This inspection took place on 13 March 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because the registered manager and other senior staff are often out of the office supporting staff or providing care. We needed to be sure that they would be in. Westward Consultants Ltd is also known and trading as Draycott Nursing. This service is a domiciliary care agency and provides nursing and personal care to people living in their own homes in the community. It provides a service to adults. At the time of the inspection 80 people were using the service.

There was a registered manager in post at the time of the inspection and they were present during the inspection 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.

At the last inspection of this service on 15 and 16 October 2015 they were rated Good. The service was rated Outstanding for Caring and Good for Safe, Effective, Responsive and Well-led. At this inspection the service continued to meet and improve standards and we have therefore rated the service as Outstanding overall.

People who used the service said they received an exceptional quality of care. Staff went ‘over and above’ to ensure people received the care and support that met their individual care needs. People said staff were kind, gentle and helpful.

Staff respected people in a way that promoted their human rights. Staff delivered people’s care and support in a dignified and compassionate way. Staff treated people in a way that made them feel special.

The nurse liaisons carried out assessments of need carried out assessments of need. This ensured people’s needs and the support they required matched. People made decisions in the planning of their care which was integral to the support provided to them. Staff provided care that was person centred and people’s support was delivered taking into account their views. Care and support was flexible to meet people’s changing needs. The registered provider used evidence based practice and developed their own research to improve people’s lives. Staff celebrated people’s lives in a way that made them feel valued. Staff understood end of life care and delivered sensitive care to people taking into account their wishes. Staff developed and understanding of people’s religious and cultural needs at the time of their death.

People and staff confirmed that the service was exceptionally well led. They said that the management team were remarkable and open, honest and approachable. The management team placed people at the centre of the service.

The Head of HR and Operations monitored the quality of the service. The quality assurance systems allowed for the registered manager and office based staff to assess, monitor and review the service to ensure standards remained high. A service action plan was in place. The registered manager identified and recorded any areas for improvement with details of the action staff took to resolve the concern. The registered provider had plans in place to develop the service through an enhanced staff training programme and by using technology.

The registered manager understood their responsibilities and sent notifications to the Care Quality Commission (CQC) as required.

The registered manager had developed relationships with external organisations. This helped to improve the care people received because advice and support was obtained promptly. The registered manager was involved in raising awareness of people living with physical disabilities.

Safeguarding systems and processes used helped to protect people from harm and abuse. Staff knew what abuse was and completed safeguarding training to update their knowledge.

Staff

We carried out this announced inspection of Draycott Nursing and Care Agency on 14 and 15 October 2015. We informed the provider two days before the inspection that we would be coming. At the time of our inspection 65 people were receiving privately funded personal care services. At our last inspection in July 2013 the service was meeting the regulations inspected.

There was a registered manager at 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 2008 and associated Regulations about how the service is run.

People told us they were very pleased with the care provided by the service and felt safe with the care staff and nurses in their homes. Staff had received safeguarding training and there were established systems to protect people from the risk of harm.

Policies and procedures were in place in relation to the Mental Capacity Act 2005 (MCA) and staff demonstrated their understanding of how to provide care and support in accordance with this legislation.

People received care and support from suitably trained and supported staff. The provider offered a wide range of training and opportunities to undertake national courses in health and social care.

Systems were in place to support people to meet their nutritional needs and a creative approach was used to support staff who wanted to improve upon their own skills to make healthy meals.

People and their relatives tended to independently access healthcare in the community, although the service liaised with healthcare professionals and offered people support, where necessary.

Staff were described as being kind and caring. People’s dignity and privacy was maintained and the provider had implemented support and networking opportunities for local carers.

People’s individual needs and wishes were assessed and care plans were developed, which took into account the views of people, and their supporters.

Information about how to make a complaint was given to people and relatives, and complaints were effectively managed.

The service was well managed by the registered manager, the managing director and the senior team. Systems were in place to check the quality of care and seek the views of people, their relatives and staff in order to look for ways to improve the service.