This inspection site visit took place on 31 July 2018 and was unannounced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to older adults. On the day of our inspection there were 165 people receiving the regulated activity of personal care.

Not everyone using the service receives regulated activity; The 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 consider any wider social care provided.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were consistently supported to have choice and control over their own lives from being supported by sustained person-centred care. Person centred care is when the person is central to their support and their preferences are respected.

We found the culture of the service was extremely positive, person centred, inclusive and forward thinking. We spoke with a range of professionals, families and staff who were confident that crescent always went above and beyond their remit to enable and support people. Staff had excellent knowledge of people’s likes, dislikes, preferences, mobility and communicative needs.

The service was extremely well led, leadership, management and governance of the service assured the continual delivery of high-quality, person centred care by staff who worked within an open and fair culture.

The management was very passionate about ensuring staff were always valued highly, supported, equipped with information and empowered to be confident, attentive, caring and knowledgeable.

The service was committed to valuing community engagement and developed positive partnership working. By establishing working relationships with community groups and organisations in the local area.

The service showed continual commitment and dedication and went over and above their remit in ensuring clients received their care in adverse weather conditions.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 had extensive experience of working in the social care sector and a passion for valuing people and staff.

Staff, people who used the service, relatives and other professionals agreed that the registered manager led the service very well and was always approachable and accountable. We found they had excellent knowledge of the needs of people who used the service and clear expectations of staff. They had plans in place to make further improvements to service.

People were actively supported to maintain their independence by staff that were patient, equipped with information and knowledge and valued the importance of this.

People who used the service and their representatives were regularly asked for their views about the support through questionnaires and feedback forms and visits that were responsive and proactive.

Care plans were person-centred and covered giving members of staff and external professionals relevant information when providing care to people who used the service. Care plans were reviewed regularly with the involvement of people who used the service and their relatives.

Notifications of significant events were submitted to us in a timely manner b

This inspection took place on 2 & 5 November 2015 and was announced. The provider was given 48 hours’ notice because the location provides personal care and support to adults in their own homes. Therefore, we needed to be sure that someone would be in office.

We last inspected this service in August 2013. At the time of our last inspection the service was meeting our regulatory standards.

Crescent Home Care provides services to some young adults but mainly to older people living in their own homes. They provide personal care and support and for some people, this also included social care in their community.

At the time of our inspection there were 137 people receiving a service from Crescent Home Care across six geographical areas of County Durham. We found the registered manager had mapped where staff lived and had considered the distances between each visit in order to maximise the quality time support staff could spend with people.

The service is a small family run agency that had been operating for over 20 years. During our inspection we saw lots of examples of how the service had sustained high standards and strived for continuous improvement over the years.

The service had a registered manager in post. A registered manager is a person who is 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.

We found the service to be very well led, leadership, management and governance of the service assured the delivery of high-quality, person centred care that supported learning and innovation, and promoted an open and fair culture.

We found every person had a personalised care plan and risk assessment in place. Staff were aware of these risks and worked on a multi-agency basis to minimise those risks.

We found the service had a positive culture that was person centred, inclusive and empowering.

We found regular quality monitoring of the service had been undertaken. In addition, to continuous self-monitoring, in July 2015 the agency had achieved the ISO 9001 CQS certified quality system award. This is an internationally recognised award as proof of their commitment to providing a quality service to people who they supported. This meant the provider was committed to self-monitoring and using a verifiable professionally recognised quality assurance system reflecting aims and outcomes for people that they supported in their own homes.

The provider had also achieved the Investors In People Award. The framework is a performance model that provides a pathway towards future progress, and a journey of continuous improvement.

The service had also signed up to the ‘social care commitment’. This was made up of seven ‘I will’ statements each of which had an associated task and focussed on the minimum standard required when working in social care. The service’s promised to continually strive to deliver high quality care and invest in staff to ensure that people who used the service had confidence in the care and support the service offered.

The service worked in partnership with other organisations to make sure they were following current practice and providing a high quality service. They strived for excellence through consultation and reflective practice. A care manager told us this was a very reliable and effective domiciliary service. The service regularly gathered feedback from people who used the service, relatives, friends, health care professionals, commissioners and used their feedback to help to drive improvement within the service. We spoke with a range of professionals, families and staff who all felt this was an excellent, enabling and inspiring service.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. We saw staff had also received Mental Capacity Act and DoLS training as part of the 12 week Care Certificate induction training that was provided by New College Durham.

We also found the service worked within the principles outlined in the fundamental standards of the Human Rights Act 1998 to make plans and decisions involving each person and in their best interests

We found people’s medicines were well managed so they received the treatments they had been prescribed. We found these were in line with the Royal Pharmaceutical Society Guidance.

On the second day of our inspection, we visited five people in their own homes. We observed staff speaking with people in kind, respectful and reassuring ways. We also viewed 15 satisfaction surveys from people who used the service, all were consistently very positive about the care and support they received,

People told us they felt their dignity and privacy were respected by staff. One person said, “The staff are just wonderful, and they have time to sit and have a chat, and they often take me shopping and we pop into the café for a cupper.” Another said, “If I have a hospital or doctor’s appointment, the staff will take me.”

Professionals who referred to the service told us they were very responsive and provided a flexible approach to meet individual needs in their own homes and the local community. One professional we spoke with said, “I had a client who displayed at times, very challenging behaviours. The way the agency supported them was extremely impressive. Staff were professional, patient and very caring, which meant my client was able to remain living in the community for far longer than expected.”

Two relatives described the support their relative received before and during their end of life care as “Outstanding.” They told us, “The staff had been excellent, at times going far and beyond their call of duty. The care provided can only be described as first class.”