This comprehensive inspection took place on 9 and 10 August 2018 and was announced. We gave the provider 48 hours' notice that we would be coming because we needed to be sure that someone would be available to support us with the inspection process.

Home Instead Senior Care 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 predominately older adults with physical disabilities or those living with dementia. Not everyone using the service 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 this inspection the service was providing personal care services to 43 people.

At our last inspection in March 2017, we rated the service good. However, we did find one breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, where risk assessments did not always capture risks to people and did not identify measures to address or minimise those risks. At this inspection we found that the service had met the breach in regulation that we had identified. Evidence seen as part of this inspection process continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People received a safe service. Safeguarding policies and procedures were clearly understood and followed by all staff. Safe and robust recruitment processes ensured that only those care givers assessed as safe to work with vulnerable adults were recruited.

Risk assessments identified people’s individual risks and gave clear guidance to care givers on how to mitigate known risks and ensure people remained safe and free from harm.

People received their medicines safely and as prescribed. Policies and processes supported this.

People and relatives confirmed that they always received care and support from a regularly allocated team of care givers.

Care givers received training on a variety of topics to support them effectively in their role. Care givers confirmed that training was highly effective and in addition received appropriate support in the form of regular supervision and annual appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service carried out needs assessment for each referral they received prior to starting any package of care. This allowed the service to determine that they could meet the assessed and required needs of the person.

People were supported with their meals and hydration needs where this was an assessed part of the package of care. People had access to a variety of healthcare professionals and were supported by care givers where needed.

Care plans were detailed and person centred. They gave clear information about the person and how they wished to be supported.

During the inspection, care givers visited the office along with the person they were supporting. During this time we observed people had established positive and caring relationships that were built on trust and mutual respect. People and relatives confirmed that they were involved in every aspect of their delivery of care and periodic review meetings were held with the service.

People and relatives knew who to speak with if they had any complaints or issues to raise. The service had not received any complaints since the last inspection. Procedures were in place to manage and address any

Home Instead Senior Care is a domiciliary care agency who at the time of our inspection was providing a service to 108 people in their own homes. The provider was registered to provide personal care to people with dementia, learning disabilities or autistic spectrum disorder, mental health, older people, physical disability, sensory Impairment and younger adults. Staff providing personal care to people were called ‘care givers’. This is the term we will use in this report.

This was the service first comprehensive inspection, as such they had not yet received a CQC rating. The registered manager had left the service just prior to our inspection. 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. At the time of the inspection day to day management was provided by the head of care who was applying to the CQC to be the registered manager.

We found a breach of the regulations because although people had risk assessments that covered a number of areas some hazards had not been identified and risk assessed to ensure people’s safety.

People’s medicines records indicated what level of support they required and if they had capacity with regard to their medicines. When identified in assessment the service supported people with the complete management including reordering of medicines. We noted however that it was not always clear from people’s medicines records if the family member or the care giver had the responsibility to prompt people who required reminding to take their medicines.

We had very positive feedback from people and their relatives about the service. People told us they felt safe with their care givers and confirmed they attended and stayed for their allotted time and were caring in their approach.

The directors, head of care and office staff were well informed about people who used the service and had a close working relationship with the care givers. There were systems of monitoring to ensure the service given was of a high standard. People and their relatives were encouraged to contact the office and asked to provide feedback about the service they received.

The service undertook some excellent work in partnership with voluntary organisations in the community to reduce the risk of falling and to make people aware of fraudulent scams. This helped people in the community to protect themselves and get help when needed.

The service had a robust recruitment process to ensure the care givers were safe to work with people. Care givers told us they received a thorough induction, ongoing training and supervision to support them to undertake their role. Care givers were knowledgeable about the people they cared for and ensured they received support from health care professionals.

Care givers demonstrated they understood their responsibilities to report abuse under safeguarding adult’s legislation and obtained people’s consent before acting in accordance with the Mental Capacity Act 2005. People or their relatives were involved in care planning and signed care plans to show they agreed with the care and treatment provided. When people did not have the capacity to consent to their care the agency checked that people’s relatives had a legal right to act in their best interest. This was in line with good practice guidance.

Home Instead Senior Care aimed to keep people as independent as possible in their own homes. Care plans highlighted what people could do for themselves and identified where they required assistance from the care givers. People were supported with their diverse needs and care plans were person centred with care given tailored to meet the needs of each person. Care plans were reviewed and updated on a regular basis.

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