Cygnet Care is registered with the Care Quality Commission (CQC) as a domiciliary care agency. It provides personal care to a range of older adults and younger adults living in their own houses and flats in the community. This included people living with dementia, a mental health illness, a physical disability, a learning disability or sensory impairment.

At the time of inspection, there were 37 people receiving a service from the agency. Although the majority of people using the agency received a regulated activity, six received support visits only. 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. The time of visits ranged from 15 minutes to two hours and 15 minutes, with the frequency of visits from once a week to six times a day. There was one person who required two care workers at each visit to support them. There were 14 full and part-time staff employed.

There was registered manager in post. 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.

At the last inspection, the service was rated as good in five areas, with an overall rating of good.

At this inspection, we found the service remained good in four areas and outstanding in one area. The overall rating remained good.

The registered manager and care workers provided people with a bespoke service and delivered care and support which took into account people’s individual choices and preferences. People were very happy with the service they received. Care workers treated people with respect, dignity and compassion at all times. Meaningful relationships had been developed with the care workers who supported them. Families, friends and pets were involved in their care, support and wellbeing. A relative said, “My (family member) is very happy to see her ‘friends’ (care workers) and appears to be more relaxed after their visits” and a friend said “(Friend) feels very comfortable with your carers and looks forward to (care worker’s) visits very much.” People were encouraged to be as independent as possible by care workers they trusted and felt safe with.

Care workers supported people to lead an enhanced quality of life. People commented, “During the time carers came to help (family members), the care and time given has been wonderful. They both enjoyed their carer’s visits and were always happy with the care given … more like friends”; “All the carers are really good”, and “They will do anything.” People said care workers went ‘the extra mile’ and the agency put people at the heart of their service. The agency went above and beyond what was expected of them and due to the small size of the agency, delivered a personal service where the registered manager knew each person extremely well and visited them regularly. Caring for people’s wellbeing was an important part of the agencies philosophy. Care workers regularly carried out duties over and above what was expected from them.

Meaningful relationships had developed between staff, people and their relatives. Friends and family were involved in people’s care and spoke highly of the agency. People had a regular team of care workers and felt they had become part of the extended family.

People were kept safe and cared for by care workers who were aware of their safeguarding responsibilities. Care workers were safely recruited, trained and supervised in their work. They enjoyed their jobs, felt included and listened to in the running of the agency.

People had confidence in the management of the service and the registered manager acted as a role model for the staff team. People were confident any i

We spoke with the registered manager, office manager and three care staff members. We also spoke with and met people who use the service.

People we spoke with told us they were very happy with the service they received from the agency. One person told us "I was concerned about people coming into my home but I could never have imagined just how well it works ". A member of staff told us “I don’t look upon what I do as a job because I love it so much. I get so much out of helping others it's amazing”.

We saw that people had specific and individualistic care plans. These had been updated daily in accordance to people's wishes. Support staff had been provided at a level required by the individual and their families and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient support workers to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

The inspection took place over two days on 22 and 23 September 2015 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

Prior to this inspection, this service had an inspection carried out on 14 January 2014. This found the provider was fully compliant at this visit.

Cygnet Care is a small family run domiciliary care agency that provides bespoke packages of care and support to older people in their own homes. It covers the urban and rural areas of Barnstaple, Bideford and South Molton in North Devon. At the time of our visits, the agency provided a service for 36 people and employed approximately 17 care staff. Times of visits ranged from 15 minutes to 1 hour. The frequency of visits ranged from one visit per week to 35 visits per week. The service provides a variety of care and support services from personal and end of life care to shopping, cleaning, maintenance and pet care (not all of which are regulated by the Care Quality Commission).

There was a registered manager in post. 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.

Feedback received from people and their relatives was very complimentary. They consistently told us staff were caring, professional and kind. People said “They are caring and have a lot of compassion” and “They treat me well…all become friends…they are just caring and lovely.”

Both care staff and the management team knew people well and had regular contact with them. Staff spoke of the people they supported with kindness and compassion while people described extra tasks and jobs that staff completed in addition to their specific care responsibilities.

People had built positive relationships and got to know staff well. They had a regular team of carers who never missed a visit and were rarely late. People received a rota to tell them who would be coming into their homes and if there were any necessary changes to be made, they were always informed beforehand. Staff always stayed the right amount of time and made sure people were comfortable before leaving.

Staffing arrangements were flexible and adjusted where necessary. Care staff responded to people’s needs, preferences and wishes and gave people choices in how they liked to be looked after. People were treated in a friendly but professional way. Care staff received the training they needed to do their jobs properly.

People had personalised care given. People felt they were treated as individuals and one person said “They go above and beyond what is expected”. Another person said “The agency looks after me as an individual…it is person centred care…I am looked after”. There was some variation in the quality of care plans used but the registered manager was addressing this with new care planning documents.

The service was well led and staff felt motivated and listened to by the registered manager who supported their staff. The registered manager valued her staff and recognised the service was “Only as good as what the staff deliver.”

The service worked in close partnership with other health and social care professionals who were positive about the good care and communication.

The service sent out regular quality surveys which showed a high degree of satisfaction with the service. Some other systems were in place to monitor the quality of the service but the registered manager was aware these needed improving upon. People had only positive comments and compliments about the service.