About the service: Three Sisters Community Care LLP is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people and those living with dementia. At the time of the inspection, they were providing a service to 65 people; 39 of which were receiving a regulated activity of personal care and support.

People’s experience of using this service: Staff were kind, caring and passionate about their role and people were extremely happy with the care provided. People said, “We've been extraordinarily lucky to come across Three Sisters Community Care LLP. A friend recommended them to us and they’ve been amazing."

Staff were respectful and built trusting relationships with people. They supported people to maintain their dignity and independence. People were supported to access healthcare services in a timely manner. Equality and diversity was respected and people were recognised as individuals.

Staff were skilled and provided person-centred care to meet people’s needs. Staff told us they felt well supported by the management team and received regular supervision and appraisals. Staff received appropriate training and were supported to undertake additional training specific to people’s needs.

People were supported by a consistent team and were protected from avoidable harm and abuse by staff who could identify and report safeguarding concerns. People’s medicines were administered as prescribed and this was closely monitored. Staff understood people’s needs and risks to their safety; risk assessments guided staff on how to safely meet people’s needs.

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. Staff were trained in mental capacity legislation and understood their responsibilities. They gained consent before providing care and supported people to make their own decisions and choices.

The registered manager used their experience to provide a high-quality, person-centred service. They had an open and honest approach and supported staff. People were confident their concerns or complaints would be addressed promptly and the management team used feedback to develop the service.

Rating at last inspection: Good (The last report was published 9 July 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: . We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

This inspection took place on the 13 June 2016 and was announced. At our last inspection in April 2014 the service was meeting the regulations of the Health and Social Care Act 2008.

Three Sisters Community Care LLP is a family run business which provides personal care and support to people that live in the community. At the time of our inspection 53 people received personal care and support.

There was a registered manager in post, but she was on holiday on the day, therefore the nominated individual assisted us with this inspection. A nominated person is a person who is appointed to oversee 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 and associated Regulations about how the service is run.

People were safe and the provider had effective systems in place to safeguard people from harm. People received their medicines as prescribed and staff had received training to ensure they administered medicines safely. Staff were recruited in a safe way which ensured they were of a good character to work with people who used this service.

Risk assessments and care plans had been developed with the involvement of people. People had equipment in place when this was needed, so that staff could assist them safely.

Staff were trained to care for people and they used their training effectively to support people. Staff were described as caring and respectful and people confirmed their privacy, and dignity was maintained and their independence was promoted.

The staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People confirmed that staff sought their consent before providing their care.

People were supported to maintain good health. People told us that staff contacted health care professionals if they had any concerns about their health. People and their relatives confirmed they had received a copy of the complaints procedure and they had confidence that any issues would be addressed.

We had not received information relating to incidents that the provider had a legal requirement to notify us about. This information was sent to us following our inspection. We found improvements were required to ensure all required records were in place. For example in relation to people’s ability to make decisions, and protocols for the staff to follow when supporting people with their medication and with behaviours that can challenge.

Positive feedback was received about the service. People told us the service was managed well and they were happy with the care that was provided. Systems were in place to monitor the quality of the service provided.

During our inspection we saw that the service currently supported 18. We people talked with the manager and looked in detail at the records for four people and three staff. We talked with two staff members and four people who use the service by telephone. We also spoke to three relatives of people who use the use on the telephone. One relative commented, “I think it’s first class, I’ve no complaints as they go the extra mile. They are very caring and very professional.”

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

The detailed evidence supporting our summary please can be read in our full report.

This is a summary of what we found;

Is the service safe?

The manager told us that a member of the management team was available on call in case of emergencies at all times. People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Recruitment practice was safe and thorough.

There was a comprehensive induction process and ongoing learning around safeguarding for the staff team. The manager sets the staff rotas. They take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. There were policies and procedures in place to make sure that unsafe practice is identified and people are protected. This helps to ensure that people are kept safe.

Is the service effective?

All the people we spoke with told us that they were very happy with the care that had been delivered and that their needs had been well met. It was clear from the records we sampled and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well.

We saw that wherever possible people received care from the same staff members and that a new electronic rota system was being introduced to manage this process. We found that the service was very person centred and staff were aware of peoples choices, preferences and support needs. We found evidence that people and their relatives had been involved in planning the care and support. One person told us “I think they are good, the carer is marvellous, very caring and thoughtful.”

Is the service caring?

Everyone we spoke to on the telephone commented that the service was very caring. One person told us “It’s all excellent, they care. Whoever comes through the door is very pleasant and nearly always on time. They try their best and the attention I get is very good because the carer knows exactly what to do.” A satisfaction survey had recently been sent to people using the service and the manager was able to tell us what improvements had been made from the comments received. When speaking with staff and the manager it was clear that they genuinely cared for the people they supported.

Is the service responsive?

People had care and support delivered to them in a way they were happy with, and staff were aware that people’s needs often changed. There was a clear process for making complaints. A relative told us “The agency is very adaptable, and they’ve helped us without fuss. Nothing is too much trouble for them, they’ve been brilliant, I don’t know what we would have done without them.”

Is the service well-led?

All the staff we spoke with told us they were clear about their roles and responsibilities. The service worked well with other agencies and services to make sure people received their care safely and effectively. There were clear processes in place to keep people safe and the manager knew what to do if there was a problem or concern. The manager was aware of their responsibilities in order to comply with current legislation. There was a quality assurance process and we were told of the plans to improve it.

The agency was supporting nine people on the day of our inspection. We spoke with five people who used the service, two of their relatives and three members of staff by telephone following the inspection visit to the office. At the office we met with two of the providers, two members of staff and looked at records.

We saw that people's needs were assessed before they started using the service and from this a care plan was developed. This showed staff how to support the person to meet their needs.

Systems were in place to ensure that people who used the service were safeguarded from the risk of harm.

Appropriate pre-employment checks were completed when staff were recruited to ensure they were suitable to work with the people who used the service.

Staff were supported in their job role and received the training they needed to safely support the people who used the service. One person told us, “The carers are very helpful, they are first class.”

People were asked for their views about the service and these were listened to. Action was taken to make improvements where needed. One relative told us “I can contact the agency when I need to and if I email, they always get back to me which is helpful.”