This inspection took place on 27 July and 8 September 2017 and was announced. Break Barriers [the service] is a domiciliary care agency which supports people in their own homes living in the Nottinghamshire area.

There was a registered manager in post who was out of the country on the first day of 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. In this report when we speak about both the charitable body and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection in April 2015 the service was rated Good. At this inspection we found the service remained Good overall but outstanding in being a responsive service.

People received safe and effective care from staff. Staff had a good understanding of the various types of harm and their roles and responsibilities in reporting any safeguarding concerns.

Risks to people's individual needs and their home environment had been assessed. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks.

There were sufficient numbers of staff to meet people’s care needs and staff were recruited safely. Staff received regular training and supervision and were able to reflect on the care and support they delivered and identified further training requirements.

People received their medicines as prescribed. Staff were able to explain the process they followed when supporting people to safely take their medication. Records we checked confirmed this.

People’s rights were protected under the Mental Capacity Act 2005. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance. People were supported to eat and drink sufficient amounts to meet their nutritional needs. External health professionals were involved in people’s care when required.

The service was outstandingly responsive and caring. People's care plans clearly reflected their individual needs and personal wishes. People and their relatives were fully involved in the development of their care plans and these were reviewed regularly. There were varied activities that respected people’s cultural diversity that suited everybody’s individual needs. Advocacy information was made available to people. The service encouraged feedback from all people involved with the service.

A complaints process was in place. People were able to make a complaint and felt confident that staff and the registered manager would respond appropriately.

People were extremely complimentary of all aspects of the service provided and spoke very positively of both staff and the management team. People received care and support from kind, caring and compassionate staff, who respected their privacy and dignity at all times.

People had full confidence in the registered manager and the way the service was run. The vision and values of the staff team were person-centred and made sure people were at the heart of the service.

We undertook an announced inspection of the Break Barriers service based at New Brook House on 9 December 2014. We told the provider two days before our visit that we would be coming.

This was the first inspection of this service.

Break Barriers (Nottingham) Ltd is registered to provide personal care from New Brook House to people in their own homes. This is a small service and was providing care to 14 people when we carried out this inspection.

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 were kept safe and free from harm. The manager supplemented the staff team by carrying out some of the care and support herself, so that people’s needs were always met and a flexible service was provided. There were systems in place to ensure support was provided on time.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs and provided a personalised service. Care plans were in place, which detailed how people wished to be supported and people were involved in making decisions about their care. People received a caring and appropriate service that met their needs.

Staff supported people to access the community and attend healthcare appointments. The service was able to respond to people’s individual preferences which enhanced people’s quality of life.

The manager led by example and was arranging further support to assist with managing the service.