About the service:

NC Homecare Limited t/a Home Instead Senior Care is a Domiciliary Care Agency located in Frodsham, Cheshire. The service provides care and support to people living in their own home and out in the community. At the time of this inspection 40 people were receiving support from the service.

People’s experience of using this service:

People received exceptionally personalised care and support specific to their needs and lifestyle choices. People’s needs were assessed and planned for with their involvement. Each person had a care plan that contained extremely detailed information about how their needs were to be met.

The leadership of the service demonstrated a high level of experience and capability to deliver excellent care. The registered manager promoted a culture that was extremely person-centred and inclusive which provided high-quality care and put people at the heart of the service. The registered manager was extremely knowledgeable and inspired confidence and passion within the staff team. They had a commitment in ensuring equality and inclusion across the workforce and this was reflected in the high levels of satisfaction of staff. There was a strong framework of accountability to monitor performance and risk leading to continual improvement within the service. The management team and staff worked with local communities in providing and working in conjunction with local initiatives to keep older people safe and well.

People were treated with dignity and respect and felt the service was caring towards them and was at the heart of the service’s culture and values. Information was available in different formats to meet people’s individual needs. People and their family members provided extremely positive feedback about the support they received and how they were treated. Staff worked hard to ensure that people benefited from continuing to and exploring new experiences. People were matched with staff who shared common interests to pursue activities. Staff supported people to maintain their independence within their own home and maintain a community presence. People were regularly asked for their opinions on the service and had information as to how to make a complaint if they were not happy.

People were protected from abuse and the risk of harm. Staff had received training in safeguarding and knew who to contact if they had any concerns about a person’s safety. People’s medicines were managed by staff who had received appropriate training. Safe recruitment procedures were followed so that suitable staff were employed. People received their care and support mostly from the same members of staff. Staff received the training and support they needed for their role. Staff clearly understood and respected people’s rights to make their own decisions.

Rating at the last inspection: Good (report published 16 June 2016). The rating of outstanding in the Responsive and Well-led section of this report reflects the improvements made within the service since the previous inspection.

Why we inspected: this was a planned inspection based on the rating of the last inspection. This service had improved on the quality of care provided and has been rated as outstanding overall with outstanding in the Well-led and Responsive sections.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 12 and 13 May 2016 and was announced. The provider was given a short amount of notice because the location was a domiciliary care agency and we needed to be sure that someone would be present in the office. N C Homecare provides a personal care service to people living in their own home. On the day of the inspection 44 people were using the service.

The service had 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.

During the inspection, office staff were friendly and relaxed. Information we requested was supplied promptly, records were clear, easy to follow and detailed. People, relatives and staff all spoke positively about the service. Comments included, “I have complete trust in all the staff”, “I feel very confident about the service and I trust all the staff with my Mum” and “It is an excellent service”.

People valued their relationships with staff. People said they felt really well cared for. One person said, “The staff never forget anything”. A relative commented, “I am very happy with the service, all the staff are lovely and all very different”.

People were supported by staff that encouraged them to remain as independent as possible. Staff knew how to respect people’s privacy and dignity.

People told us they felt safe. Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the registered provider managed the concerns promptly and where required, conducted thorough investigations to protect people. People were protected by the registered provider’s safe recruitment practices. Staff underwent the necessary checks before they started their employment to determine their suitability to work with vulnerable adults.

People were supported by staff that had received the training they needed to meet people’s needs. Staff put their training into practice and delivered good care.

People and relatives were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People told us staff provided consistent personalised care and support. Staff responded quickly to changes in people’s needs, and they communicated changes to those that needed to know.

Risks to people were anticipated, identified and monitored. Staff managed risks effectively and actively supported people’s decisions, so they had as much control and independence as possible. Risks were regularly reviewed and updated promptly following any change in a person’s needs.

People knew how to raise concerns and make complaints. People and their relatives who had raised

concerns confirmed they had been dealt with promptly and satisfactorily.

Staff described the management as very open, supportive and approachable. Staff spoke positively about their jobs and were highly motivated.

There were effective quality assurance systems in place. Action was taken to address areas where practice could be enhanced, and as a result, changes had been made to help ensure the service moved forward and continually improved.