We inspected Middleton Care Limited on 14 August 2018. This was an announced inspection so that people could be informed that we wished to speak with them in their own homes.

Middleton Care Limited is a domiciliary care agency. It provides personal care to people living in their own homes in Middleton in Teesdale and Barnard Castle. This area includes rural villages and remote areas in County Durham. Not everyone using Middleton Care Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of inspection 78 people were receiving a regulated activity.

We inspected the service in April 2016 and rated the service as Outstanding. At this inspection we found the service remained Outstanding.

Middleton Care Limited ensured people were at the heart of their care and support. People received a high standard of person centred care by the staff and management team who were reported to be exceptionally kind, caring and considerate.

The staff team clearly knew the people they supported including their likes, dislikes and interests and life history and the service ensured a small and consistent team who lived locally worked with each person.

We saw the staff team had gone above and beyond and worked in their own time, or gone out of their way for the benefit of people using the service, to ensure their care needs had been met and to ensure they were safe during adverse weather in a rurally remote area.

People, their relatives and the staff we spoke with, told us the service was extremely well-led and managed. The management team had expanded and we saw that care staff had been given the opportunity to achieve degree level qualifications in leadership and human resources so ensure the business continued to develop and grow. Other staff we spoke with told us of the training opportunities and of overcoming their own fears of information technology by supportive one to one training and coaching.

The service continued to develop strong relationships with partners in the local community. An inventive scheme had been developed between the GP surgery and local pharmacist which meant the service checked and collected people's medicines and delivered them to them at home each week. People and families told us this had helped them immensely and gave them reassurance.

To ensure high quality care and consistency continued to be delivered, the service completed regular monitoring, spot checks and formal audits of service provision. The management team also worked alongside staff to provide support and complete additional observations of practice.

Staff received high levels of support to enable them to provide outstanding care. In depth induction training was provided upon commencing employment, which included completion of the care certificate. Ongoing refresher training, regular supervision, team meetings and appraisals were also provided. Staff members were an integral part of the service and very much involved in feedback and decision making, and without exception told us they were proud to work for Middleton Care Limited.

People told us they felt safe as a result of the care and support they received. The service had comprehensive safeguarding policies and procedures in place. Recruitment procedures were robust. The staff we spoke with said they were given enough time to travel between calls and that they worked in small local teams to ensure consistent support for people.

The medicines policy and procedure had been reviewed and updated. People we spoke with were complimentary about the support they received to ensure medicines were taken when required and as prescribed. All staff administering medicines had received training and had their competency assessed.

There were general risk assessments and appropriate health and safety measures were

Middleton Care - Teesdale provides personal care for people living in their own homes in rural Teesdale and surrounding areas. The service provides care and support to around 60 people.

The service has a registered manager who was also the registered provider and was involved directly in the running of the business and the provision of care. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Nominated individuals, 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 service was an active part of the local rural community, and we saw and heard how staff provided information for people not just on the work of its service but on a variety of services and opportunities for older people in the local rural community. The office was more of a ‘hub’ for the local area, with lots of information regarding services for older people which members of the public could access. The service won a local business innovation award in 2015 for its work to support older people in its community. We saw staff were highly committed and motivated to supporting people to remain in their own homes with support including the provision of exceptionally dedicated palliative care. The commitment shown by staff included using neighbourhood support and ensuring the service could get to people in isolated areas in extremely poor weather conditions.

The service worked very closely and collaboratively with partners such as the local pharmacy, GP service and district nurses and had developed strong links and solutions to overcome the difficulties that could come with being an older and more vulnerable person in isolated rural communities. The service served an area that was a minimum 25 miles away from any residential nursing provision. We heard from people and other professionals that the service would go ‘the extra mile’ to collect people’s medicines and to support the district nursing service and GP in preventing social isolation. District nurses told us of the service’s commitment to providing ‘excellent’ palliative care with a dedicated and trained team of caring staff.

Everyone we spoke with told us the registered manager, who was also the registered provider went ‘above and beyond’ in terms of their role and ensuring people were supported. They led by example in providing care that was person centred and in making people lives better. We heard examples of them taking people’s ironing home with them, looking after people’s pets by taking them to the vets and going to see people to offer support when they had received difficult news.

Staff members told us they felt part of a team, were proud to work for the company and said the registered manager put the people who used the service and their needs before anything else. We were told the staff team shared the registered manager’s vision and values of providing personalised high quality care by people and in feedback from relatives and professionals. Staff staying overnight with people when they were unwell and helping people sort out crises in their own time were examples of the caring nature of the staff team at this service.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management listened and acted on staff feedback.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs. People who used the service and their relatives told us that they had a small team of staff, who were reliable and arr

The arrangements for supporting people to make decisions about their daily lives and their preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff and the people they supported in the community were good. Personal support was provided in a way that promoted and protected their privacy and dignity. This was confirmed when we spoke with two people who used the service and another person's relative.

Suitable arrangements were in place for handling complaints. There was a competent staff team who had the training, skills and experience to meet the specific conditions of the people who they supported.

The provider had an effective quality auditing system in place.

The manager told us they always ensured they carefully assessed the care and support needs of people wishing to use the service. All people their relatives, representatives and health care professionals, where necessary were involved in this process.

We saw detailed care plans, these described the actions staff needed to take to meet people's needs.

This meant staff had the information they needed to support each person and keep them safe.

Suitable arrangements were in place for handling complaints and for protecting people from harm. People told us they could share any worries with the staff and felt their views were listened to.

People told us they were very happy with the care and support they received.

One person said "The support workers always treat me with respect and they do things for me in the way that I prefer.”