This inspection took place on 24 September 2018. This was an announced inspection to ensure there would be somebody available in the office and so that people could be informed that we wished to contact them for their views.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults.

Not everyone using Cleveland Care at Home Limited t/a Home Instead Senior Care receives regulated activity; Care Quality Commission (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 take into account any wider social care provided. At the time of this inspection 28 people were receiving support which included personal care.

We previously inspected the service in March 2016 and rated the service as good overall. At this inspection we found that the service had improved. The service was found to be outstandingly caring and well led and as a result was rated outstanding overall.

There was 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.

Cleveland Care at Home Limited t/a Home Instead Senior Care ensured people were at the heart of their care and support. People received a high standard of person centred care delivered by staff who were extremely well trained and supported.

People received care from staff who had developed their skills and knowledge through an excellent programme of training that was adapted to suit individual needs. In depth induction training was provided upon commencing employment. Ongoing refresher training was also provided and this was regularly updated to meet the changing needs of the people receiving care.

Staff received high levels of support to enable them to provide outstanding care including regular supervision, team meetings and appraisals.

Staff clearly knew the people they supported and they were carefully matched by considering things such as people’s personality, likes, dislikes, hobbies and interests. The service ensured a small and consistent team worked with each person and it was evident that both staff and people using the service benefitted from this approach.

Care was delivered safely by staff who understood how to recognise and report abuse if necessary. People received their medicines as prescribed and clear accurate records were kept. Risks to people were assessed and minimised by careful care planning.

Staff supported some people with food preparation and at times went out of their way to ensure people’s nutrition needs were met.

The provider had a strict recruitment process that ensured all necessary checks were conducted to minimise the risk of unsuitable people being employed.

Calls were carefully monitored by office staff and people were alerted if staff were going to be late. There had not been any missed calls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff ensured people had access to external health professionals and supported them to appointments.

People’s care needs were reviewed regularly. Changes to people’s needs were monitored by management and staff and calls changed accordingly. Temporary changes could be accommodated at short notice when necessary.

End of life care plans were put in place where appropriate. On one occasion the service was required to provide support at short notice and this was handled in a sensitive way that ensured continuity of care for the person and support for thei

This inspection took place on 9, 10 and 11 March 2016. The inspection was announced which meant that we gave 48 hours’ notice of our visit. This was because the location provides a domiciliary care service and we needed to be sure that the registered manager would be available.

The service was registered with the Care Quality Commission on 26 February 2015 and had not previously been inspected.

Cleveland Care at Home t/a Home Instead is a domiciliary care agency registered to provide personal care to people in their own home. At the time of our visit five people were receiving personal care.

The service had a registered manager in place. 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 told us they felt safe using the service. The same staff regularly attended calls which meant people knew who to expect, and staff were never sent to a call without being introduced first. Call times were adhered to and the service had no recorded missed calls.

There were systems and processes in place to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific to the person. They included things such as risk of falls and moving and handling. Older forms did not contain sufficient detail but new paperwork had been introduced and all plans were in the process of being updated.

Staff were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were aware of whistle blowing procedures and all said they felt confident to report any concerns without fear of recrimination.

Safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work.

The service had policies and procedures in place to ensure medicines were handled safely. Records were kept to show when medicines had been administered, however we found that a full audit trail was not always present.

Appropriate environmental checks had been done on people’s homes to ensure the health and safety of staff and the people they cared for.

Staff received appropriate training and had the skills and knowledge to support the people they cared for. New staff underwent a three and a half day induction and shadowed a more experienced colleague before undertaking calls alone.

Staff had a working knowledge of the principles of consent and the Mental Capacity Act and understood how this applied to supporting people in their own homes.

Staff received regular supervision and annual appraisals to monitor their performance.

People were supported to access external health services to ensure their general health and wellbeing. Some people were also given support to prepare meals to ensure they enjoyed a good diet and suitable level of nutrition.

Staff were knowledgeable about the people they provided care to and were respectful of people’s privacy and dignity. People who used the service said that staff were caring and kind. People and their relatives spoke highly of the service and said that it provided high-quality care.

Care plans detailed people’s individual needs and preferences which meant that they received support tailored to their personal needs. People and their relatives were involved in care planning.

The service had clear procedures for dealing with any complaints but had not received any complaints at the time of our inspection.

There were systems in place to monitor and improve the quality of the service provided and the registered manager audited paperwork and conducted spot checks on staff practice regularly.

Staff described a positive culture that focused on delivering high-quality