This inspection took place on 1, 6, 8, 15 and 22 June 2017 and was announced. We gave the provider 24 hours' notice of our visit because the location provides and coordinates care in people’s own homes and we needed to make sure there would be someone in the office at the time of our visit. This was the first inspection we had undertaken with this service.

Office F10 James House is registered with the Care Quality Commission to provide personal care to people who wish to remain independent in their own homes. The agency provides services throughout England and provides care for people with healthcare and social care needs. At the time of our inspection there were nine people using the service, including younger adults with complex physical care needs.

At the time of our inspection a new application was underway for the position of registered manager. 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.

Relatives told us the service offered a high degree of safety for people with complex needs. This included staff being skilled around the use of specialist equipment and reducing risks during activities. The provider worked closely with external healthcare professionals in understanding how to keep people safe. Staff and management were clear about how they would identify potential abuse and their responsibilities for reporting it. People were supported by the correct number of staff which was kept under constant review. Medicines were managed safely and staff ensured people received their prescribed medicines in the correct way. The provider worked with relatives to ensure their safe involvement in administering medicines.

People received care and support from staff who were very knowledgeable and well trained in their role. Staff received specialist input to ensure they were trained to deal with people’s sometimes complex and rare conditions. The management team and staff showed a good knowledge of issues around consent and their legal duties in this respect. Staff ensured people received adequate food and drink with the correct level of support. Staff demonstrated a strong knowledge of people’s vulnerability to certain illnesses and how people might communicate being unwell. Staff acted promptly in seeking medicinal help when required. Staff worked very closely with people’s external healthcare professionals in order to promote their wellbeing.

Relatives were very positive about the levels of compassion and care shown by the provider and staff. Staff worked towards making people as independent as possible. Staff respected and promoted people’s privacy and dignity in a person centred way. The provider worked to include family in people’s care, where appropriate. Staff worked in a way which respected family relationships and friendships.

Care planning was highly person centred. People’s past histories, wishes and hobbies were carefully considered and explored to ensure they could still engage with these with the support of staff. People were supported to safely, constructively and fully participate in external activities. Relatives had a number of ways in which they could raise issues with the management team and staff, although no one reported they had needed to. People described all staff, including office staff and the management team, as being highly responsive to their needs and opinions.

Relatives, external healthcare professionals and staff praised the way in which the service was managed. The provider demonstrated they were acutely aware of the importance of creating an open, honest and positive culture among people, staff, professionals and relatives. The provider had a strong emphasis on team work in delivering a service which cont