We carried out an inspection of Bellcare Domiciliary Care Services Limited (Bellcare) on 20 and 22 September 2016. The inspection was announced. We last inspected Bellcare in September 2014 and found the service was meeting the legal requirements in force at that time.

Bellcare provides personal care to adults in their own homes mainly in the west of Cumbria. At the time of inspection the agency provided care and support to 224 people. People who received a service included those living with physical frailty or memory loss due to the progression of age. Visits ranged from half an hour up to seven and a half hours; and 24 hour support packages. The frequency of visits ranged from one visit per week to six visits per day depending on people’s individual needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. During our inspection the registered manager was present.

The feedback we received from people was excellent; they expressed great satisfaction with the caring attitude of staff and the reliability of the service. People were all very enthusiastic about how the way in which care was given made a “huge difference” to their lives. They all spoke very highly of the registered manager, the owner and staff. People, relatives and professionals consistently gave us positive feedback about how the service was personalised to meet people's individual needs.

A social care manager told us,"Bellcare are really stepping up to the mark and are delivering really good packages of care to people. We can always rely on them. The staff are well trained and confident in what they are doing."

People told us they felt very safe with the staff that came to their home and confident in the care they provided. Staff were trained in safeguarding and understood the signs of abuse and their responsibilities to keep people safe. The provider's policies and procedures for keeping people safe included very thorough pre-employment checks, to make sure staff were suitable to deliver care in people's own homes.

People told us that staff were always kind and respected their privacy, dignity and independence. Care staff were very thoughtful and recognised and respected people's cultural values and preferences. One person summed up people’s positive views by telling us, “The staff make me feel like the Queen mother. There’s nothing they won’t do.” Another said, “Bellcare and the staff have given me back the will to live, they are so positive with me.”

We saw that staff had created really positive, caring and empowering relationships with those people they supported. Staff had high expectations for people and were positive in their attitude. People expressed how their independence had been promoted to the extent that many had regained skills they thought they had lost. For example one said, “I never thought I’d be up on my feet again, I’m over the moon. It’s all down to the staff being so patient with me and letting me take my time to build up my confidence again.” Another person said that they had been "thrilled" to be supported to have a bath again. The service worked towards every person being able to regain or maintain skills wherever possible while feeling supported at the same time to help build confidence.

Risks to people's health and wellbeing were identified at the initial assessment of care and their care plans included the actions staff should take to minimise the risks. Staff understood people's needs and abilities very well because they read their care plans and shadowed experienced staff, so they could get to know people well before working with them independently.

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People we spoke with who received care from the agency told us Bellcare Domiciliary Care Services Limited (Bellcare) provided good quality care and offered a reliable service. The relatives and people we spoke with told us they were ''extremely happy" and ''thoroughly satisfied’’ with the support provided and said the service provided was ‘’excellent’’.

The majority of the comments made by people we spoke with were positive about the staff who visited them and care they received. Some people told us that on occasions care staff can be a bit late but they said that they always got a phone call to let them know.

Staff told us that the agency was very keen to ensure that people’s dignity was upheld. Both staff and those receiving support commented on the focus in encouraging people to retain as much independence as possible by providing the right levels of support and care.

We saw the agency involved other services to ensure people received timely healthcare to maintain their health and wellbeing. Staff in the agency were using creative and innovative ways to support people, in particular to assist and support people with dementia.

When we looked at how medicines were handled we found that people were protected against risks because the provider had appropriate arrangements in place to manage medicines safely.

The agency had in place all the necessary equipment to support the operation of a busy domiciliary care agency. We found that records in the agency were well kept being up to date and reviewed on a regular basis.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an “expert by experience”; people who have experience of using services and who can provide that perspective.

We used telephone interviews and home visit to people who use the service and to their main carers (a relative or friends) to gain views about the service. We spoke to 18 people on the telephone and visited 3 people in their own homes. We contacted the local authorities who have a contract with the agency, and the social workers who assess and place people with the agency. We also contacted healthcare professionals who have an input into the care people receive from the agency.

The people we spoke with who received care from the agency told us Bellcare provided good quality care and offered a reliable service. We received comments such as, “They are wonderful, I could not be without them”, “Without them I could not keep stay at home.”, “The carers are absolutely marvellous”, “I needed more help and Bellcare came along, I couldn’t do without them”, and “The night staff come no matter what the weather, they are always helpful and professional”.

People told us they had been asked by the agency about the care they needed and said the care staff treated them, their families and homes with respect.