The inspection took place on 25 and 27 October 2016 and was announced. This was an announced inspection so that the service had time to arrange for us to visit and talk with people using the service in their own homes. We also inspected office based records and spoke with staff during this time. From November 9 to 24 we contacted other people using the service by telephone to understand their views of the service. At our last inspection of February 2014, using our methodology at that time the service was viewed as compliant.

The service is registered to provide personal care and is a domiciliary service. There were one hundred and fifty-seven people receiving support at the time of the inspection.

The service has a registered manager. 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 service was outstandingly well-led which was demonstrated by how the staff were supported and how well the service was organised to ensure people received high standards of care according to their assessed needs.

The care plans were person-centred written to clearly identify the support required alongside what the person could do for themselves.

All staff had attended training as part of their induction to the service designed to help them recognise abuse and know what actions to take to protect people as far as reasonably possible from actual or potential harm. Staff had a clear understanding of their roles and responsibilities, whether this was staff involved with providing direct support or those working to organise and support. People using the service were supported by a sufficient number of suitably experienced and knowledgeable staff to meet their needs. The manager carried out appropriate recruitment checks before staff began work with the service. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred. As part of the assessment process to determine if the service could meet the individual’s needs, people were asked about their preferences and choices and the support plans were written in a person-centred style.

The service had a medicines policy, staff had received training and systems were in place to manage medicines and people were supported to take their prescribed medicines safely. The service carried out an audit to determine that medicines were being managed safely.

People using the service experienced a service based upon their assessed support needs which was person-centred. The staff were knowledgeable about the people they supported. Individual goals were identified as the service employed occupational therapist alongside experienced care staff and sought the advice of other professionals to organise and deliver the care support.

Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 including best interest meetings. A best interests meeting may be needed where an adult (16+) lacks mental capacity to make significant decisions for themselves and needs others to make those decisions on their behalf.

Positive and caring relationships had been developed between the people using the service and staff supporting them. Staff responded to people’s needs in an empathic manner. People’s choices were respected as was their privacy and dignity. The care plans were written to take account of people’s needs and to promote and maintain independence. People were involved in the planning and reviewing of their care and support, as were family members with their permission. The service was focused upon a solution based approach and to achieve this aim.

The service had a clear set of values, positive culture and ethos which

We spoke with 26 people, of which five were family carers over the telephone and visited five people in their own homes. We asked people for their feedback about the staff provided by the service. Comments included, “The carers are first class, they are really nice people and very helpful”. “I love them all to bits, they're lovely people”. "They ask me what I want them to do, and what I would like to eat, they definitely respect me and don't rush me". “They respect me and my house, I feel completely safe”. “I wouldn't change them for the world, they're very good”. “I have one person and they are wonderful, courteous and nothing is too much trouble”. “The agency have a lovely team looking after my relative, they are caring and compassionate”.

Overall people spoken with gave positive feedback about the service they received. However we received mixed feedback about the timing of visits and the consistency of staff. The majority of people told us that their visits were fairly prompt, however one person commented, “The timing we requested can be out by an hour”. Another person stated that, “We have to wait up to an hour with some care workers, but not others”. Other comments included, “They can come about ten to fifteen minutes late, but that's not a problem”. “I have carers four times a day, on time, and it's very rare they're late”. “If the rotas change, it can shift things a little but they do try and keep to times”.

People told us that most of the time the same staff visited. However one person commented, “We don't get the same carers every day, and occasionally get new ones”. One person told us that they were, “Not quite sure who's coming”. One person said, “I've got to know the regular person who I have most of the time, however somebody else comes on a Monday, and there's no real telling who I have on a Monday, unless my regular carer tells me on a Sunday”. One person commented, “I usually do know whose coming as you get a rota”.

People told us that they felt safe and relaxed with staff. We saw that people who used the service were well cared for by responsive and well led staff. We found that people received care and support according to their assessed needs. Where people did not have capacity to consent to their care we saw evidence that best interest meetings had been held, in accordance with the legal requirements of Mental Capacity Act (MCA) 2005.

We found that there were enough skilled and experienced staff to meet people's needs. Staff told us that they had received appropriate training and spoke knowledgably about the people they provided care and support to. Systems were in place to assess and monitor the quality of the service that people received.