About the service: Hestia Care at Home is a small domiciliary care agency located in the South Hams town of Totnes, Devon. The service provides personal care and domestic support to adults within their own homes in Totnes and the surrounding villages. Hestia Care at Home is a Community Interest Company, which means it is a company that uses its profits and assets for 'the public good'. At the time of the inspection the service was providing support to 18 people, 10 of whom were receiving support with personal care. As the Care Quality Commission (CQC) does not regulate domestic support, this inspection relates only to people receiving the regulated activity of personal care.

People’s experience of using this service:

• The service remained outstanding in the personalised care and support provided to people. The service valued and respected people’s preferences, lifestyles and choices. Without exception people, relatives and healthcare professionals told us the service was “excellent”. We were provided with examples of how the service had gone above and beyond what was expected of them to promote people’s well-being.

• People were safe and received the supported they needed to remain living at home. Relatives told us how much they valued the service. One relative said, “The best team we have ever had helping us out. Hestia have never let us down. Always been patient and polite and supportive not just to mum but to me.”

• People were fully involved in decisions about their care and support. The service regularly reviewed people’s needs to ensure these were fully understood and support plans reflected this. Where necessary healthcare professionals were involved in supporting people with guidance and advice about how to meet people’s support needs. The service was able to demonstrate the positive impact their care and support had on people.

• The service had a strong commitment to social inclusion and guided people to other support services. The service was very much involved in working with other agencies to make Totnes an accessible town for all.

• Staff were safely recruited and received the training and support they required. People remained at the heart of the recruitment and selection process, and no member of staff would be employed if a person felt they were not suitable.

• The service had been nominated for the Outstanding Care Awards 2019 in recognition of the high standards of care provided. One healthcare professional said the director, “Fights hard to make sure Hestia achieves the gold standard care for all in her care.”

• The service continued to be exceptionally well-led. We were told the management team were passionate about the care the service provided. Staff demonstrated a pride in working for the organisation.

• The service managed their resources to ensure they could meet their commitments and keep people safe. For example, when staff fed back they could not work additional hours to cover sickness for example, the management team took action to address this. The service had placed a temporary voluntary suspension on taking new people until they had recruited additional staff. Following the inspection, the director confirmed that new staff had been appointed and the suspension was no longer required.

• The service used reflective practice to review how well people were being supported and whether any more could be done. There was a commitment to continuous learning and improvement.

The service met the characteristics for a rating of “good” or “outstanding” in all the key questions we inspected. Our overall rating for the service after this inspection was “outstanding”.

Rating at last inspection: Outstanding (September 2016)

Why we inspected: This inspection was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect soo

Hestia Care at Home is a small domiciliary care agency located in the South Hams town of Totnes Devon. The domiciliary care agency provides personal care and domestic support to adults within their own homes in Totnes and the surrounding villages. Hestia Care at Home is a Community Interest Group, which means it is a company that uses its profits and assets for ‘the public good’.

The director of the company held the position of the registered manager and managed the service on a day to day basis. 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.

This announced inspection took place on 21, 22 and 25 July 2016 and included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 24 people were using the service, of which 13 were receiving support with their personal care needs. Domestic help is not regulated by CQC, and therefore this inspection looked at the care and support of those people who received assistance with their personal care. The service was previously inspected in January 2014 when it was found to be meeting the regulations at that time.

Throughout the inspection the service was able to demonstrate its outstanding care and support of people. The feedback we received from people and their relatives was that the service was excellent. People described the service as “marvellous”, and “exceptional”. Health and social care professionals told us Hestia Care at Home was a service they would recommend to people: it was described as “first rate” by one. They said the service worked closely with them and alerted them promptly to people’s changing needs. A GP told us this had helped avoid a number of hospital admissions.

The registered manager said the aim of the service was to support people to stay in their own homes as long as possible, if this was what they wished, and to provide a tailored service that provided choice and options for people. The staff and management team demonstrated a clear commitment to promoting a strong, person-centred and caring culture throughout the service. They were motivated and clearly passionate about making a difference to people’s lives. Staff told us they were proud to work for Hestia Care at Home. People told us the service was managed well and the registered manager led by example.

People described their relationship with the care staff as “excellent”. They said staff knew them well and cared for them in the manner they wished. One person said, “I consider the service offered by Hestia is quite outstanding.” The service placed great emphasis of respecting people, and providing care in a manner that upheld people’s dignity. The service had signed up to the Dignity in Care Campaign, a campaign that ensures dignity and respect are at the heart of care services. For example, the service recognised that people may be anxious about undressing in front of staff. People were offered a ‘towelling cape’ to wear to remain covered at all times. Care plans were developed with each person and described how people wished to be supported. Staff were responsive to people’s changing needs and, where necessary undertook additional specific training to ensure people’s needs could continue to be met. For example, staff researched how to support a person living with dementia who had lost their appetite. They changed the way in which the food was prepared and served and this had resulted in the person eating more and gaining weight.

Risks to people’s health, safety and well-being were identified and staff were guided with detailed information about how to minimise the chance of harm occurring to people and themselves. Advice was sought from specialist servi

At the time of our visit there were fourteen people receiving a service from the agency. We were able to meet with 2 people who use the service and speak with 5 family members of people who received a service.

Everyone we spoke with was complimentary about the service. One relative told us "I cannot think of a single thing to criticise, I could set my clock by them. They are always so prompt". Another relative told us "I would rate them as very good. They do a good job and are always pleasant".

One person who uses the service told us "It's worth the expense just to chat and see them smile. They are cheerful and friendly". Another person who uses the service was not able to verbally communicate an opinion but smiled broadly when we asked if the carers were kind.

We saw that care plans were person centred and that this was reflected in the care given. One relative told us that the care plan had been discussed and agreed before implementation and the care package agreed.

The service manager showed us evaluation sheets and a comprehensive review schedule was in progress which showed us that the service consistently strived to deliver the package that people wanted them to provide.

We were told by family members of people who used the service that if a change of time of length of visit was necessary or preferable they only had to ask and their request would be actioned as soon as possible. We were told "they are very accommodating, they are so good".

People we spoke with were pleased with the service they received. One person said “They care for the whole family.” Another said “They never rush; they take their time and make sure the job is done properly.”

Everyone we spoke with thought that staff were “gentle” and “kind” and said that staff provided care and support in a respectful way.

People spoke highly of the staff who provided support. The people we spoke with said care staff were “skilful” and “knowledgeable”. We saw evidence that appropriate background checks had been carried out prior to employing staff. We saw there were effective induction training and supervision programmes in place to support staff.

People told us they felt safe in the presence of staff and said staff respected them. Staff were aware of the different types of abuse and knew how to recognise and report any allegations appropriately.

People knew how to provide feedback and make complaints, although they said they had not had to make any complaints. We saw that systems were in place and planned to make sure the quality and safety of the service was maintained.