This announced comprehensive inspection took place on 23 and 25 October 2018. At the last inspection in 29 February, 02 March and 04 March 2016 the service was rated Outstanding. At this inspection we found the service remained Outstanding.

Home Instead Senior Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults based in Budleigh Salterton, Exeter and East Devon area. Not everyone using Home Instead Senior Care receives the 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 the inspection the branch provided personal care to 42 people living in their own home in the. The service employed 77 care workers, known as Caregivers.

Why the service is rated Outstanding.

People praised staff and said they were exceptionally caring and compassionate. Comments included, “Each carer provided warmth and loving care along with great attention to mums needs and interests,” “Nothing is too much trouble for them, they are so kind to her, explaining what they are doing.” Staff were matched with people based on their life, experiences, interests and hobbies. This helped them develop positive, meaningful relationships with people. They knew each person as an individual, and what mattered to them and treated people with the utmost dignity and respect. Staff went that extra mile to promote each person’s wellbeing and improve their quality of life. For example, taking one person to visit their old home and helping another person reconnect with old friends. The service had a strong, visible, person centred culture which people and staff described as “like an extended family.” Staff said, “The hour minimum visit gives us a chance to really connect with clients,” “I am proud to work with this friendly professional caring team that always puts the clients first.”

People were safe because there was an exceptionally strong emphasis on safety. Staff were skilled and proactive in recognising and reducing risk. They used innovative ways to support people to stay safe in their own homes, lead fulfilling lives and minimise restrictions on their freedom. Staff proactively helped people improve their health and reduce their risk of falling. The service held Falls Prevention Workshops for local community groups to spread message about how to prevent falls. They used an innovative mobile lifting chair to help people up, when they had fallen off the floor, which prevented unnecessary admissions to hospital. The agency has also extended this service to local people through their links with their local GP surgeries, NHS staff and Age UK at their local community hub.

People felt safer because staff worked with the police and the fire service to protect people from crime and improve fire safety. The provider promoted a ‘no blame’ culture, whereby staff were encouraged to speak up if they made mistakes or got things wrong. This was so wider lessons could be learned and safety improved.

People and families praised the exceptional skills of staff who supported them. Their comments included: “We are so grateful for the high quality, efficient and reliable care you provide.” Staff were well trained using best practice evidence and felt supported in their role. The service used innovative training methods to help staff understand people’s experience of becoming frailer, and experiencing visual impairment. They were proactive in ensuring people newly discharged from hospital had increased support.

People living with dementia received best practice care and the agency participated in dementia research. They promoted and encouraged people with dementia to live well. The service worked in partnership with local health and social care organisations to improve people's health. Staf

This inspection took place on 29 February, 2 and 4 March 2016 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. This was Home Instead Senior Care’s first inspection since registering at their new location with the Care Quality Commission in December 2014. The last inspection at the previous location in January 2014 had found the provider had met all the standards inspected.

Home Instead Senior Care is a domiciliary care provider based in Budleigh Salterton, Devon 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 135 people living in Budleigh Salterton and the east Devon area including the city of Exeter. 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. Of those 135 people, 35 received personal care and the remainder receive help in their home or companionship. 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,’ we have called them this in the report. We have referred to the office personnel as office staff although they were also trained to provide personal care to people when required. The provider had 90 staff employed with 78 of these staff trained to deliver personal care.

When we visited there was a registered manager in post. 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 caregivers were able to demonstrate a good understanding of what constituted abuse and how to report if concerns were raised. The safety of people who used the service was taken seriously and the registered manager and staff were well aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed. Where there were issues the service responded well, investigated and addressed them in line with their policies and procedures. The provider drove forward support from caregivers who knew them well. People received a two week schedule of who was visiting and had always been introduced to new caregivers before they received support from them.

People received a service that was based on their personal needs and wishes. Care plans were personalised. Caregivers felt they had enough information to meet people’s needs, including receiving regular up to date information. Changes in people’s needs were identified and their care packages were amended to meet their changing needs. The service was flexible and responded positively to people’s requests where possible. People who used the service felt able to make requests and express their opinions and views. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.

People spoke highly of the quality of care provided by the caregivers. They said they trusted the caregivers to have the skills to keep them safe. People had positive relationships with their caregivers and were confident in the service. There was a strong emphasis on the key principles of care such as compassion, respect and dignity. Nobody expressed