This inspection took place on 5, 8 and 13 November 2018. At our last inspection in April 2016 we rated the service ‘Good’ overall. At this inspection we found that Trinity Homecare had improved to ‘Outstanding’ overall.

Trinity Homecare is a domiciliary care agency. It provides personal care to people in their own homes. There were 200 people using the service at the time of this inspection with 24 people receiving live-in care.

The manager of the service had started the process to be a registered manager at the time of our inspection and was confirmed in the post shortly afterwards. 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.

The provider demonstrated exceptional responsiveness to the needs of people and their relatives by developing mobile phone accessible applications alongside electronic care records. These innovative programmes enabled people and relatives to see what care and support was planned, when it was delivered and by whom. This was reassuring for people and relatives, particularly relatives who lived considerable distances from their loved ones. The provider developed unique software to maximise people’s data security and confidentiality. People and the relatives were actively involved in the development of care records which were highly personalised and unique.

The provider was exceptionally flexible in meeting people’s rapidly changing needs to ensure they remained in their homes rather than in health or social care settings. The provider extended this capability to support people receiving care from other providers to remain in their homes too.

There was outstanding leadership at the service. The provider was exceptional in its commitment to the training and development of staff. People benefited from the provider’s outstanding approach to partnership working with other organisations and its pioneering approach to technology. Trinity Homecare engaged with the public extensively and used feedback and ideas from people and staff to plan, implement and achieve continual improvements in care delivery.

People receiving care and support felt it was delivered safely by staff they felt safe with. People’s risk of experiencing avoidable harm were reduced by the provider’s risk assessments and risk management plans. Robust procedures were in place to ensure care visits were not missed. Staff and managers were clear about their responsibility to safeguard people from abuse. People received care in their own homes from staff whose suitability was established through thorough recruitment processes. People received their medicines safely and staff followed appropriate hygiene practices.

People’s needs were assessed and met by trained and supervised staff. People were supported to remain healthy and access healthcare services when required. People chose what they ate and staff supported people to eat and drink in line with their assessments. The provider met the requirements of the Mental Capacity Act 2005 (MCA) to help ensure people’s rights were protected.

People received care and support from regular staff they knew well and with whom they shared trusting and positive relationships. People were encouraged to make decisions about their care and to be as independent as possible. Staff maintained people’s dignity when providing personal care and were respectful to people and their homes.

This inspection took place on 05 and 06 April 2016 and was announced on the first day. The provider was given 48 hours’ notice because the location provides domiciliary care and we needed to be sure that someone would be available in the office so we could look at certain documentation. The last Care Quality Commission (CQC) inspection of the agency was carried out on 07 January 2014, where we found the service was meeting all the regulations we assessed.

Trinity Homecare (Worcester Park) is a care agency that provides personal care and support to people living in their own homes in South London and the bordering Home Counties. Personal care and support is provided to younger adults and older people with a range of health care needs and conditions including, dementia, learning disabilities, mental ill health, physical disabilities, sensory impairments, and end of life care. When we inspected this agency 160 people were receiving a service from them, 143 of whom were older people and the rest younger adults. The vast majority of these people received just an hourly domiciliary care service from Trinity Homecare, while 22 people had full-time live-in care workers or a combination of the two.

The service had a registered manager in post. 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 a 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 were happy with the standard of care and support they received from Trinity Homecare and that staff who worked for the agency were kind and caring. People’s rights to privacy and dignity were also respected. Our discussions with people receiving a service, their relatives and community based health and social care professionals supported this.

People told us they felt safe when staff from Trinity Homecare visited them at home. Managers and staff knew what constituted abuse or neglect and who to report it to if they suspected people were at risk. They had all received up to date training in protecting children and safeguarding adults at risk. Staff had access to appropriate guidance to ensure identified risks to people were minimised. Regular maintenance and service checks were carried out on equipment used by staff in people’s homes, including mobile hoists.

People were supported to stay healthy and well. Staff were knowledgeable about the signs and symptoms to look out for that indicated a person’s health may be deteriorating. If staff had any concerns about a person’s health, appropriate professional advice and support was sought. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received their medicines as prescribed and safe medicines management processes were followed.

Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care plans. Staff regularly discussed people’s needs to identify if the level of support they required had changed, and care plans were updated accordingly.

People were involved in decisions about their care. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. People were supported to make decisions about end of life care and how they would like to be supported during that time. Staff were also aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Staff supported people to be as independent as they could and wanted to be.

Staff had developed caring and friendly relationships with people. There were enough suitably competent staff to ca