The inspection took place on 19 December 2016 and was announced. The service was previously inspected on 8 September 2013 when we found the service was fully compliant with all regulations covered in the inspection. During this inspection we found no breaches of regulations and we found people received a good service.

Home Instead Senior Care is a domiciliary care provider based in North Somerset, providing personal care and support to people in their own homes. Home Instead Senior Care is part of a franchise that delivers care to people in many areas of the United Kingdom. This service supports 100 people in Bristol and North Somerset. The service offered includes personal care, such as assistance with bathing, dressing, eating and medicines. The service also offered home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties; and companionship services such as escorting people on visits or appointments, simple conversation and company. We only looked at the service for people receiving personal care as this is the activity that is registered with Care Quality Commission (CQC). The staff who support people are known as ‘caregivers,’ and we have called them this in the report.

The person managing the service had been in post since August 2016 and had sent their application to the Care Quality Commission to become the registered manager. 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.’

Staff told us there had been a lot of changes in office staff, and a period of ‘disorganisation’. The manager had been proactive in identifying areas for improvement, including the quality of the care plans, the completion of regular spot checks and the provision of consistent support for caregivers, and was taking action to address any failings. Staff commented; “The team has really pulled together in the last three months”, “[Manager’s name] is really good. It’s an enormous responsibility. We are getting there. [Manager’s name] has worked really hard with the team”.

The manager and provider were ‘hands on’ and approachable. Caregivers and people who used the service told us how accessible and supportive they were. There were systems in place to monitor the quality of the service, including regular checks, audits and quality assurance surveys completed with people every three months.

The service had an ethos of providing continuity and person centred support to people. People received visits of at least an hour from a staff team of no more than three caregivers, with whom they had been carefully matched. People confirmed staff had a good understanding of their needs and were well informed about the care to be provided. Comments included, “They provide very good support. I have two visits a day. I couldn’t manage without them.” and, “All the staff are well trained. They have a good understanding of my family member’s needs”.

People’s legal rights were protected. People who used the service and others involved in their care were fully involved and consulted. People were always asked for their consent before caregivers assisted them with any tasks. Caregivers respected people’s privacy and people were treated with respect and dignity.

Comprehensive risk assessments had been carried out, in liaison with people, relatives and health and social care professionals where appropriate. This meant that caregivers were well informed about any risks and the action needed to keep people safe, while minimising restrictions on freedom, choice and control. Care plans were reviewed at least every three months and people were fully involved in this process.

People were kept safe and free from harm. Their small, consisten

We spoke with 15 people by telephone interview to find out their views of the agency and the service they provided. We also spoke with three relatives to find out what they thought of the agency.

People felt satisfied and pleased about the service they received from the care workers. Examples of comments made included “the service is excellent my carer does everything that I ask and I’m very happy”, “they are absolutely fantastic I’m so lucky to have my carer”, “it is an excellent service they always seem to go that extra mile”, and “they are very good I would use them all the time if I could”.

People were able to plan the care they received and the agency worked with them so that a package of support was put in place in the way they wanted it to be.

People were safeguarded from abuse because the agency had systems to minimise risks to protect them from harm. Every person we spoke with felt safe with the care workers who visited them in their home.

People were protected from the risks of unsuitable staff because the agency had recruitment procedures that ensured suitable staff were employed.

People were assisted by staff who were monitored and supervised. This was to ensure they provided a suitable service. People were supported by staff who were trained to understand their needs.

The provider had systems for monitoring the service so that it was safe and suitable. Where action was needed to improve the service this was put in place promptly.

We spoke with one person who used the service and their relative who came to the agency’s office. We also spoke by telephone with 11 people who used the service.

People told us about the care and support they received from the staff who visited them in their own homes. Examples of comments we were told included, “my carer is wonderful, she’s first class, she’s like greased lightening”, “the service is fine, it’s absolutely perfect”. Other comments included “we are very happy, the carer is absolutely first class, she fits in with everything”, and “the carers are excellent they think of everything”.

Peoples’ care plans were informative and they explained what actions were needed to effectively assist them with their care and their needs.

The provider had systems in place to minimise risks to people and to protect them from abuse.

People were assisted with their needs by staff who were monitored and supervised in their work. People also benefited because they were supported by staff who were well trained to understand their needs.

People were assisted to make complaints’ about the service the agency provided. Complaints were taken seriously by the provider and they were used to improve the overall quality of the service.