We undertook an announced inspection of Caretree Limited on 31 October and 5 November 2018. We told the provider two days before our visit that we were coming to make sure that someone would be available to support the inspection and give us access to records. At the time of our inspection 50 people were receiving a personal care service from Caretree. Not everyone using Caretree Limited receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service was supporting people with a range of needs, including older people with living with a dementia type illness, people with physical disabilities and people living with mental health needs.

At our last inspection we rated the service outstanding in to areas and overall. At this inspection we found the service was outstanding in all areas and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Outstanding.

The service had a registered manager. 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 leadership and management of Caretree Limited continued to be outstanding and the provider aspired to be a role model in the domiciliary care industry. The provider was always thinking of ways to highlight better ways of working in co-ordination with relevant parties such as the local authority and health services. With this in mind, steps had been taken to develop ways to improve hospital discharge with clearer communication and co-ordination. This was to avoid people being affected by delays with returning to their homes. This vision and values of the organisation were mirrored by care staff who were motivated to make a difference where they could, often acting outside of their contracted hours. The impact of this meant people felt valued and cared for and their feedback reflected this.

People’s safety was paramount and due to the low turnover of staff it meant people’s safety was enhanced. This was because staff knew people well and could note any changes in their condition and alert as necessary. Staff also undertook tasks related to people’s safety in respect of taking action to identify any infections so they could be treated as early as possible. Some of these tasks involved going to the pharmacy and dropping off samples to surgery’s often in their own time. Caretree Limited had devised their own IT system which linked visits to specialist tasks required and staff training. We saw the management of medicines was excellent with staff having an awareness of what medicines were for, side effects and a facility to call a pharmacy for advice if necessary. All these measures helped to fully optimise people’s safety.

Staff had been well trained and in ways that met their learning style to ensure they had a full understanding of what was required in their roles. Staff were supported well and their health wellbeing had been considered with recognition of the challenges their jobs could bring. Staff received both formal support meetings but could always contact the provider or office staff at any time for assistance and advice. This ensured that staff were able to deliver the best possible care to people and were motivated to carry out extra small tasks in their own time where they felt that would help someone.

People and their relatives repeatedly praised the kindness of staff. Everyone we spoke with praised the exceptional care that they received from the service and used the word ‘outstanding’ on many occasions. We were given num

We carried out this inspection on 8 December 2015. The provider was given 24 hours notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies.

Caretree Limited provides domiciliary care services to mainly older people who live in their own home. At the time of our inspection there were 45 people using the service.

The service had a registered manager in post. 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 and management team promoted extremely strong organisational values. They promoted a caring culture that put people at the centre of everything the service did. The registered manager was knowledgeable about the needs of people using the service, relatives and staff and saw this as an important part of the manager’s role.

Everyone we spoke with was exceedingly complimentary about the registered manager, the staff and the quality of care provided. People and their relatives spoke highly of the skills and knowledge of the staff. People told us staff were thoughtful and caring. Staff were compassionate and regularly carried out spontaneous acts of kindness.

People received care that was personalised and recognised each of them as an individual. Care plans were extremely personalised and contained detailed information to enable staff to know each person as an individual, their needs and how their needs should be met. People were involved in their care and felt valued and listened to.

People were encouraged and supported to remain as independent as possible. Where risk assessments identified potential risks, plans were in place to promote people's safety whilst enabling them to maintain their independence. Staff understood the importance of promoting independence.

People benefited by staff who were well supported by the management team. Staff were positive about the support they received and were encouraged to ask for advice and guidance whenever it was needed. Staff spoke of the organisations ‘family values’ and how much they enjoyed working for the organisation and were proud to do so. Staff received regular support through one to one meetings with the registered manager. Staff felt valued, respected and that all suggestions and ideas were listened to.

Staff had access to development opportunities and regular training to ensure they had the skills and knowledge to meet people’s needs. The registered manager ensured staff were competent before allowing them to work alone and worked with them to build confidence.

People were extremely satisfied with the service and had not needed to use the complaints procedures. Any minor issues people had raised with the service were addressed immediately and people were confident that complaints would be dealt with effectively.

The service looked for ways to continually improve the quality of the service and the lives of people they supported. There were effective quality assurance processes in place to monitor the quality of the service and these were used to continually review and improve the quality of care for people.

We spoke to a person who uses the service, three relatives and three members of staff. We tried to contact other people who use the service but they were not available on the day of the inspection. We reviewed documents including care plans and staff files.

A person who uses the service said that they were in control of their care plan “that’s all up to me”. A relative told us “I can’t speak highly enough” of the care provided. Staff told us they were trained and supported to deliver effective care to people.

People’s safety was supported by the service. The service sought and responded to the views of people who use it, their representatives and staff.

A relative said “Dad is very happy” with the support he receives.

We found a service where people receiving care were involved in planning their care and gave formal consent to their care package. One person told us "I signed a consent form" and "they do what I asked and arranged with them.

It was evident that personal care was planned and delivered in a way which ensured people's safety and welfare. One person said "we are happy with the service we get" another said "I trust them, in two years they have always been good". People's care plans were set out in a form that all could understand and were updated when needs changed.

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. A relative said the person cared for was "extremely" safe with their carers.

Staff received appropriate training and support. One member of staff told us "I've never worked in care before, but this company is so professional", "I love the job".

People who use the service and their representatives were asked for their views about the service. One person told us the manager "keeps in regular contact" and "pops out periodically".