About the service: Jane Lewis Health and Social Care is a Domiciliary Care Agency which provides clinically-specialised care packages to children and adults with complex healthcare issues.

People’s experience of using this service:

People and families told us the staff were kind, compassionate and respectful towards them. They described how they trusted and felt safe with the staff. The management team and staff had developed strong relationships with people and family members and were described as ‘going that one step further’ in order for them to have an improved quality of life.

People had had the opportunity to choose their own staff and ensure that they were compatible. Family members told us they had become reliant on the staff, had full confidence in them and they were more like friends.

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

The service was exceptionally well-led. There was a visible and effective leadership team who were open and transparent. This resulted in an effectively organised, supportive and well managed service. Professionals told us they continued to return to the service for new support packages as they had “Every confidence” in them and they would “Think outside of the box” to make things happen.

The registered manager demonstrated how their robust quality assurance systems had sustained continual development and improvement at the service. They had demonstrated innovative ways of working that ultimately improved the outcome for people and families they supported. They were clear about their expectations relating to how the service should be provided and led by example. Since the last inspection, they had made many positive changes and were driven to provide an outstanding service. They were supported by support workers and a management team who were passionate and fully committed to delivering quality person-centred care to people. Morale was high within the service.

People and families were extremely complimentary about the support provided and told us how they had been able to maintain wider family relationships, work, education and social lives. A very person centred approach had been adopted in the assessing, planning and delivery of people’s care and support. This took into account all aspects of a person’s health and wellbeing. Care plans were extremely detailed and informative yet highly personal. They identified positive outcomes for people.

Staff were highly skilled, motivated and knowledgeable. They provided flexible care and support in line with a person’s needs and wishes. The staff team was consistent and people achieved positive outcomes which exceeded expectations. People were able to live in their own homes and maintain personal or family relationships. Staff worked alongside other family members and professionals to provide a better quality of life for people in the short and long term: supporting them to develop in areas such as communication, social interaction, education and independence.

People told us they felt safe whilst being supported by staff. Families were confident that loved ones were well cared for despite known risks to their health and wellbeing. Adults and children were supported to live at home with complex health needs. Staff encouraged them to be as independent as possible whilst ensuring they remained safe and well. There was a proactive approach to assessing, anticipating and managing risk which allowed people to remain safe.

People were encouraged and supported to take positive risks so the restrictions on their own or family life were kept to a minimum.

Medicines were managed safely and people received medication at the right time.

Rating at last inspection: The service was rated good on 5 May 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspectio

This was an unannounced inspection, carried out on the 7 and 8 April 2016.

Merchants House is a domiciliary care agency registered to provide nursing care or personal care to people who live in their own homes. The service was previously registered as Jane Lewis Health and Social care and had reregistered under the name Merchants house in August 2015. The service currently supports 60 people, both children and adults who have a wide range of complex health and support needs.

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.

This location had not been previously inspected by Care Quality Commission. However we identified during our inspection that the registered provider had made an administration error when changing the location address. The new location had been registered as Merchants House instead retaining their former name of Jane Lewis Health and Social Care. The registered manager took immediate action to submit the correct change of name forms to CQC.

The registered provider had safeguarding policies and procedures in place. All staff received training to raise awareness of how to recognise signs of potential abuse and poor practice and what actions they would need to take. Staff were confident in their knowledge and understanding of abuse.

Individual risk assessments were completed to ensure both people supported, relevant others and staff were protected from the risk of harm. Assessments relating to activities taking place within peoples living environments and outdoor spaces had been completed.

Processes for recruiting staff were safe and thorough to ensure staff were suitable for their role. People’s needs were understood and met by the right amount of skilled and experienced staff.

Staff were supported well by the registered provider. Supervision and appraisal sessions were regularly completed to reflect on good practice and areas of improvement.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act

2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood what their responsibilities were for ensuring decisions were made in people’s best interests.

Staff understood how to meet the needs of individuals supported. The service ensured that where possible a consistent approach to staff was developed. This enabled people, their family members and staff to build good working relationships and develop confidence in the support provided.

People and/or their family, friends or significant others were encouraged to be involved in the planning and review of individual care and support needs. Family members told us that staff were patient in their approach and had a good understanding of people’s preferred style of communication to ensure that they were involved as much as possible.

Family members told us that they felt staff and management listened to people’s concerns and acted upon them immediately. People and their family members knew how to raise a complaint and to whom.

Support plans were in place for people and regular reviews were completed to ensure that the needs of people were sufficiently met by the registered provider.

The registered provider maintained robust, effective quality assurance systems to ensure that all aspects of service provision were regularly reviewed and maintained to a good standard. We were notified as required about incidents and events which had occurred at the service.