This first comprehensive inspection took place on 31 August 2017 and was announced.

The head office in Northampton for Xtra Healthcare Limited provides personal care for adults living in their own home, including people living with dementia. At the time of our visit there were four people using the service.

The service did not have a registered manager. The provider was managing the service and a new manager, who had already been recruited, was due to commence the following day after our inspection visit. 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 felt safe and were protected from the risk of avoidable harm. Staff were knowledgeable about the risks of abuse and there were suitable systems in place for recording, reporting and investigating incidents. Risks to people’s safety had been assessed and staff used these to assist people to remain as independent as possible. There were sufficient staff employed to meet the range of care and support needs of people who used the service. Staff had been recruited using effective recruitment processes. At the time of our inspection there was no one using the service that required support to take their medicines. However we found that systems were in place should this service be required.

Staff were knowledgeable about the needs of the people they cared for. They attended a variety of training to keep their knowledge and skills up to date. They were further supported with regular feedback from the provider about their work performance. People who used the service were encouraged to make their own decisions and staff followed the principles of the Mental Capacity Act 2005. People were provided with nutritional support if this was an assessed part of their package of care. Staff would be available to support people to access healthcare appointments if needed.

There were positive relationships between people, their families and members of staff and they were treated with kindness and compassion. People’s rights in making decisions and suggestions in relation to their support and care were valued and acted on. The privacy and dignity of people was promoted by staff and they treated people with respect.

People received person centred care that met their needs and centred around them as individuals. People’s needs were assessed before a care package commenced and care plans gave clear guidance to staff on how people were to be supported. Records showed that people and their relatives were involved in the assessment process and review of their care. The service was flexible and any additional support was provided where necessary. People knew how to make a complaint. There was a complaints procedure in place which was accessible to all.

There were quality monitoring systems and processes in place to make positive changes, drive future improvement and identify where action needed to be taken. There was an open culture and a clear vision and staff told us they were proud to work for the service. People and their relatives expressed confidence in the provider’s ability to provide person centred care and good oversight and leadership of the service.