This announced inspection took place on 12 and 13 December 2017. We visited the office on 12 December 2017 and carried out phone calls to people who used the service and their relatives on 13 December 2017.

Palm Tree Home Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. Not everyone using the service 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 take into account any wider social care provided. At the time of this inspection 43 people were receiving personal care from the service. People who use the service live in Paignton and Torquay.

At the last inspection, the service was rated Good overall. At this inspection, we found the service remained Good and had improved to an outstanding rating for caring.

Why the service is rated good:

People received a safe service. One person said “Totally safe, I have no worries.” A relative said “Living at a distance it gave me great peace of mind to know she was in safe and understanding hands.” People told us they felt safe and comfortable when staff were in their home and when they received care. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service's safeguarding policy. Risks had been appropriately assessed and staff had been provided with clear guidance on the management of identified risks. People were protected from the risks associated with unsafe medicine administration because medicines were managed safely.

People received effective care because staff had the skills and knowledge required to support them. People commented, “They’re a good group of carers” and “Very efficient and well trained”. A community professional said, “I have met a couple of staff who have appeared to be professional, helpful and proactive.” Staff monitored people's healthcare needs and advice and support was sought from healthcare professionals when needed.

Staff provided a very caring service to people. We heard many examples of how staff went over and above their responsibilities, in their own time, to support people and their families. Without exception, we received excellent feedback from people who used the service, their relatives and representatives. Comments included, “They’re excellent”, “I’d put a gold star against them”, and “I’d give them A*, always willing to go that extra mile.” People benefited from small, regular staff teams who they had built strong relationships with over time. People and their relatives said, “They’re marvellous and very caring” and “They always send the same staff. She knows them, they’re like family to her.”

People received personalised care which was delivered in accordance with their wishes and lifestyle. People’s communication needs were met. The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss. For example, one person was unable to communicate verbally. Staff told us they understood what the person wanted through facial expressions. The person’s representative told us they were happy with the way staff communicated with them. This ensured the person was able to communicate with staff and their needs were met in the way they wanted.

The service was well led. People and staff told us the management team were open and approachable. People told us “They’re absolutely brilliant”, “I can’t praise them enough” and “I don’t know what I’d do without them.” Staff said “They’ve been amazing”, “They’re always on the end of the phone” and “I love working for them.” The manager and provider sought people's views, listened to them and used suggestions to mak

Palm Tree Home Care Limited provides care and support to mostly older people, who live in their own homes. The services provided include personal care and domestic work in Paignton and Torquay.

The provider of the service also worked as the registered manager in day to day charge of 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.

We visited the office on 27 October 2015. At the time of this announced inspection 37 people were using the service. This service was registered in May 2014 and this was the first inspection.

People and their relatives were positive about the way staff treated them. Each person we spoke with told us their care workers were kind and compassionate. Comments included “We’ve seen a significant improvement in the care since Palm Tree took over”; “They’re (staff) all lovely, always so caring”; “We feel so much better with their support, we’re so glad we’ve got them”. People told us staff never rushed them and always checked whether they could do anything else to support them. People were happy and relaxed when we visited them in their homes. Staff treated people with respect and kindness. People responded to this by smiling and engaging with staff in a friendly way.

People and their relatives told us they felt safe when they received care. People told us ‘I feel safe, I know the staff” and “There’s nothing to worry about”. We saw that staff ensured people had their pendent alarm on in case they needed to summon help. People told us staff were careful to ensure their homes were secured on leaving.

People had a regular team of staff who had the appropriate skills to meet their needs. Comments included “I have regular staff who go above and beyond. They take initiative, if anything needs doing, they do it”; “They co-ordinate what’s needed”; “We have a committed and skilful care worker” and “They know where everything is”.

People told us staff were usually on time. One person said “They can’t help it if they get delayed with the person before”. Staff told us they had enough time to travel between visits. One staff member said “I only have to travel for five to ten minutes as my round is close together”.

Staff knew people well and were able to tell us how they supported people. During a home visit, we saw staff responded to people’s requests and met their needs appropriately. People told us they received support that was personalised to their needs. Staff were aware some people were at risk of becoming socially isolated. One staff member said “When people don’t have any family at all, we may be the only person they see that day. It’s nice we can spend time and chat”. One person told us “I look forward to them coming, it gives me a purpose”.

Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people. People were protected by staff who had completed safeguarding training and knew what to do if they were concerned that a person was being abused. Where the agency had been involved in a safeguarding process, this had been well managed. A healthcare professional told us the service supported the person throughout the process and handled it very sensitively.

Risk assessments had been undertaken and included information about action to be taken to minimise the chance of harm occurring to people and staff. Where people were supported to have their medicines this was done safely. People had received their medicines as they had been prescribed by their doctor to promote good health.

People told us the registered manager knew them well and often spoke with them or visited them. The registered manager was working towards the Level 5 Diploma in Leadership and management. A healthcare professional told us the registered manager was very good at communicating with them. Staff told us the registered manager and seniors were very approachable. Comments included “Any problems we can go straight to them”; “(The registered manager) provides brilliant support” ; and “When I had a personal emergency, they came straight out and supported me. They 100% care”.

People and their relatives felt able to raise concerns or make a complaint if the need arose. However, everyone we spoke with told us they had no complaints. Comments included “No complaints whatsoever” and “If there’s ever a problem I can ring them and it’s sorted straight away”.

The provider had systems in place to assess and monitor the quality of care. The service encouraged feedback and used this to drive improvements. Monthly reviews showed people were asked about the quality of the service. A quality assurance survey was sent to people in August 2015. The service received 25 responses. All of these people said they were ‘happy’ or ‘very happy’ with the care and support they received. Some people were not sure if they had been involved in their care plan. The registered manager responded to people and offered to go out and meet with them.

The registered manager was keen to improve the service. They were able to describe the improvements they planned to make in the next 12 months in the provider information return. When we asked people, relatives and staff what could be improved, no one was able to suggest anything. Comments included “It’s all perfect as far as I’m concerned”; “I think they’re doing really well”; “It couldn’t be better” and “I can’t fault them”.