The inspection took place between 19 and 29 March 2018 and was announced.

At the last inspection in January 2016 we rated the service ‘Good’ overall and in each domain. At this inspection we found the service had maintained its overall rating of ‘Good’ and improved its rating in the ‘Is the service Caring?’ domain to ‘Outstanding’.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the service was delivering personal care to 25 people.

A registered manager was in place. 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.

We found an extremely caring service. Staff demonstrated very caring values and were highly passionate about the people they were supporting. They had developed exceptionally strong relationships with the people they supported. The trust developed between people and staff helped promote people’s independence, confidence and helped them achieve good outcomes. People had a say in who supported them, and great care was taken to match people and staff with shared interests. We saw staff regularly went the extra mile for people, to ensure their comfort and meet their preferences.

People felt safe using the service. Risks to people’s health were assessed and clear plans of care put in place for staff to follow. People received their medicines safely as prescribed. There were enough staff to ensure a consistent and reliable service.

Effective care was provided. People praised staff skill and knowledge and said staff knew their needs well. The service was very selective about the staff it employed, to ensure they were suitable to work with the client group. Staff demonstrated maturity and a broad knowledge of the people they were supporting. The service worked with a range of health professionals to help meet healthcare needs.

The service was responsive to people’s changing needs. Comprehensive care plans were in place which were subject to regular review involving people and/or their relatives. Everyone said care was appropriate and met people’s individual needs. The service was very effective at meeting people’s social needs and encouraging them to participate in the local community. Comments and complaints made by people were quickly responded to, to help improvement of people’s care experiences.

The service was well managed. People, relatives and staff all praised the approach of the registered manager and said they were effective in their role. There was a clear and visible person centred culture. A range of audits and checks were undertaken by the registered manager to ensure it continued to perform to a high standard. People’s feedback was regularly sought to determine whether any improvements were needed to the service.

This inspection took place between 4 February and 15 February 2016. The inspection was announced. This meant we contacted the service 48 hours before we visited the office. This was to ensure the office would be open and someone would be available on the day of our visit.

The last inspection of this service took place in July 2013. The service was found to be compliant with all of the legal requirements inspected at that time.

Ladies in Waiting provides a wide range of home care services and support to older people who live in Ilkley and surrounding areas. These services are provided to private clients in their own homes. Their head office is located within Ilkley town centre. At the time of this inspection 30 people received support with personal care. The service also provides support with a range of other tasks such as shopping and cleaning. However, this level of support does not fall under the regulated activity of personal care and regulatory remit of the Commission.

The service has a registered manager who had been in post since the service opened. 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.

Risks to people’s health and wellbeing were being effectively assessed, monitored and managed.

The provider had appropriate arrangements in place to help reduce the likelihood of abuse going unnoticed and help protect people from the risk of abuse.

Sufficient staff were employed to ensure people’s individual care needs were met. Care rotas were realistically planned and well organised to ensure people received consistency in the time of their visits and the staff who provided their care.

The provider had effective medicines management systems in place which evidenced medicines were being safely managed.

Care was delivered by suitably skilled and experienced staff. The provider only employed staff with previous experience in care and those able to engage in meaningful conversation with people. Many of the staff employed were retired nurses or social workers which meant they had a thorough understanding of the care sector.

People’s individual dietary needs and preferences were planned for and met. Staff worked in partnership with a range of health professionals to ensure people maintained good health.

We received consistently positive feedback about the communication between frontline staff, office staff and other health and social care professionals. This was a positive feature of the service because good communication is particularly important to ensure joined up care where people are supported by a range of health and social care professionals.

Staff demonstrated understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and had a good knowledge of the people they supported and their capacity to make decisions.

The feedback we received about the standard of care was consistently good. We saw that people were supported by regular staff. This consistency enabled care staff to develop meaningful relationships with the people they supported.

People told us staff were kind, caring and treated them with dignity and respect. Staff actively sought opportunities to help promote people’s independence and ensure people made decisions about how their care and treatment was provided. Where people raised issues or concerns they were listened to and staff tried to make improvements to the quality of care they received.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address any shortfalls.

People using the service, relatives and staff we spoke with were very positive about the registered manager. They all said the registered ma

We spoke with the registered manager about the provider's Statement of Purpose (SoP) and a copy was available and provided on request. We found the SoP included the necessary information including aims and objectives, the kinds of services provided, names of key individuals working for the service, legal status of the provider and details of the office address.

We found that care records provided relevant information and risk assessments in order that staff could provide personalised care. Records had been re-organised to make them easier to navigate and were stored securely. The provider used a care plan and plan of care to mange people's care delivery and this caused minor confusion in two instances; actions were taken to rectify this on the day of the inspection. We found that complaints were handled appropriately and staffing levels were sufficient to meet the needs of people who used the service.

We spoke with four people that were involved with the service including two relatives and two people that used the service. One person commented that staff were very caring, another person said they were very happy with the service and another person said the service was excellent.

We spoke with three people who used the service. They all told us they could make changes to the care and support they received at any time. One person said, “I get the exact service I want, nothing seems to be too much trouble for staff”.

People said they were pleased with the care and support they received. One person said, “I couldn’t manage without them, they know when I am having a bad day and give me the support I need to get through it”. Another person said, “it’s almost as if my carer has been tailored to fit my needs”.

The people we spoke with told us they felt safe whenever their carer visited. They said staff were caring, approachable and had enough time to ensure they performed all care tasks but also spent time speaking with them.

All three people we spoke with told us they had never had to complain about the service they received. However, they felt able to approach staff if they did have a concern and were confident staff would listen to them.

However, despite the positive comments people made, we found evidence that people were not always protected from the risks of unsafe or inappropriate care and treatment as the documentation we saw was uncoordinated, inconsistent and unclear.