We inspected Care at Home (Swindon) on the 23 and 30 September 2016. The inspection was announced. Care at Home (Swindon) is a domiciliary care service that provides support to people in their own homes. The service also runs a supported living service that provides personal care and support to people in order to promote their independence. In supported living services personal care is regulated by the Care Quality Commission (CQC), but the accommodation is not. The service covers the Swindon area and currently provides outreach support to 65 people living in their own homes and 24 people across 11 supported living properties.

There was an experienced and committed registered manager in post whose aim was to find ways to enable staff to provide safe and responsive care to people that use 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.

The registered manager placed safety at the forefront of everything. Robust systems and processes were in place to ensure people’s safety. The provider had also put in place extra support in the way of implementing various innovative and proactive measures. For example, regularly changing key pad codes and putting up posters for people that did not want ‘Trick or Treat’ visits around Halloween. The registered manager and care workers knew what to do if they suspected someone was being abused or harmed. Recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in adult social care. The registered manager ensured medications were safely managed. They liaised with individual professionals to ensure the effective management of this and to reduce anxieties of people. People received their medicines as prescribed.

People received outstandingly effective care as staff were trained, experienced and supported to offer care to people over and above expectations of their role. Staff had received a wide range of training so that they had a good understanding of how to meet people’s needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. Staff were clear about the importance of gaining consent from people. People told us their wishes and decisions were respected.

Staff made sure if people became unwell, they were supported to access healthcare professionals for treatment and advice about their health and welfare. They did this in partnership with people and provided full information for people to help them understand their health needs.

People received compassionate care and respect from staff that valued them as individuals. Relatives described staff as excellent and who went out of their way to support people to achieve their expressed wishes. Staff were respectful of people’s privacy and dignity.

People’s dietary needs were monitored and referrals to professionals such as a dietician were made when appropriate.

People received a good level of care that was responsive to their individual preferences and needs. The provider had a strong commitment to ensuring people in the service received individual person centred care. Documentation was meaningful to the person and provided a personal glimpse of the person and the life they wanted to live and their history. People and their relatives described a staff team that were able to support individuals in a caring and effective way.

Management and staff understood the importance of responding to and resolving concerns quickly. People felt confident they could raise any concerns to

This was the first CQC inspection of this home care agency; it was registered on 26 March 2013.

We spoke with three relatives and three people who used the service. They told us that they, or their relative had been involved in developing their care plans, for example by saying what support they needed and when. All six people said that they had been given information about the service and there was their or their relative’s care plan in their home.

There were safeguarding procedures and staff had received training so that people were protected from abuse. Staff had also received a range of training and they were supervised and supported so that they could meet people's needs.

One relative said that care staff had “all been lovely” and another relative said staff would “go out of their way to help”. All comments made by relatives and people were positive.

We saw positive feedback from people in the satisfaction survey that had been sent out in April 2013. We noted that there were 27 responses from people who used the services and generally the service was very well received. At that same time a staff survey was completed and we noted that the responses they made were positive.

People and their representatives were asked their views about the service and these were listened to and acted upon. There was a system to monitor the quality of the service that people received and to make improvements when needed.