Inspection site visit activity started on 31 October 2018 and ended on 01 November 2018. This was the first inspection of this service since it was registered with the Care Quality Commission (CQC). This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people, people living with dementia, people with mental health conditions, physical disability and sensory loss.

The inspection was announced 24 hours earlier as the service is small and we needed to make sure that the registered manager would be there.

Not everyone using Extra Mile Home Care receives regulated activity; 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. At the time of our inspection there were 35 people in receipt of a regulated activity.

The service had a registered manager in place. 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.

We identified one breach of the Regulations of the Health and Social Care Act (2008). This related to lack of governance and audits completed by the registered manager. This is discussed in more detail in the well-led section of the report and you can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. Care staff were trained in safeguarding and understood their responsibilities to report concerns. Processes were in place to ensure any concerns raised were dealt with appropriately.

Risks to people were identified and assessed, but the documentation lacked clarity and detail.

Checks were made on new care staff to ensure they were suitable before they were offered employment. Once care workers had been offered employment they underwent appropriate training and were shadowed by more experienced staff until the management were satisfied they were competent and knew the people they were supporting.

The service had introduced on-line documentation which was available to care staff via a smart phone application. If care staff failed to log that they had arrived at someone’s home within 15 minutes of the pre-arranged call time the registered manager received an alert and was able to investigate.

Care staff felt supported and commented that they saw the management team frequently. Care staff told us the training they undertook provided them with the skills they needed. Care staff had regular formal supervisions but also had frequent informal support from the management team.

People’s ability to make decisions for themselves was assessed and kept under review. Where people sometimes lacked the ability to make decisions, efforts were made to help them make the choices they could and family members were involved in making the decisions they could not, in line with the Mental Capacity Act.

People were encouraged to remain as independent as possible and do the things they could for themselves. People working in the service were aware of the needs of the people they supported and knew them well. The managers of the service chose to do care calls to ensure they also knew the people using the service and the care staff well.

The managers of the service told us they kept the service to a size where they felt they knew the people using the service and the care staff well to ensure they were providing the best quality care they could.