H and H Healthcare Limited is a domiciliary care service providing personal care to 51 adults in the South Hams, Plymouth and surrounding areas.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

This inspection took place on 8 and 9 March 2017. 72 hours’ notice was given as the service is small and we needed to be sure the registered manager would be available when we visited the agency offices. This time also enabled the registered manager (who was also the provider) to arrange home visits. This allowed us to hear about people’s experiences of the service.

At the time of the inspection, the domiciliary care service was providing personal care to 51 people. People were either funded through their local authority, NHS funded or through private arrangements.

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.

People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted. People were actively involved in making choices and decisions about how they wanted to live their life. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process, to attend care reviews where possible or via telephone conference facilities. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.

Risks associated with people’s care were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. The registered manager / provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

The service was well led by a registered manager / provider and supported by a small administration team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which required improvement. The registered manager promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong. The service was constantly striving to improve.

H & H Healthcare Limited is a domiciliary care service that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs in the Plymouth, Ivybridge and surrounding areas. This includes people with physical disabilities, mental health problems and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection 19 people were receiving a personal care service. These services were funded either privately, through Devon and Plymouth Councils or NHS funding.

There was a registered manager in post who was responsible for the day-to-day running of the home. 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 and associated Regulations about how the service is run.

We carried out this announced inspection on 7, 12 & 13 January 2015; we told the provider the day before that we would be coming. This was to ensure the registered manager was available when we visited the agency’s office and so we could arrange to visit some people in their own homes to hear about their experiences of the service. This was the first inspection since the service was registered.

People we spoke with told us they felt safe using the service. People told us, “I can rely on them {staff}” and “overall very good”. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. Staff supported people to attend healthcare appointments and liaised with other healthcare professionals as required if they had concerns about a person’s health.

People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke well of staff, comments included, “good attention to detail” and “they {staff} do a brilliant job”. Health and social care professionals told us managers kept in contact with them and informed them of any concerns about the people using the service. They told us staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.

Health and social care professionals told us staff really understood people’s needs, were flexible and willing to provide a service for people with complex needs. One professional told us, “they are an outstanding service; they don’t treat people as ‘difficult’ seeing beyond people’s behaviour and supporting them to become independent. They take our most complex cases and have achieved amazing results with people”.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a positive culture in the service, the management team provided strong leadership and led by example. The provider/registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way that they cared for people. Care staff told us, “you have time to give people the help they need and deserve” and “clients get a good service and have the care that’s right for them”.

People and their families told us the management team was very approachable and they were included in decisions about the running of the service. People told us someone from the office rang and visited them regularly to ask about their views of the service and review the care and support provided. Staff were encouraged to challenge and question practice and were supported to try new approaches with people.

The service worked in partnership with other health and social care professionals to seek their advice about current practices and monitor the quality of the service provided. Health and social care professionals were all very positive about working with the service and how the service sought different ways to improve the quality of the service provided.