This inspection took place on 20, 24 and 27 July 2018 and was announced. This was to ensure someone would be available at the office to speak with us and to show us records.

Mid Suffolk Home First is provided by Suffolk County Council. The service provides two distinct services. Reablement and, since our last inspection, they now provide a longer term care service to support people to meet their needs. The reablement service concentrated on supporting predominantly older people following a hospital admission with the aim of helping the person to their optimal level of independence. After six weeks of reablement support people are assessed to see if the person should stay with this service or progress to longer term support..

At the time of the inspection, the service was providing support to 55 people in their own homes including 12 people needing longer term personal care.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

Mid Suffolk Home First was last inspected by CQC in December 2015 and was rated Good. At this inspection we found the service had improved to Outstanding.

The service was very flexible and extremely responsive to people’s needs. We saw and heard from people using the service and their relatives how staff went above and beyond their role.

People’s care and support was planned proactively with them in a person-centred way. People’s preferences and choices were clearly documented in their care records and people told us they were involved in planning the care they received.

The service had used case studies to review the support people had received and identify good practice or lessons learned. There were consistently high levels of constructive engagement with staff and people who used the service.

Staff felt supported by the registered manager and said there was an “open door policy” at the service. Policies and procedures were in place to keep staff safe, and management and office staff provided outstanding support to care staff.

Governance was well embedded into the management of the service. Service quality and improvement was measured through a variety of audits, satisfaction questionnaires and performance indicators. There was a strong emphasis on continually striving to improve the service for the service users.

As well as continuing to develop the reablement service in a difficult situation, the service had taken over the provision of longer care to people in need of a service to meet their needs. As well as attentive management to ensure the service was delivered well an assessment of need had been carried out and additional training was provided to staff.

There were sufficient members of staff employed by the service and no call visits had been missed and staff were not late for appointments. Staff had time to travel safely between care visits and people informed us the always stayed for the length of time agreed.

The staff received supervision and training and on-going support.

Staff respected people’s privacy and dignity. People spoke positively about how staff respected their privacy and dignity while carrying out the support they received to help them regain their independence as well as during personal care.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place to ensure the safe administration of medicines.

People were supported to have maximum choice and control of their lives, and staff supported them i

At the time of our visit the provider was supporting approximately 50 adults to live within their own homes following a hospital stay, illness or injury. The provider's purpose was to support people while they worked towards regaining their abilities to live independently on a permanent basis.

We spoke with five people who used the service and one close relative. One person said, "I would not have been able to stay at home on my own after the operation without the carers." Another person said, "The carers are very nice - all of them." No one we spoke with raised any concerns about the service.

We saw that support plans and risk assessments were informative and up to date. Staff we spoke with were aware of their contents, which supported them to deliver appropriate and safe care. Staff recruitment systems were robust and staff were supported to do their jobs properly through appropriate training and supervision.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff in line with individual care plans, and that people were satisfied with the service they were receiving.

We found that care and support needs were assessed and appropriate plans were then agreed with people. Appropriate systems were in place to safeguard vulnerable people from abuse.

We spoke by telephone with eight people who were using the service and two relatives. People were very complimentary about the service. People told us that they felt safe, that staff treated them well, and that they were supported to be independent. One person told us about staff, “They are absolutely super, very caring and understanding, they are very punctual and I could find no fault.” A person’s relative told us that their partner had been worried about using a hoist but the carers had always put their partner at ease when they provided support.

We saw that staff had received comprehensive training to provide a wide range of care and support to people.

We found that there were appropriate arrangements to manage any complaints about the service. People had information about how to make a complaint if they needed to.

The inspection was carried out on 17 December when we visited the offices, plus 23 & 29 December 2015 when we spoke to three people using the service on the telephone. We gave the provider 48 hours’ notice of the inspection in order to ensure people we needed to speak with were available.

The service is registered with the Care Quality Commission (CQC) to provide personal care and support to people in their own homes. The service assesses people’s needs for domiciliary care and provides support usually for up to six weeks until a decision is made about whether the person requires longer term care and support following discharge from a hospital stay.

The manager was seeking registration with the CQC. A registered manager is a person who has registered with the CQC 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.

Our findings showed care and support was provided to people in their own home on a flexible basis and in accordance with their individual assessed need. The amount of support provided varied accordingly to the individual’s need and was offered over several hours and up to 4 visit per day, over seven days per week if so required.

The manager was determined to provide a service which took into account people’s individual needs and their wishes. A great deal of time was spent with people during the initial assessment to determine if the service was appropriate to them and could meet their needs.

Everyone we spoke with told us they felt safe when the staff from the service were in their home.

People told us they received care and support from a consistent staff team and the visits by staff were conducted on time.

Staff rotas showed there were sufficient numbers of staff to meet people’s needs.

Risks to people’s safety and welfare had been assessed and information about how to support people to manage risks was recorded in their plan of care.

The manager had a clear knowledge and understanding of the Mental Capacity Act (MCA) 2005 and their roles and responsibilities linked to this. People told us they were able to make their own choices and were involved in decisions about their support.

There were processes in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding vulnerable adults’ procedures.

Medicines were administered safely to people by staff.

Recruitment checks were robust to ensure staff were recruited safely to work with vulnerable people. The service had a safeguarding and whistleblowing policy, which was available to staff. Staff told us they would feel confident using it and that the appropriate action would be taken.

People’s medical conditions were known by the staff and the service staff liaised with healthcare professionals to monitor, promote and maintain people’s health and wellbeing.

We visited three people in their own home and they informed us that support was carried out in accordance with what they needed.

Staff supported people with their nutrition and food preparation as assessed and documented.

All people told us they had a care plan. The care plans were detailed providing information to enable staff to give the care and support in accordance with individual need.

Speaking with care staff confirmed their knowledge about the people they supported and how they would respond if a person was unwell or there was an emergency situation.

Staff were supported by induction and on-going training, supervision, appraisals and staff meetings. Formal qualifications in care were offered to staff as part of their development.

People who used the service told us the staff treated them with kindness and staff were polite and respectful.

A complaints procedure was in place and details of how to make a complaint had been provided to people who used the service. People we spoke with knew how to raise a complaint.

Systems and processes were in place to monitor the service and drive continuous improvements.

A number of audits (checks) on how the service was operating were also undertaken. These included visits by senior staff to see people in their own home and to check they were happy with the care received.