The inspection took place on 25 January 2018 and was announced. We told the provider 48 hours before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the registered manager and staff might not be available to assist with the inspection if they were out visiting people. A second day of inspection took place on 26 January 2018 using telephone interviews.

We last inspected Home Instead Senior Care in November 2015, at which time it was rated Good. At this inspection we continued to rate the service as Good overall with an Outstanding rating in the Caring domain.

Home Instead Senior Care provides a range of services to people in their own home including personal care. Most people using the service were older people, some of whom were living with the experience of dementia. At the time of our inspection 56 people were receiving a service in their home, including personal care, shopping, cleaning and companionship. All the people using the service funded their own care and support.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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. The provider was also involved at the service on a day to day level.

Staff were caring, compassionate and creative in overcoming obstacles and finding opportunities to go' the extra mile' in order to promote people's independence and wellbeing. People told us they valued their relationships with staff and they were treated with dignity and respect.

People who used the service gave examples of how staff supported them to maintain their independence in their own homes, and in the community. Staff had formed strong bonds with people they cared for and took pride in them fulfilling their potential and goals.

People consistently described staff as friends or members of the family and we saw the strength of these relationships were maintained by dedicated staff and a provider that understood the importance of providing a continuity of care to people. All members of staff we spoke with demonstrated high levels of compassion and people confirmed they were skilled at empathising and supporting them patiently.

Staff followed the procedure for the management of people’s medicines and regular medicines audits indicated that people were receiving their medicines as prescribed.

The risks to people's wellbeing and safety had been assessed, and there was information on people’s records about how to mitigate these risks.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

The provider had systems in place to manage incidents and accidents and took appropriate action to minimise the risk of reoccurrence.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff’s absence. Recruitment checks were in place to obtain information about new staff before they were employed to care for people.

People's health and nutritional needs had been assessed, recorded and were monitored.

Staff received effective supervision and training that was relevant to the people they supported.

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.

Care staff received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

Care planning was person-centred and took into account people’s preferences and chosen routines. Care plans were revi

Home Instead Senior Care is a domiciliary care service. It provides personal care for people living in their own homes in Darlington and surrounding areas. The service now provides care and support to 50 people, on our last visit in 2014 when the service was relatively new it provided care to 14 people.

The service has a registered manager and the registered Nominated individual is involved directly in the running of the business and the provision of care. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Nominated individuals, 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 were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management listened and acted on staff feedback.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs. People who used the service and their relatives told us that they had a small team of staff, who were reliable and arrived when expected. Staff confirmed that they were not rushed and had time to provide the care people expected.

Staff told us they were supported by their management and could get help and support if they needed it. Staff did receive supervision although the regularity of the programme had slipped slightly. The registered manager assured us they would address this issue straight away.

The service had comprehensive systems to ensure staff were appropriately recruited, trained and supported. The service had introduced the Care Certificate for all staff and staff also had training in dementia care and all were Dementia Friends (this is a scheme run by the Alzheimer’s Society to help people understand about living with dementia).

The staff undertook the management of medicines safely and in line with people’s care plans. Staff were assessed by the registered manager on occasions to ensure they were carrying out medicines administration safely. Some recording on medication records needed to improve.

The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with delivering the person’s care.

People told us when they raised any issues they were dealt with promptly and professionally and everyone we spoke with knew how to speak to the management team at the office if they had any concerns.

Whilst the service ensured it sought written consent in terms of providing any care and support for people, the management team and staff required training in the Mental Capacity Act (MCA) 2005 to ensure people’s capacity to consent was assessed and recorded. The service needed to ensure it was aware and following the correct procedures for people who may lack capacity. The management team told us they would immediately seek guidance in this area from the local authority who lead on MCA.

There was a good quality assurance system in place to ensure the service and staff were checked regularly for quality and safety. There were regular staff meetings and incidents and accidents were monitored and reviewed within 24 hours by the registered manager. Home Instead Senior Care also ensured that people who used the service were contacted on a regular basis to check if the package of care they received met their needs and they were happy with the service.

An inspector visited this service which helped us gather evidence against the outcomes we inspected to help answer the five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and staff who worked there, and looking at records.

Is the service caring? – Comments we received from three people we spoke with who used the service were very positive. We saw that care plans were written with the person they supported and people’s preferences were clearly recorded. Staff members had all been trained to be “Dementia Friends” and half the staff team had completed a City and Guilds course in dementia care.

Is the service responsive? - The provider and manager told us that the service reviewed the quality of service people were receiving on an ongoing basis and we saw this was clearly recorded in people’s plans of care. We observed the provider and manager dealing with phone calls from staff and offering advice and support. The three members of staff we spoke with said they felt very supported at all times by the service. One person who used the service told us they had arranged some extra care at very short notice when she had been unwell.

Is the service safe? – Risk assessments were carried out to ensure that both people and staff members maintained a safe working environment. Staff members received regular training in safeguarding and how to deliver care safely and the three staff we spoke with knew how to respond to any incident of concern.

Is the service effective? – Care plans and risk assessments were written with the person receiving the service and we saw they were updated regularly in consultation with the person. We saw that staff were trained in the use of moving and handling equipment and risk assessments were completed on new equipment before staff were able to use it.

Is the service well-led? – Policies and procedures were in place and we saw were updated and shared with staff when this happened. Staff members told us they felt very supported by the service and could contact the officer or manager at; “ Any time of the day or night”. There were robust systems in place to monitor the quality of the service.

What people told us – We spoke with the provider, the registered manager, three members of staff and four people who used the service.

The staff members told us; “They are very supportive, they are always at the end of a phone”; “I had a good induction before I started working with clients”; “It’s lovely, everyone cares about the clients so much”; “I have regular supervision sessions with the manager and she always stresses she is available, even though you are lone working I never feel alone” and “It’s a really nice and friendly place to work”.

Clients told us; “A very nice lady comes and helps me in the home and looks after my husband if I need to go out, it is a treat to have some good help”; “They let me know if anyone other than my usual carer is coming”; “They are very good”; “The girl I have is lovely, they must choose people to suit who you will get on with”. One person also told us how the registered manager visited them about once a month; “To check I’m fine and happy with everything”. Another person told us; “I feel very safe and my daughter and family are also really pleased with the service”.

People who used the service were very positive in their comments about the staff and service from Home Instead Senior Care. There were 13 people who received a service from Home Instead Senior Care. We spoke with three people during the course of the visit who lived in separate properties across Darlington and they said:

“I’m very pleased with the service and support I’ve had”;

“I’ve found it excellent” and

“I can’t fault them, they are very professional”.

We found policies and procedures were available in the office. We looked at staff recruitment and found that the organisation had policies and procedures in place for making sure there were checks carried out on people applying to work at the service. We also saw the provider had a system in place for checking on the quality of the service it provided which included talking to people who used the service.

Care plans were very personalised and written with the involvement of the person.