The inspection was announced and took place on 4 December 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.

This was the first inspection of the service since it was registered with the Care Quality Commission in May 2016. Assistants at Hand provide personal care and support to people who have general personal care and mental health needs in the Plymouth, Plympton and surrounding areas. The office is accessible to people with mobility difficulties and there are car parking facilities close by. At the time of this inspection Assistants at Hand were supporting 17 people with personal care needs.

There is a registered manager in post who was also the provider. 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 service was a small family run business and the provider was supported by a team leader and administrator and a staff team of 14 inclusively.

The team were committed to providing a high quality effective service to people. They did this by providing very person centred care, supporting staff well, listening to people’s views and looking at ways to continually improve. One person emailed us to say, “[The provider] hand picks all the staff and they are all outstanding. None of them are work shy and they always maximise their time, keeping everything in order.” Other comments included, "They always ask if there is anything else they can do. They even shook my rugs. We have a chat and a cup of tea. They become like family friends.” The relative said they even had a communication book in the home so they could check what had been done or to write down any anniversaries. A care worker said, “The establishment is excellent and to see the outstanding work they all do is amazing. I am a very happy employee looking forward to a bright future with Assistants at Hand.”

People told us they appreciated the visits from staff who were always cheerful and treated them with respect. One relative said, "We were so lucky to find Assistants at Hand. They go over and above the call of duty and take really good care of [person’s name]. [Person’s name] loves them all and they take their time and see the person behind the [medical condition].

Care workers said they enjoyed working for the service. They were well motivated and committed to providing a service that was personalised to each individual. People were fully involved in planning their care and support and care plans were comprehensive to make sure staff had all the information required to support the person. This helped to make sure people received the support they wanted.

There were quality assurance systems which monitored standards and ensured any shortfalls were addressed. People and care professionals felt listened to and said they could speak with a member of the management team or any staff, at any time. Any complaints, including smaller comments and 'grumbles' made were fully investigated formally and treated as learning to enable the service to improve.

People received effective, safe care which met their individual needs and preferences. People told us the service was flexible and made adjustments to accommodate their wishes and changing needs. For example, when people had health appointments or had a health need or just additional shopping requests. Where any concerns were raised about a person's health or well-being prompt action was taken to make sure they received the support and treatment needed. Staff were pro-active in recognising areas of improvement for people, suggesti