About the service: 1st Homecare is a domiciliary care agency that was providing personal care to 37 people.

People’s experience of using this service:

• People supported by 1st Homecare continued to receive safe care from skilled and knowledgeable staff.

• The provider sought training to ensure staff were knowledgeable to look after people with complex needs such as learning disabilities, autism and dementia.

• People and relatives told us staff were kind and dedicated. They said staff knew people well and treated people with dignity and respect.

• 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.

•1st Homecare remained well-led. People, relatives and staff were complimentary of the registered manager’s leadership. The provider had effective quality assurance systems in place which were used to drive improvement.

Rating at last inspection:

At our last inspection we rated the service good. Our last report was published on 1 December 2016.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection remained “good”.

More information is in our full report.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

1st Homecare (Oxford) is a domiciliary care service providing care to people in their own homes in and around Oxford. At the time of the inspection the service was supporting 58 people.

There was a registered manager 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.

Leadership within the service was open and transparent and promoted strong organisational values. This resulted in a caring culture that put people using the service at the centre. People, their relatives, staff and healthcare professionals were complimentary about the management team and how the service was run.

People who were supported by the service felt safe. Staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicines as prescribed. There were systems in place to manage safe administration and storage of medicines.

There were enough suitably qualified and experienced staff to meet people needs. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) to help them meet the needs of the people they cared for.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of the MCA.

People’s nutritional needs were met. People were given choices and were supported to have their meals when they needed them. Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received quality care that met their needs.

People were supported to maintain their health and were referred for specialist advice as required. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. Staff supported and encouraged people to engage with a variety of social activities of their choice in the community.

The service looked for ways to continually improve the quality of the service. Feedback was sought from people and their relatives and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and further improve the service. Staff spoke positively about the support and leadership they received from the management team.

Abacus Care delivered a service to 60 people in their homes. This was provided by 45 care workers and 12 nurses. We spoke with six care workers / Nurses and four office staff. We also spoke with five people who used the service and their relatives.

People we spoke with were very positive about the quality of the care they received. People told us that they knew who to contact within the agency if they had any concerns.

We saw that people were involved in decisions about their care and treatment. We saw that individuals were respected and consulted about how their care was delivered. People were treated with dignity and respect. For example, one person told us, “they meet my needs wonderfully”.

We looked at how safe the service was. We spoke with people about their experiences. A person who used the service told us, “I feel very safe in their care”.

The agency had a robust recruitment and selection policy. Care workers received appropriate professional training, development and induction. We asked care workers if they had access to training. One care worker said, “I have had lots of training, safeguarding and whistleblowing which is an important part of the training”.

You can see our judgements on the front page of this report.

People we spoke with were very positive about the quality of the care they received. People told us that they knew who to contact within the agency and that staff were well trained and knowledgeable about their care needs.

People told us that they had a choice in who provided their care and could request a change if care was not being given in the way they wanted.

People we spoke with told us that their care was regularly reviewed and that if there were problems they were confident that the manager would investigate them. People told us that they would be listened to and that action would be taken if they had a complaint or concern