This inspection took place on 11, 13 and 18 September 2018 and was announced. We gave the service 24 hours’ notice of the inspection to ensure that the people we needed to speak with were available.

Perfect Care Limited is a domiciliary care service. It provides personal care and support to people living in their own homes. At the time of our inspection Perfect Care Limited provided a service to 165 people to maintain their independence at home. Of those, 151 people received the regulated activity personal care. 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.

Perfect Care Limited was last inspected by CQC on 21 and 22 March 2016 and was rated Good. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risk or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager was not present during our visit. However, a registered manager from another of the provider’s locations was present and was acting as manager at the time of the inspection.

People who used the service told us they felt safe. Relatives and external professionals expressed no concerns regarding safety. The acting manager understood their responsibilities with regard to safeguarding. Staff had received training in prevention of abuse and were knowledgeable in recognising signs of potential abuse and the relevant reporting procedures.

Accidents and incidents were appropriately recorded. Health and safety checks had been carried out and risk assessments relating to the environment and the delivery of care were in place. Appropriate arrangements were in place for the safe management and administration of medicines.

There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People who used the service, relatives and external professionals were complimentary about the standard of care provided by Perfect Care Limited. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People’s needs were assessed before they started using the service. Care and support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. The plans made good use of personal history and described individuals care, wellbeing and support needs. Staff knew the people they were supporting and provided a personalised service.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People were supported during visits to and from external healthcare specialists.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

The provider had an

The inspection took place on 21 and 22 March 2016 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

We last inspected Perfect Care on 11 February 2014, at which time it was meeting all our regulatory standards.

Perfect Care is a domiciliary care provider based in Spennymoor providing personal care to people in their own homes in the County Durham and Darlington area. The service is also registered to provide nursing care in people’s own homes although no one was receiving nursing care at the time of our inspection. At the time of our inspection the service provided personal care to 112 people.

The service had a registered manager in place. 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. The registered manager had extensive experience of working in the social care sector.

We found the service had in place a range of risk assessments to ensure people were protected against a range of risks and that these risk assessments were regularly reviewed.

There were effective pre-employment checks of staff in place and effective supervision and appraisal processes, with all staff we spoke with confirming they were well supported.

Medicines administration was found to be safe and in line with recognised good practice, with people not at risk of unsafe medicines administration.

We found infection control procedures were in place and people were protected against the risk of acquired infections.

People who used the service, relatives and external healthcare professionals expressed confidence in the ability of staff to ensure people were safe. No concerns were raised from relatives, external healthcare professionals or local authority commissioning professionals on this issue.

We found there were adequate staff to ensure people’s needs were met safely. We found policies regarding the planning of care calls were clear but, on occasion, the staffing rota had not been managed to ensure the adequate provision of travel time.

We found staff were trained in core areas such as safeguarding, food hygiene, first aid, as well as training specific to the individual needs of people using the service, for example dementia and PEG feed training.

We found staff had a good knowledge of people’s likes, dislikes, preferences and communicative needs.

We found care plans to be person-centred and sufficiently detailed so as to give members of staff a range of relevant information when providing care to people who used the service. We saw these care plans were reviewed regularly and with the involvement of people who used the service, relatives, healthcare professionals and, where applicable, advocates. We saw professional advice was incorporated into care planning and delivery.

The registered manager displayed a good understanding of capacity and the need for consent throughout care practices. We saw one person had been supported to receive the support of an advocate.

People’s changing needs were identified and met through liaison with a range of external health and social care professionals and we saw these interactions were clearly documented.

We saw the majority of complaints were comprehensively responded to, with one not being responded to by the registered manager – they undertook to rectify this. People we spoke with and relatives told us they knew how to make a complaint if they needed to, and to whom.

Staff, people who used the service, relatives and other professionals praised the support they received from the registered manager and we found the registered manager and nominated individual to have a good corporate oversight of the organisation, as well as a

We found people were involved in decisions about their care and had people identified who could support them to make those decisions when required. We also found that consent to provide people with care was required by the provider. One person said, “Consent was checked at the review.”

We saw comprehensive care plans and risk assessments were in place. These were regularly reviewed to ensure people’s needs were being addressed. One person said, “Overall the quality is good.”

The provider had a rigorous procedure in place for checking new staff, and staff confirmed to us they had undergone the procedure before starting work.

We found staff were appropriately supported to carry out their work.

We saw the provider had put arrangements in place to ensure people were safeguarded from abuse.

We found the provider had mechanisms in place to ensure the service was continually monitored, improved and updated.

People said they were involved in all aspects of their care. One person told us "They (the care staff) always ask if I am happy with everything before they leave." People said the same care staff would normally come to their home at the agreed times.

People told us they were happy with everything and they felt well looked after. One person said "I wanted continuity (of care)" and went on to explain they had received it. Another person said "They (the service) are one of the best I’ve used."

People said they were happy with the staff employed by the service and the care they provided. One person said "They (the staff) are really good" and another person said they were “First class.” People also said the staff knew them well and how best to help and support them in their everyday life. Everybody we spoke with told us they felt safe in their homes with the care staff employed by the service.

People had their comments, complaints and compliments listened to and acted upon.