the service that was expected. People told us that staff arrived on time, did not rush and that the aim of the service was to provide consistent care staff. Where it was known that staff were not going to be able to make planned visits, arrangements had been made for someone else to provide the care and respond and wherever possible this was someone the person had already met.

CQC monitors the operation of Deprivation of Liberty Safeguards. There had been no applications to deprive any people of their liberty at the time of our inspection.

Is the service effective?

We found that staff were trained in moving and handling of people by a member of staff that had the appropriate training qualification. We saw and were told that where relatives wanted extra records to be kept to ensure the service was delivered as required or risks minimised care staff maintained these records. People or their relatives told us that care staff knew how to use any equipment that may be needed to support people in their own homes. We talked to staff about the care people needed and found that they knew about the care needs of specific people they were supporting.

Amongst the comments we received from people, relatives and staff were: "They made a thorough assessment of my relative's needs, they provided good support and (my relative) has taken to (care staff name)," "Two of the care staff who visit (my relative) stand out in their understanding of dementia" and "I work for this service because we are not expected to rush and also you do not just get generic moving and handling training you get training specific to the individual." People received a service that was effective in providing for their needs.

Is the service caring?

People who used the service or their relatives told us they felt cared for. Their comments included: "The three care staff that are in place are very caring...they remembered my relatives birthday and took them out," "I wouldn't want to change the care staff coming into my home they are excellent," "They have been really good to me and they love my relative to bits," and "(My relative) loves the care staff, their care is spot on."

We spoke to six care staff as well as the management team and provider. All of them spoke about people in a caring way and wanted to ensure that people received the care in the way that they wanted. We spoke with three care staff in detail about the values of the service they worked for all of them told us that the service covered this in their initial training. They all told us that: they had to be polite, not to rush people's care, be 'talkative' when supporting people, be mindful that it is the person's home and to respect people's religion and culture. People received a caring service.

Is the service responsive?

People's comments included: "We have been listened to, if my relative hasn't got on with a member of care staff they have been changed," "They are conscious of my relative's good and bad days and they ring me if they have any concerns" and "We started off with a call a day but it is likely to increase." All of the people we contacted said that they could contact the office and change arrangements if they needed to. Several of the people we spoke with described the service as "Professional."

We found that there were appropriate records of complaints and that the service acted appropriately to them. We spoke with two health professionals who told us that they had worked well the service and the nominated individual.

Is the service well-led?

The service was led by a manager who had the qualifications, skills and experience to provide a good, well led service.

People or their relatives we spoke with were confident that they could speak with the office staff and management and their concerns would be listened to. Comments included: "We have been listened to, if my relative hasn't got on with a member of care staff they have been changed," "They are conscious of my relatives good and bad days and they ring me if they have any concerns" and "We started off with a call a day but this is likely to increase." A number of people we spoke with told us that the service offered good value for money.

There were systems in place to ensure that people received care from a small group of consistent care staff. Rotas were available to people receiving a service and their relatives. These rotas were only changed when care staff were not available; at which point efforts were made to ensure that the covering staff were known to the individual needing support.

People we spoke with knew the office staff, the manager, and the nominated individual of this service.

This led us to conclude that the service was well led.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

The detailed evidence supporting our summary please can be read in our full report.

Below is a summary of what we found.

Is the service safe?

Staff had the information they needed if they had any concerns or there was an allegation of abuse. The registered manager told us that a member of the management team was available at all times in case of emergencies. People told us they felt safe. Safeguarding procedures were in place and recruitment practice was safe and thorough.

There was a comprehensive induction process in place and ongoing learning around safeguarding was provided for the staff team. A senior member of staff organised the rota and any cover that was needed. They had taken people’s care needs into account when making decisions about the numbers, qualifications, skills and experience of staff. There were policies and procedures in place to make sure that any unsafe practice was identified and people were protected. This helped to ensure that people were kept safe.

Is the service effective?

All the people we spoke with told us that they were very happy with the care that had been delivered and they told us that their needs had been well met. It was clear from the records we sampled and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

We saw that wherever possible people received care from the same staff members. We found that the service was very person centred and staff were aware of peoples choices, preferences and support needs. We found evidence that people and their relatives had been involved in planning the care and support. A relative told us “I’m very pleased with them, it was a huge relief to find them. They’ve been very flexible and we appreciate that.”

There were sufficient staff who were trained and supported in their role to meet the needs of people. This helped to ensure that people received a good quality service at all times.

Is the service caring?

One person told us “They do a very good job, everything they do is good. The company are very efficient and the carers seem handpicked, they are very nice.” When speaking with staff and the manager it was clear that they genuinely cared for the people they supported. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People had care and support delivered to them in a way they were happy with, and staff were aware that people’s needs often changed. A relative told us “They are the best company we have used so far. They have bent over backwards to get things right and if there’s a problem they rectify it straight away.” People’s needs were assessed and planned. People received care in the way they wanted and as identified.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. There were clear processes in place to keep people safe and the manager knew what to do if there was a problem or concern. One person told us “The manager sorted out a problem for me straight away.” The manager was aware of their responsibilities in order to comply with current legislation.

We inspected the agency office and we spoke with the director, the registered manager, the recruitment and training manager, the client scheduler manager and three staff that provided care to people. After our inspection, we spoke on the telephone with three people who used the agency.

People were complimentary about the care and support they received. One person told us: “It makes a huge difference to my life. They take me out, I go out to lunch”. Another person we spoke with said the care they received was: “Excellent and the staff are very caring and sensitive”.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had been recruited in an appropriate way. We found that thorough checks had been undertaken before staff started work at the agency to ensure they were suitable to care for vulnerable people.

The provider had systems of audit in place to enable them to monitor the quality of the service provided and ensure that people received appropriate care and treatment.

We found that any comments and complaints people made were responded to appropriately. People we spoke with were pleased with the service they had received.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We spoke with the provider and the manager when we visited the offices of the agency. We also spoke with four care workers. We visited three people in their own home and spoke with them about their experiences of the support they had received. We also spoke with two people over the telephone.

Everyone spoke positively about their care workers and felt that they fully supported their care needs. Without exception, people said that all their care workers spoke with them in a calm and respectful way. One person told us, “I find them very good, extremely nice and personable people”. Another person said, “People couldn’t be more helpful”.

People told us that they felt safe and if they had concerns, they would speak with a relative or someone from the agency.

All of the people we spoke with told us that the care workers who supported them understood their care needs, made any necessary changes in a timely way and they had the knowledge and skills to support their needs safely.

Although a relatively new agency we saw that the provider had systems in place to monitor and assess the quality of services being provided to people. The provider was open in sharing where he had identified shortfalls, and was able to produce a plan which identified how this was going to be monitored in the future.