This inspection took place on 12 January 2017 and was announced. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

AcreCare Limited provides a domiciliary care service. It is registered to provide personal care to people living in their own homes. The service provided personal care to 90 people on the day of our inspection.

A registered manager was in post and was present during our 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.

People felt safe with the service provided to them and staff were aware of how to protect them from the risk of potential abuse. People were protected from the risk of harm because staff were aware of their responsibility of identifying possible risks and to avoid them happening. There were enough staff to ensure people's needs were met and to support them to take their prescribed medicines.

People were supported by staff who had been checked to make sure they were suitable to work in their homes. Employment and criminal records checks were carried out on all staff before they started work at the service. Staffing levels were kept under review and people saw the same staff regularly which helped to make sure they had consistency of care.

People were treated with respect and their privacy and dignity was promoted. People said their care workers were kind and caring. Staff were responsive to the needs of the people they supported and enabled them to maintain their independence as much as possible.

People were cared for by staff who were skilled and who received regular support and supervision. People's human rights were protected because staff applied the principles of the Mental Capacity Act in their care practices.

Staff had the skills and knowledge to understand and support people's individual needs. These skills were kept up to date through regular training.

People's care needs were assessed and measures were in place to manage risks. People were involved in the development of their care plans which provided staff with guidance on how to support people safely whilst promoting their independence. The provider had recognised care planning as an area they wished to develop greater detail.

There was a complaints procedure and people knew how to use it. People and their relatives were confident that any concerns raised would be responded listened to and addressed.

People benefitted from receiving a service that was managed well. Quality assurance systems were in place to monitor the quality of the care and support being delivered and the running of the service.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

People's care plans included information about risks to people's health, safety and welfare. Staff we spoke with had a good understanding of people's needs, risks and actions required to reduce the risk. We saw evidence care practices were observed and reviewed to ensure people experienced safe care and treatment. People we spoke to told us they felt safe with the providers staff.

Staff completed annual training in safeguarding adults at risk of abuse and staff we spoke with understood the signs of abuse and how to report concerns. We saw the provider acted on concerns and worked with other agencies to support people who were at risk including the risk of self-neglect.

Is the service effective?

People told us they were satisfied with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs. People and their relatives told us the continuity of care provided was very important to them and they valued this. A person's relative said, "It's really good to have the same staff caring for my relatives. They (my relatives) are living with dementia and it is important for them to have the same faces, people they recognise and feel safe with." We noted some care plans and risk assessments required updating to ensure people's needs were met when they were cared for by less familiar staff. Staff had received training to meet the needs of people they supported including on the Mental Capacity Act (2005). Records showed where a person lacked the capacity to make a decision the appropriate procedures had been followed.

Is the service caring?

People were supported by kind and attentive staff. We visited four people in their home with care staff and saw care workers were patient and gave encouragement and choice when they supported people. A person said, "They (care staff) are very good I wouldn't want to be without them." Staff told us that they spent the time required to meet people's needs and people we spoke with confirmed this. A person's relative said, "Staff go over and above to care for my relative - it's not just about what's written down."

Is the service responsive?

People’s needs had been assessed before they received care and treatment and this included people’s preferences and abilities. Care plans were developed to meet people's desired outcomes and people told us care and support was provided by staff who respected their choices and wishes. Two people's relatives told us how the provider had responded promptly to concerns they had raised. One relative said, "They (managers) are very easy to contact, flexible and accommodating, they just do it."

Is the service well led?

Quality assurance processes were in place and records showed people and/or their representatives were asked about their satisfaction with the care provided. The registered manager told us about how they acted on people's feedback and this was confirmed by people's relatives we spoke with. Staff we spoke with told us they were well supported by their managers. A staff member said, "the manager and care manager are always at the end of a phone if I need them. If I disagree with something I can tell them and I feel listened to, they are very caring." Records showed staff were observed in their practice and supported through supervision, training and appraisal to meet people's needs.

We found the agency to be appropriately managed so that people could rely upon receiving the service they needed. We spoke with three people who used this agency's services. Each person confirmed that they had received a reliable service from care workers who knew their job, were friendly, and consistently provided the support that had been agreed with them.

One person we spoke with commented, "My carer is a treasure” another person told us “It’s a wonderful service I get”.

Staff were only employed following a structured recruitment and interview process and relevant checks were carried out prior to them starting work.

There was a complaints policy in place. In order to ensure that people's concerns were fully addressed, improvements were needed to the way complaints are recorded and acted upon.

We found people had personalised care plans and risk assessments. We found for every identified risk there was a plan in place to address the risk. We saw people had daily preference lists that were used to meet their preferences.

We found the provider had a system in place to monitor the quality of the service they provided.

During our visit we spoke with three members of staff and we observed staff talking with people who used the service. We spoke with people who used the service and their family members. One relative told us "you enabled my mum to fulfil her wish of staying at home."

We made observations throughout the visit and saw people being offered choices as to when they wished to be visited. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People that used the service told us "the service is absolutely superb" and "the carers are wonderful."