Our last comprehensive inspection of this service took place on 7 December 2015. We rated the service ‘Good’.

At this inspection we found consistently good care delivery and excellent leadership. We rated the service ‘Outstanding’.

This inspection was announced and took place on 8 and 9 February 2018.

Kingsmith Care is a domiciliary care service providing personal care and support to adults. Whilst we have taken into account any wider social care and support provided to people in their homes and in the community, the Care Quality Commission (CQC) carried out this inspection only in relation to the regulated activity of 'personal care'.

At the time of our visit the service was supporting 24 people. Of these people, 13 were receiving support and assistance with personal care tasks. People who use the service live in Hammersmith and Fulham and the surrounding areas. People and their relatives consistently told us staff were very caring and always treated people with great respect and empathy.

There was a registered manager 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.

The company ethos is that ‘every action matters’. The registered manager told us their focus was on building trusting relationships and delivering care that brought about positive outcomes for people and their family members.

Without exception, we received excellent feedback from people who used the service, their relatives, health and social care representatives and community professionals. People were supported by a strong, stable staff team who knew them well and focused on ensuring they received the highest quality of care.

People told us they felt very safe and comfortable when staff were in their home and when they received care. People told us staff knew how to meet their needs, were kind, always respectful and very well trained.

Staff promoted people’s dignity and protected their privacy. People and their relatives were unanimous in their praise for the sensitivity and kindness of staff in relation to this matter.

Care plans and risk assessments were developed from the initial assessment information. Care plans were comprehensive in scope, individualised and developed with each person. They described the support the person needed to manage their day to day health needs.

Risks to people were identified in relation to falls, nutrition, skin care, and mobility. Risk assessments relating to each person's home environment were also being completed. Guidance and control measures were in place to enable staff to support people safely.

People's care and support was regularly reviewed and updated and appropriate referrals were made to external services to ensure people's needs continued to be met.

People’s care records documented whether they had capacity to make specific decisions and also contained a written record stating whether people had appointed someone as their Lasting Power of Attorney (LPA). Staff told us they gained consent from people before carrying out personal care and respected people's choices.

Recruitment practices ensured the right staff were recruited to support people to stay safe. Staff told us they were happy in their jobs, were paid well and had access to further training. They said they felt well supported and had regular opportunities to discuss their work.

People were protected from avoidable harm and abuse because the provider had effective safeguarding systems in place. Staff knew how to recognise the signs of potential abuse and understood how to report any concerns in line with the provider's safeguarding policy.

People were always visited by the same staff or small groups of staff to maintain continuity and build posit

We conducted an inspection of Kingsmith Care on 7 December 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. The service provides care and support to people living in their own homes. There were 17 people using the service when we visited. At our last inspection on 12 December 2013 the service met the regulations we inspected.

There was a registered manager at the service. 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities. They demonstrated a detailed understanding of the medicines people took and why they were taking these.

Risk assessments and care plans contained very detailed information for staff. All records were reviewed within six months or sooner if people’s needs changed.

Safeguarding adults from abuse procedures were clear and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Kingsmith Care was meeting the requirements of the Mental Capacity Act 2005. Care records recorded whether people had capacity to make specific decisions and also contained a written record from the registered manager about whether the person had appointed someone as their Lasting Power of Attorney. Care workers were also aware of their responsibilities under the Act in relation to protecting people’s rights.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Care workers were provided with appropriate training to help them carry out their duties and were encouraged to develop their skills and take on responsibilities in areas they found interesting. Staff received regular supervision. There were enough staff employed to meet people’s needs.

Staff demonstrated an excellent understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans that reflected their assessed needs. We saw evidence that the registered manager proactively explored new ways to engage people in activities they enjoyed.

People were supported to maintain a balanced, nutritious diet. Staff at the service worked with people and their relatives to provide food they enjoyed as well as encouraging them to explore healthier options. People were supported effectively with their health needs and were supported to access a range of healthcare professionals. People’s emotional needs were also considered extensively and people were given the support they needed.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints policy and procedure in place.

Staff were supported and given the resources to develop and drive improvement within the service. Improvement was incentivised and the service operated a forum to discuss best practice.

The organisation had appropriate systems in place to monitor the quality of the service. The registered manager reviewed all care records and daily notes completed by care workers. We saw evidence that feedback was obtained by people using the service and the registered manager visited people at least every two months. The results of feedback was very positive.