We undertook an announced inspection on 28 February and 2 March 2017. At our last inspection in July 2015 we found the service was good across all the five questions.

We gave the provider 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes; we needed to be sure that someone would be available at the office.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It primary focus was to provide a service to older and younger adults who were living with a dementia, who may also be living with other conditions. At this inspection we found 75 people were receiving support with personal care.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

All the people spoke highly of the service provided for them. People said they would recommend the service. People we spoke with told us staff were caring and compassionate. We saw and heard a sense of fondness between people and the staff who supported them. Relatives we spoke with informed us the staff showed a high level of compassion towards their family members. All the people we spoke with explained how staff went over and above what they expected from them and they couldn’t ask for anything more. People told us the support they received improved their well-being. Staff were positive about the people they supported and the service provided.

The management team focussed on feedback from people, their relatives and staff as an integral part of their quality assurance system. This was achieved through annual surveys, meetings with people, complaints, and reviews. We saw action was taken and improvements were made to improve the quality of people’s lives. The management team monitored and audited the quality of care provided, and used this information to continuously improve the quality of the service provided. People, their relatives and staff spoke highly of the management team. Staff told us there was a high level of leadership which had a positive impact on staff morale. The management team participated in forums and community events to ensure best practice was maintained.

People we spoke with said they felt confident with the staff who supported them. Staff we spoke with recognised the different types of abuse and were confident with the systems in place to guide them in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were supported to receive their medicines by trained staff who knew the risks associated with them.

Staff had up to date knowledge and training to support people and told us they shared best practice to ensure they had the skills to meet people’s needs. Staff always ensured people gave their consent to the support they received. People we spoke with explained they were supported to make their own decisions and felt listened to by staff. The management team regularly reviewed how people were supported to make decisions. People were supported to eat and drink well when part of their identified needs. People and their relatives told us staff would support them to access health professionals when they need to and the management team had effective links with services available in the community. People told us there was effective communication between themselves, staff and health and welfare professionals.

People we spoke with and their relatives told us their support was flexible to meet their needs. The management team demonstrated they understo

We undertook an announced inspection on 16 June 2015. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes and or the family home; we needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care and support for people with a range of varying needs including dementia, who live in their own homes. At the time of our inspection 94 people received care and support services.

At our last inspection in August 2013 we found the provider was not meeting the regulations in relation to assessing and monitoring the quality of service provision. Following our August 2013 inspection the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found that these improvements had been made.

There was a registered manager for this service, who was unavailable on the day of this visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they had no concerns about the care they received. People told us staff were caring and treated people with dignity and respect. Staff we spoke with had awareness of, and recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns, and who to report these concerns to.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff had up to date knowledge and training to support people.

People and their relatives told us staff treated people with dignity and respect whilst supporting their needs. Staff really knew people well, and took people’s preferences into account and respected them. The management team were responsive to changes in people’s needs and cascaded information effectively.

We found that staff had a good understanding of how to obtain consent from people and what to do where people did not have the capacity to make certain decisions. They worked within the confines of the law which meant they did not treat people unlawfully. There were no applications to the court of protection to deprive people of their liberty. Staff were knowledgeable and passionate about ensuring people gave their consent to the care and support they received.

People were supported to eat and drink well. People and their relatives told us they had access to health professionals as soon as they were needed. Relatives told us they were always kept up to date with any concerns for their family member.

Staff said they were well trained and supported. The provider had the ethos to invest time and resources into staff, to support them in their role. This assisted the provider to provide quality care and support.

People and their relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and action taken if required.

The registered manager promoted a positive approach to including people’s views about their care and service development. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. Systems were in place to monitor and improve the quality of the service. The provider used different resources to receive as much feedback from people, their families and staff as possible.

We inspected the agency office and spoke on the telephone with two people who used the agency. We also spoke with two relatives of people who used the agency. We found people had been involved in making decisions about their care and treatment. People expressed their views on how they wanted to maintain their independence. Staff we spoke with told us how they supported people in their choices.

People were complimentary about the care and support they received. One person told us: “The staff are very friendly and polite”. A relative we spoke with said: “The manager was very good at putting us at ease. That’s why we chose Home Instead”.

The staffing levels for the agency were sufficient to meet the needs of the people they supported. People told us they received their care and support when they needed it.

The provider supported their staff and had made sure staff were trained to an appropriate standard to meet people’s needs.

The provider did not have an effective process in place that monitored the quality of the service they provided.

People we spoke with told us they had not felt the need to make a complaint because they were satisfied with the service they had received.

This was the service’s first inspection since registering with the Care Quality Commission in February 2012. Since then the service had gradually increased the numbers of people they provided personal care to. At the time of our inspection there were a small group of people who received personal care with the majority of people receiving companionship and support.

As part of our inspection we visited the agency office, spoke with three people who used the service, the representative for one person who used the service and three care givers (care workers).

We found that people had been involved in making decisions about their care and were satisfied with the care they received from staff.

Care plans had been recorded for each person and provided information for staff when they visited people to ensure people’s individual needs would be met. When we spoke with staff they told us about the care people received and this matched the information in their care support plans.

Staff employed by the service had a good understanding about safeguarding people from abuse and the action they should take if they had any concerns about the people they cared for.

There were effective recruitment and selection processes in place to ensure that only suitable staff were employed to work for the agency.

We saw that arrangements were in place for monitoring the quality of the service and for people who used the service to provide feedback about the service.