The inspection took place on 20 and 22 June 2017 and was an announced inspection. The provider was given 48 hours’ notice. At our last inspection in April 2015 the service was rated as Good. At this inspection, we rated the service as Outstanding.

The service provides personal care to people living in an extra care housing scheme. People live in their own flats within the complex and staff are based on site to deliver their commissioned care packages. The service also provides personal care to people in their own homes within a small radius of the office. Throughout the report we refer to the extra care housing scheme as ECHS and those people receiving care in their homes outside of the complex are described as receiving ‘domiciliary care’. This is how staff distinguished between the two aspects of the service.

There was a registered manager 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 the service to be very well led. The registered manager had embedded a strong person centred ethos throughout the service. This was reflected in the Customer Service Excellence (CSE) accreditation that the registered manager had been part of achieving. We found clear examples of how this approach to care had impacted on people. For one person, the registered manager had supported them to make contact with family that lived abroad and this had resulted in family flying over to attend the person’s birthday.

Staff and other professionals spoke very highly of the registered manager and gave positive feedback about their approach to caring for people. The registered manager told us they were passionate about providing social and community engagement opportunities for people they supported and this was evident throughout our inspection. The registered manager was innovative and proactive in their approach to finding ways to enhance people’s lives through social activities. This was achieved through applying for and being awarded funding; this included a grant from the National Lottery to provide community activities for people. The impact of these opportunities was clear for people as they told us about the difference this had made to their lives.

The service often went above and beyond their contractual obligations to ensure people had a good quality of care. This was evident in feedback we received and the feedback we viewed from the service’s own quality monitoring measures. Comments included, “We would like to say a special thank you to X (staff) and X (staff) who were with him at the end. The way they handled their job was above and beyond and earned the love and respect of our whole family”. Another comment was “Thank you so much for all the love and care you have given to mum and as a family. You really have gone above and beyond”.

People receiving support from the service were safe. There were sufficient numbers of staff to meet their needs and ensure their calls happened at the right times. There were processes in place to ensure people received their medicines as prescribed.

Staff had good links with healthcare professionals to ensure people’s health needs were met. People had clear information in their support plans about their dietary needs.

Staff received good training and support and their performance was monitored. This included senior staff undertaking ‘spot check’ of care staff carrying out care, to ensure this was done safely and in a person centred way.

The inspection took place on 30 April 2015. The registered manager was given 48 hours’ notice of the inspection. The last inspection took place in January 2014 and there were no breaches of legal requirements at this time at this time.

Mears Care provides a domiciliary care service in a supported living complex in Bristol. This is where the registered office is based. A service is also provided to people in their own homes in the local area. A domiciliary care service is provided in Newport and also managed from the office in Bristol. 47 people live in the supported living complex and approximately a further 60 people receive care in their own home across Bristol and Newport.

There is a registered manager in place 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.

People in the service received safe care; however there were areas where improvements could be made. Care staff arriving on time and communication with people when staff were running late were inconsistent in the Newport domiciliary care service. People told us for example, that staff didn’t always arrive on time for them to prepare to go out to their day care. Another person told us there were occasions when staff did not arrive at all. The service was working with the local authority to address these concerns.

People told us they felt safe with staff and we found that suitable recruitment procedures were in place to ensure their suitability. Staff wore uniform and identity cards so people could be sure they were from the agency concerned.

There was guidance in place for staff to ensure that people were cared for in a safe way. Risk assessments included advice from healthcare professionals such as the speech and language therapist.

Some people received support from staff with their medicines. These were managed safely; however we found that practice didn’t fully meet the provider’s policy. This was because no receipts were obtained for medicines returned to the dispensing pharmacy.

The links that the registered manager had built with the local community was an outstanding feature of the service for people in the supported living accommodation. Volunteers from the local area came to the service to run a small shop offering groceries, toiletries and other items. Other organised events included, a community fun day which people who used the service helped to organise.

Overall, people were very happy with the care and support provided by staff. People told us they were treated with dignity and respect. Comments included “Staff are fantastic; they go over and above what is expected of them”, “Carers are brilliant, we have a good relationship, we have a laugh and a joke, they know all about me” and “They’re all wonderful”.

Support plans were in place that described people’s individual routines and preferences. This meant that information was available to support staff in providing person centred care. People and their relatives were involved in developing and reviewing their support plans so they were current and reflected any changes in a person’s care needs. There was a complaints procedure in place and we saw examples of where formal complaints had been responded to appropriately and in line with the complaints policy.

Staff received training and supervision to enable them to carry out their roles effectively. This included core topics as well training to support the particular needs of people when required. There was a clear induction programme in place which supported staff to feel confident before beginning to work independently.

The service was well led and all staff felt confident about raising any issues or concerns. Staff were all positive about the support they received from the registered manager. There were systems in place to monitor the quality and safety of the service provided.

We spoke with three people who all said that they were happy with the service that they were receiving. One person told us "the carers are all lovely." They all told us that they received the support that they needed. They also said that they were supported to be as independent as they could be. One person told us about how they liked to go for a walk and to go out to the shops.

People told us that they had been involved in developing their care plans and that they consented to the care and support provided. There were suitable arrangements to manage medication to keep people safe. Two people told us that they could manage their own medication.

The staff had had recruitment checks before they were employed to make sure that they were suitable to work with people. They also had provided information about their qualifications and experience to show that they had the skills to work with people. Staff received more training to keep their qualifications and skills up-to-date.

There were arrangements to monitor the quality of the service provided and people were asked their views about service. There are also arrangements to make sure that people were kept safe.

We spoke with five people who were living in the sheltered accommodation on the day of our visit. Following our visit, we spoke with a further three people by telephone who were receiving care from the agency in their own homes. The feedback we got was generally very positive with comments such as "I get on well with staff" and "I love it here". One person told us that staff coming to visit them "made their day".

We did receive comments from two people that they felt staff were very rushed and we fed this back to the manager. The manager told us that she would discuss this with staff. One person expressed concern about the way in which the service had developed since it opened in terms of the level of people's needs; they felt that because people’s needs had increased, this had implications for how busy staff were. One person that we spoke with told us that generally staff had the skills to do their job but on occasion a member of staff had been sent that wasn't able to meet their relative's particular need.

People told us that they felt safe with staff and would be able to raise any concerns or issues if they had them. We saw that there were policies and procedures in place to manage complaints.

We spoke to five people about the care they received and two relatives. People told us they were very happy with the care. Comments included,. "I've got a wonderful life now" and "I'm happy with the carers and the care, I look forward to their visits".

People were very positive about the care they received and told us about the good relationships they had with care staff. Two relatives told us, "It's fantastic, you could not ask for better" and "I don't have to worry about my mum at all and I feel confident in the staff".