The inspection took place on 01 and 12 September 2016 and was announced.

Right at Home – Guildford provides care and support to people in the own homes. At the time of the inspection the service provided personal care to 56 people.

There was 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 and associated Regulations about how the service is run.

There were some outstanding elements of the service offered, particularly around the support of people living with dementia. Staff were provided with a range of training to enhance their understanding of people’s needs and use relatives told us that staff used these skills to work with people in a personalised manner. The service offered a range of activities for people to and their carers to minimise the risk of social isolation. These included a singing group, a gardening group and a weekly dementia café. Relatives told us the groups were well managed and had a positive impact on people’s well-being.

Systems were in place to ensure only suitable staff were employed and all staff received relevant training to enable them to undertake their roles. Staff received regular supervision to discuss their progress and training needs. Spot checks were completed by senior staff to monitor staff performance and ensure people were receiving support in line with their needs and expectations.

People were protected from the risk of abuse and avoidable harm because staff understood their roles and responsibilities in protecting them. People received their medicines in line with prescription guidelines although recording systems were not completed comprehensively. There was a 24 hour on-call system in place and guidance was available to staff regarding the action to take if an emergency occurred. Systems were in place to monitor accidents and incidents and where changes were required to people’s support to keep them safe these were implemented.

Staff understood the importance of gaining consent from people and acted in accordance with the principles of the Mental Capacity Act 2005. Staff were kind and caring towards people and upheld their privacy and dignity at all times. Staff had a good understanding of people’s needs and supported them effectively. People and relatives told us that staff were respectful of their homes and supported them to maintain their independence.

People were supported to maintain good health. The service had good links with health care professionals to ensure people kept healthy and well. Support was provided by staff who knew them well which meant that any changes in people’s health were recognised and acted upon promptly. Where people required support with eating and drinking this was recorded within their care plan and their preferences listed.

People’s needs were assessed prior to the service starting and staff were aware of the support people required. The service offered a minimum of one hour calls to ensure staff had time to spend with people. People were introduced to any new staff who would be supporting them and were given the opportunity to shadow more experienced staff members.

During the inspection we found that systems to monitor the quality of the service were not routinely completed with regard to care plan audits, risk assessments and medicines. Complaints were logged and action taken promptly to address people’s concerns. However, complaints were not reviewed to identify trends and improve the quality of the service. Following the inspection the provider sent us details to show they had responded to these concerns. We have made a recommendation regarding this to ensure the processes in place are embedded into practice.

Staff told us they felt valued and received support to carry out their rol

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

• Is the service safe?

The provider had effective recruitment and selection processes in place and carried out appropriate checks before staff began work.

Staff had access to training and support to enable them to deliver care safely and in a way that maintained people’s dignity.

Staff were given sufficient information about a person’s needs before they began to support them.

New staff had an induction when they started work and the opportunity to shadow colleagues before providing care themselves.

• Is the service effective?

People provided positive feedback about the service they received from the agency. They said that their care workers arrived on time and stayed for the correct amount of time, which meant that they did not feel hurried when receiving their care.

People told us that they received their care from regular staff, which they said was important to them. One person told us, “I told them I refused to have any carers other than the three I usually have and they’ve always respected that” and a relative said, “There’s a team of five carers and we always get one of them, which suits us well.”

• Is the service caring?

People spoke highly of the care provided by the agency’s staff. They told us that care workers were kind, courteous and helpful. People also said that staff were diligent and hard-working and had a positive approach to their work. One person told us, “I’m absolutely delighted with them. They’re good workers. They don’t wait to be asked, they just get on with it.”

Relatives also provided positive feedback about the care provided by staff. One relative told us, “They’re excellent; I’d recommend them to anybody” and another said of their family member, “She absolutely adores her carers. They’ve really improved the quality of her life.”

• Is the service responsive?

People received a personalised service based on their individual needs.

People’s needs were assessed before they began to use the service. The assessment identified what people wanted to achieve from the service and their preferences about their care.

Each person had an individual care plan, which was developed in consultation with them. People told us that the agency reviewed their care plans regularly to ensure that they continued to meet their needs.

• Is the service well-led?

The provider had an appropriate organisational structure within which responsibilities for key business functions were clearly defined.

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Care staff told us that they received good support from their managers. They said that their managers contacted them regularly and that they had opportunities to discuss their professional development and training needs.

The provider encouraged people to give their views about their care. People told us that their views were listened to and that the provider had responded appropriately if they had requested changes to their care.

People using the service were asked for their consent about their care and support. They told us the registered manager met with them prior to the agency providing them with a service. One relative told us “We were given a contract for the care the agency was going to provide.” Another person told us "I have watched care staff provide my relative's care, they never do anything for them without telling them what they are going to do, and they always ask if its ok"

People and their relatives confirmed that their care needs had been identified, discussed and agreed with staff. One person told us "They do what I want and I am involved in discussions." Staff spoken with were fully aware of their responsibilities in meeting people’s needs.

The staff worked in collaboration with other providers to ensure people’s needs were met.

Medicine policies and procedures were in place and staff were aware of their responsibilities regarding people’s medicines.

People told us they believed staff were well trained and supported by managers. One relative told us “Oh yes I think the girls get all the training they need. They are very good.” Another person’s relative said “X turns up frequently to help the girls out.”

People were able to feed back on the quality of the services provided and the staff assessed and monitored quality of service as an on-going process.

We spoke with people and their representatives on the telephone. People told us they were happy with the service provided. They said that the "carers were nice" One person sated "its about as good as it gets".

People's representatives told us that staff were very kind, polite and courteous, and treated their relatives and them with dignity and respect.

One representative told us their relative had already had a review of their care, despite only receiving care for a short period of time. Another person's representative told us that "the owner had had dropped in unannounced to check that staff were doing their job to a good standard".

People and their representatives told us they would feel able to raise any concerns or complaints with the provider. They told us they were confident that their complaints or concerns would be responded to and dealt with in a timely manner. They told us they had met the provider and all referred to the provider by their first name.