This inspection of the office location took place on 10 June 2016. On 16 and 17 June 2016 we visited and contacted people and relatives for feedback about the service they received.

Care by Us is a large organisation which offers personal care and other related services in East, West and North Hertfordshire, Essex and North London. This inspection covered the services provided in East and North Hertfordshire and West Essex reaching out to approximately 1200 people.

The services provided included, domiciliary care; flexi care scheme; live in services; specialist care from home services; respite care; parent support and supported living. The provider also provided a free of charge charity service which offered specialised transport with staff support for people with mobility difficulties to access the community.

The provider had specialist staff teams trained to offer a wide range of excellent care and support tailored to the individual needs of people with complex health and social care needs. These included end of life care; people with behaviours other may find challenging; people living with learning difficulties, dementia and other illnesses which required staff to have specific knowledge such as epilepsy, diabetes and eating disorders.

There was a long standing registered manager in post who was also one of the owners of the company. 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 supported to have control and choice over their care and to develop their own care plan with staff assistance based on their needs, wishes and what was important for them. Staff recorded people`s wishes, what dignity and respect meant for people and gave people choices and control over the support they required and wanted. The care and support people received was effective and enabled them to remain in their own homes and live independently.

Staff were knowledgeable in what constituted abuse and their responsibilities in reporting any concerns they had internally and externally to local safeguarding authorities. Staff were aware of the whistleblowing policy and how to report their concerns about the service if they felt there was a need for it.

People told us staff were very kind and caring towards them and offered support which met their needs and made them feel safe. Staff showed a caring attitude when talking about people and were able to tell us how they delivered individualised care which met people`s needs.

The provider delivered care and support to people against the seven outcomes of the `Ageing Well in Hertfordshire` strategy. People were enabled to live well, independently and safely, for as long as possible in their own homes, people were treated with dignity and respect. Support was offered at the right time, people had choice and control over their lives, people were helped to make informed choices about their end of life care.

The provider placed a strong emphasis on the importance of people eating and drinking well. Staff attended cookery lessons part of their induction training where they learned basic cooking skills and how to promote healthy eating for people they were supporting. Staff were knowledgeable about people`s nutritional needs and different types of diets people had.

People told us they felt staff were knowledgeable and knew how to deliver care and support in an effective and safe way. There were staff designated ‘champions’ in the service who actively supported staff to make sure people experienced good outcomes to remain longer in their own homes. In addition staff had their competencies in the areas of their responsibilities regularly checked by their managers and they worked towards a personal developm

We visited the offices of Care by Us Limited on 02 July 2013 to look at the records and speak with staff members. 60 questionnaires were sent out to people who used the service. The manager told us that before anybody was accepted for service by Care for Us they received a home visit from a customer care manager who discussed their needs in depth with them and their representatives.

We saw that either people who used the service or a close relative had signed to state that they were in agreement with and had understood the care plan. We spoke with eight care workers. They told us that they always explained to people what they needed to do and asked if they gave their consent to receive care.

People were happy with the service that they received and felt safe with the care workers. One person stated: "I have been very pleased with the care workers. They are always very helpful."

We saw that the staff had annual appraisal meetings basis when care workers had been encouraged to identify their specific training and development needs.

Quality assurance reviews were completed at the same time as the review of the care plans and were monitored to ensure that they were undertaken. We saw that the service had an up to date policy on how to handle complaints and that care workers were given advice on what to do if they received a complaint.

We saw that records for people who used the service were maintained as both electronic and paper files and were up to date.

One relative of a person who used the service said, "They are the best agency that we've ever had. They're well organised in the office and the carers are well trained. They are very good at communicating with [my relative]."

A person who used the service said, "Always before they leave they say, 'is there any more I can do for you?' "

All of the people who we spoke with said that staff stayed for the allotted time and completed all of the tasks required. A relative said that staff did generally arrive on time, albeit they may be, "A couple of minutes late here and there. They explain why."

Some relatives did raise concerns regarding the arrival of the care workers. One relative said, "They don't call to say they are going to be late." They went on to explain that they had been having a regular care worker for the last two months and that this had resolved the problem.

People explained that the service provided a rota a week in advance which detailed which staff would be attending and at what time. One relative commented, "They turn up either very early or very late and they seem to change the preferred times. If [my relative] wants to go bed at 9am, they turn up at 10.10pm. They're not good at phoning to say they're going to be late." The relative went on to say, "As a general rule they're very good with [my relative] and know what they're doing."