Ipswich is a domiciliary care agency. It provides personal care to people who live in their own houses or flats. It provides a service to adults. Not everyone using Ipswich receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. This service also provides care and support to people living in a ‘supported living setting’, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this announced comprehensive inspection of 15 and 18 June 2018, there were eight people who used the service and received ‘personal care’. The provider was given 48 hours’ notice because it is a small service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We also wanted to give them sufficient time to seek agreements with people so that we could visit them in their homes to find out about their experience of using the service.

When we completed our previous inspection on 17 November 2015, we rated the service overall Good. The key question Safe was rated as Outstanding. The key questions, Effective, Caring, Responsive and Well Led were rated Good. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new frame work some topic areas in Safe are now included under the key question of Responsive. At this inspection 15 and 18 June 2018 we found that the key questions Safe, Effective and Caring were Good. The key questions Responsive and Well Led had improved to Outstanding. Therefore, the service had improved to an overall rating of Outstanding and met all the fundamental standards we inspected against.

The service had a registered manager. 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. Statutory notifications received showed us that the registered manager understood their registration requirements.

Ipswich was exceptionally well led. The service provided high quality care and support to people to enable them to live the lives they wanted and to remain in their own home. There was visible and highly effective governance in an open and transparent culture that resulted in an organised and well-run service. The registered manager demonstrated an open, reflective leadership style working in partnership with other stakeholders to drive continual improvement within the service and local community.

Morale was extremely high within the service with employees describing how well supported and appreciated they were by the registered manager. All of the staff were proud of where they worked and told us they felt valued and respected. They shared positive experiences about the leadership of the service, and how they were continually motivated and encouraged to professionally develop by the registered manager.

The registered manager was able to demonstrate how their robust quality assurance systems had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. They were supported by a management team, office staff and support workers that were passionate and fully committed to delivering the highest standard of care to each person.

Without exception people and their relatives were extremely complimentary about their experience of using the service.

This was an announced inspection. The provider was given 48 hours’ notice because the service is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that someone would be available at the time of our inspection.

Ipswich (Papworth Trust) is a small domiciliary care service providing personal care and support for people aged 18 upwards living in their own homes. When we inspected on 17 November 2015, there were eight people who received a service from the agency.

A registered manager was in post. 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.

A transparent and open culture within the service existed. This encouraged creative and innovative thinking in relation to people’s safety and managing risk. Established procedures and processes ensured the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised but also ensured people’s rights to choice and freedom.

People and their relatives were complimentary about the care provided. They told us their support workers were extremely kind and attentive and they trusted them to come into their homes. They explained how they received safe and effective care by, support workers who knew them well and encouraged them to be as independent as possible and to achieve their goals and aspirations.

Robust systems were in place which safeguarded the people who used the service from the potential risk of abuse. Support workers understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety.

Where people required assistance to take their medicines there were appropriate arrangements in place to provide this support safely.

There were sufficient numbers of support workers who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred. People were treated with kindness by the support workers. We observed support workers respect people’s privacy and dignity and interact with them in a caring and compassionate manner.

People and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received care and support which was planned and delivered to meet their specific needs. Support workers listened to people and acted on what they said.

People told us that they were supported by a consistent team of skilled support workers who they had developed good relationships with. People and relatives valued the interactions they had with the service’s management team and support workers.

Where people required assistance with their dietary needs there were systems in place to provide this support safely. Where support workers had identified concerns in people’s wellbeing there were effective systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on. The service had a quality assurance system with identified shortfalls addressed promptly; this helped the service to continually improve.

The manager demonstrated how they had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. Creative ways to provide a personalised service had achieved effective results through working closely with other organisations.

There was an empowering and supportive culture within the service. Support workers were highly motivated and committed to providing a high standard of care to people. They understood their roles and responsibilities in providing safe and high quality care to the people who used the service.

We met with three people who used the service to gain their views and experiences. Two people did not verbally communicate their views with us so we observed their reactions and body language to staff engagement and interaction. One person told us their needs were met and staff treated them well. They said, “They (staff) are very nice and listen to me. I am very happy. They (staff) help me to get out and about and do things by myself.”

We spoke with three relatives on behalf of the people who used the service. They confirmed they were satisfied with the care, treatment and support provided and were actively involved in the ongoing development of these care arrangements.

We looked at four people’s care records which provided information for staff on how to meet people’s individual health and care needs. We saw that people’s choices and preferences were reflected in the care records and written in a way that promoted their independence.

The care records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan.

We saw the provider’s policies and procedures, which included safeguarding vulnerable adults from abuse, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that the safeguarding policy included information of the local procedures for reporting abuse. This included reporting to the local authority safeguarding team, who were responsible for investigating concerns of abuse.

We looked at staff records and spoke with three members of staff who told us they were being appropriately supervised and supported. Staff we spoke with were knowledgeable about the people they supported and how to meet their needs.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.