St Elizabeth Care Agency provides personal care to people who live in their own houses or flats. Not everyone using St Elizabeth Care Agency receives the 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.

St Elizabeth Care Agency is a domiciliary care agency and registered to support; older people, younger adults, people living with dementia, people with learning disabilities or autistic spectrum disorder, people with mental health needs, people with physical disability and people with sensory impairment.

At our last inspection on 26 May 2016, we rated the service overall good. The key questions safe effective, caring, responsive and well-led were all rated good. At this inspection on 30 November 2018 we found that the people using the service benefitted from an outstanding caring and well led service. We have rated the service overall outstanding.

This was an announced comprehensive inspection. There were 63 people who used the service and received ‘personal care’. The provider was given 48 hours’ notice because we wanted to be certain the registered manager and key staff would be available on the day of our inspection.

Excellent leadership and management was demonstrated at the service. The culture was open and inclusive which meant that people received a tailor-made service which was flexible to their needs. People consistently told us how they were treated with exceptional kindness, compassion and respect.

Without exception, people and their relatives were extremely complimentary about their experience of using St Elizabeth Care Agency. They shared with us numerous examples of how their care workers repeatedly went the extra mile to ensure every element of the care provided was correct and how this had impacted positively on their well-being. People described how they trusted and felt safe with their care workers, who knew them well, encouraged them to be independent and consistently protected their privacy and dignity. Everybody we spoke with said that they would highly recommend the service.

The registered manager demonstrated how their robust quality assurance systems had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. They were fully supported by care workers and an office management team that were passionate and committed to delivering high quality person-centred care to people. Morale was extremely high within the service, staff described being proud to work at St Elizabeth Care Agency.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s care records were comprehensive, accurate and reflected the care and support provided.

Systems were in place to minimise the risks to people, including from abuse, and in relation to mobility, nutrition and with accessing the community. Care workers understood their roles and responsibilities in keeping people safe. Where people required assistance to take their medicines arrangements were in place to provide this support safely.

Effective systems had been established to reduce the risks of cross infection.

Recruitment checks were carried out with sufficient numbers of care workers employed. They had the knowledge and skills, through regular supervision and training, to meet people’s needs.

The service continued to provide people with a responsive service. People received care that was assessed, planned and delivered to meet their individual needs. People’s care records were accurate and reflected the care and support provided. Where required there were systems in place to care for people at the end of

St Elizabeth Care Agency provides personal care support to people living in their own homes. When we inspected on 26 May 2016 there were 51 people using the service. This was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to know that someone would be available.

A registered manager was 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 2008 and associated Regulations about how the service is run.

People told us they felt safe and received effective care from a consistent staff team who were competent and well trained.

Systems were in place which provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe and actions were taken when they were concerned about people’s safety.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred. Staff had developed good relationships with people who used the service and understood the need to obtain consent when providing care.

People received care and support which was planned and delivered to meet their specific needs. People and/or their representatives, where appropriate, were involved in making decisions about their care and support arrangements.

Where required people were safely supported with their dietary needs. Where staff had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

The service had an open and empowering culture. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. There was decisive leadership in the service. The service had a quality assurance system in place and as a result the quality of the service continued to improve.

We spoke with six people who used the service and three people’s family members or representatives. Overall, people were positive about the care they received. They told us they felt safe and protected. They confirmed they were asked about the quality of service and their experiences. For example, one person said, “The manager is very proactive and the office team are quick to respond if you need anything. They (office team) ring up to check everything is in place and see how you’re getting on.” Another person said, “The office regularly rings me to check I am happy with the care arrangements or if any changes need to be made. Once or twice I have had to cancel things at short notice due to a hospital appointment and it’s never been a problem. They (office team) are very accommodating and flexible. The manager is very hands on and gets back to you very quickly. I have no qualms about the agency. I look forward to my home visits as I get lonely and it brightens up my day when they (staff) come.”

People told us their privacy was respected and that they were treated with dignity. One person told us, “I get help with getting washed and dressed. I have good and bad days and they (staff) know this and always ask first before they do anything and reassure me when I can’t do things.”

We looked at eight people’s care records which provided information for staff on how to meet their individual health and care needs. We saw that people’s choices and preferences were reflected in the care records and written in a way that promoted independence.

We saw that the service provided qualified, skilled and experienced staff to meet people’s needs. We looked at staff records and spoke with three members of staff who told us they were being appropriately supervised and supported.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided. Records we looked at, including people's care records and staff records were accurate and up to date.