We completed this announced inspection on 17, 18 and 19 July 2017.

Walnut Care at Home is registered to provide care for people in their own homes. The service can provide care for older people and/or people who live with dementia. It can also provide assistance for people who have a physical disability and/or who have a learning disability and/or who have a sensory disability. At the time of our inspection the service was providing care for 600 people. Of this total, 37 people lived in a 'housing with extra care' scheme in Skegness.

The service had its office in Langrick and covered north and south Kesteven, east Lindsey, Boston, Skegness and Lincoln. The service employed 130 care staff who were organised into local teams each of which was headed by a team leader. The teams were organised into two groups each of which was overseen by an area manager.

The service was operated by a company for which there were two directors. One of the directors was the chief executive officer. The other director was the registered manager. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 7 May 2015 the service was rated Good.

At this inspection we found the service remained Good.

The registered manager and care staff knew how to keep people safe from situations in which they might experience abuse and people had been supported to avoid preventable accidents. Medicines were managed safely and people had been helped to obtain all of the healthcare they needed. There were enough care staff to complete planned visits in the right way. Although background checks for new care staff had not always been completed in the right way, the registered persons immediately made the necessary improvements to address this shortfall.

Care staff had received training and guidance and they knew how to care for people in the right way. This included supporting people to eat and drink enough.

CQC is required by law to monitor how registered persons apply the Mental Capacity Act 2005 (MCA) and to report on what we find. The registered persons and care staff had received training in this subject and they helped people to make decisions for themselves. When people lacked the capacity to make their own decisions the principles of the Mental Capacity Act 2005 and codes of practice were followed. This helped to protect people’s rights by ensuring decisions were made that were in their best interests.

People were treated with kindness and compassion. Care staff recognised people’s right to privacy and promoted their dignity. There were arrangements in place to assist people to access independent lay advocates and confidential information was kept private.

People had been consulted about the care they wanted and they had been given all of the assistance they needed. Care staff recognised the importance of promoting equality and diversity by supporting people to make choices about their lives. This included choosing which interests they wished to pursue and how they wished to meet their spiritual needs. There were arrangements to quickly and fairly resolve complaints.

People had been consulted about the development of the service and quality checks had been completed. Good team working was promoted and care staff were supported to speak out if they had any concerns about poor practice.

This was an announced inspection carried out on 7 May 2015.

There was a registered manager. 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.

Walnut Care at Home provides care for people in their own homes. At the time of our inspection the service was providing care for 450 people. The service covered a large geographical area including Lincoln, Sleaford, Boston and Skegness.

Staff knew how to recognise and report any concerns so that people were kept safe from harm. People were helped to avoid having accidents and their medicines were safely managed. There were enough staff available and background checks had been completed before new staff were appointed.

Staff had received the training and guidance they needed to assist people in the right way including helping them to eat and drink enough. People had been assisted to receive all of the healthcare assistance they needed. Staff had ensured that people’s rights were protected because the Mental Capacity Act 2005 Code of Practice was followed when decisions were made on their behalf.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and they were supported to celebrate their diversity. Staff had offered people opportunities to maintain their independence and to pursue their interests. There was a system for resolving complaints.

People had been consulted about the development of the service and quality checks had been completed. The service was run in an open and inclusive way and people had benefited from staff being involved in good-practice initiatives.

We carried out an unannounced inspection to look at domiciliary care services. We spoke to people who use the service, relatives and staff.

Everyone spoke positively about the staff and felt they fully supported their care needs. People's preferred names were used. People told us they were happy that their care worker adapted well when care changes were made.

People told us they felt safe and if they had concerns they would speak with a family member, friend or somebody in the office.

Everyone spoke positively about the staff and felt they fully supported their care needs. Without exception people said all the staff spoke with them in a calm and respectful way.

People told us their care was personalised to their needs. They said they were happy the staff adapted well when care changes were made. They confirmed staff kept notes on them and they were involved in the planning of their care. One person said,"Staff help me a lot, in a calm and caring way."

We did not ask people who used the service about staff recruitment but they told us they were confident staff could look after them. Staff records confirmed suitable safety checks had been made prior to each staff member commencing employment.

People told us staff knew a lot about how to look after them. They told us staff knew a lot about different conditions and illnesses. One person told us, "When staff don't know about a particular problem, they find out and it is sorted very quickly." The training records held on staff showed the provider had been proactive in ensuring staff had suitable training to enable them to meet the needs of the people they looked after.

People who used the service told us they had been informed how to make a complaint. One person said, "Any issue I have raised has been dealt with quickly." Staff knew how to record concerns raised by people who used the service and records confirmed how issues had been resolved.