We inspected this service on 5, 6 and 7 June 2018. First City Nursing Services are a domiciliary care agency (DCA). The service provides personal care to people living in their own houses and flats in the community. First City Nursing Services have been operating for almost 20 years and are well known and an established local provider. Following an expansion of the business the Swindon branch had moved to a bigger building so all departments could be accommodated at the same site.

When we last inspected First City Nursing in November 2016, at their previous address the service was rated as Outstanding in well-led and Good in all other four domains and Good overall.

At this inspection we found the service remained Good in safe, effective and caring domains and remained Outstanding in well-led. We also found the service had improved to Outstanding in the Responsive domain and as a result, the service was rated Outstanding overall.

The service continued being very well-led. Staff remained extremely positive about the team work and support they received from the management and about the positive and empowering culture that was promoted within the team. Staff demonstrated a strong level of engagement, a real sense of pride of working for First City Nursing Services and there was a high level of satisfaction within the team. There was a strong emphasis on staff development and development of their skills and keeping the team motivated and enthusiastic. Staff had clear roles and responsibilities and they were constantly being upskilled so they could step up or act in other roles should this be required. Staff complimented the training provision and the support received from the management.

We found the management’s vision were imaginative, innovative and put people at the centre of the service delivery. The provider’s governance was well-embedded and there were robust quality assurance systems that remained effective. The provider welcomed any form of external auditing and any feedback received was treated as an opportunity to reflect and further improve the quality of the service for people. The management team continuously looked for new, innovative ideas how to keep people safe and how to adapt the service delivery to the changing demands and the needs of the of people and the health and social care community. There was a positive culture that reflected people were put first and that culture was reflected throughout the entire structure in the organisation.

The service acted as an important part of the local community. The provider had formed a charity that supported local community and people had opportunities to receive additional support such as from befriending volunteers. This enhanced people’s wellbeing and reduced the risk of social isolation. People had opportunities to visit a newly opened café at the provider’s office site, where they could socialise and received additional support such as signposting to other support services and voluntary organisations.

The service retained their drive for excellence and retained their position of a positive role model and earlier this year they successfully secured the contract with the Local Authority to become the Lead Provider of social care. They therefore acted as a first point of contact for all referrals for the borough. The provider enabled a number of external professionals to be based at the same site to ensure good communication and smooth referral processes were maintained.

The contract around the Lead Provider was a completely new and innovative approach. The provider’s aim was to ensure the new system was very much people led and the identifying and meeting people’s outcomes was a key point of focus. The management worked to ensure people’s stories, expectations, wishes and outcomes they wanted to achieve were captured and recorded. First City Nursing Services management involved a reputable and well known social care organisation that specialises in delivering