This inspection took place on 12 and 21 February 2018 and was announced. This was to ensure someone would be available at the office to speak with and show us records.

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 adults. On the days of our inspection there were 111 people using the service. 40 of these were being supported under the regulated activity personal care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 last inspected the service in November 2015 and rated the service as ‘Outstanding.’ At this inspection we found the service remained ‘Outstanding’ and met all the fundamental standards we inspected against.

The service had developed innovative ways to keep people and staff safe.

A ‘Senior fraud protection toolkit’ had been developed to help elderly people stay safe in their own homes.

The service had implemented the use of the ‘Herbert Protocol’. The Herbert Protocol is a national scheme which encourages carers to compile useful information that can be used in the event of a vulnerable person going missing.

Each person who used the service had a small team of staff supporting them to ensure continuity of care.

Without exception, people who used the service and family members told us people were supported by kind and caring staff. The service provided “relationship led care”. This included personally introducing staff to people before they visited and providing the same staff at every visit.

The service went above and beyond to support people outside of their agreed support package.

One of the care staff was the runner-up in the dementia care award at the regional finals of the Great British Care Awards. They had been nominated for the care and support they had given to a person with dementia.

The service provided exceptional support to people with communication needs. Communication support plans provided guidance to staff on people’s communication preferences and abilities.

The service was exceptionally well-led and had excellent links with the local community.

The service had been nominated for, and won, several national and regional awards. The provider had developed a specialised training programme in Alzheimer’s disease that had been accredited by the City and Guilds. This had led to the service being the first home care provider to win the Princess Royal training award for dementia.

People, family members and staff were empowered to provide feedback on the quality of the service.

The provider had an effective recruitment and selection procedure in place and carried out relevant security and identification checks when they employed new staff to ensure they were suitable to work with vulnerable people. People who used the service received effective care and support from well trained and well supported staff.

Appropriate arrangements were in place for the safe administration and storage of medicines.

People’s needs were assessed before they started using the service and continually evaluated in order to develop support plans. This included supporting people with their dietary needs.

People’s care records were regularly reviewed and evaluated. Care records were person centred, which means the person was at the centre of any care or support plans and their individual wishes, needs and choices were taken into account.

Staff were extremely responsive to people’s needs and people were protected from social isolation.

The provider had an effective complaints policy and procedure in place.

The inspection took place on 2 and 3 November 2015 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was registered with CQC on 20 December 2012 and was previously inspected on 4 October 2013, at which time it was compliant with all regulatory standards inspected. 

Home Instead Senior Care Durham is a domiciliary care provider based in Durham providing personal care and support to people in their own homes. There were 26 people using the service at the time of our inspection.

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.

Safeguarding principles were well established through training and regular discussion at staff supervisions and we saw evidence of concerns regarding people’s safety being appropriately managed. We found that risks were managed and mitigated well through pre-assessment and ongoing assessment. People using the service felt safe and we saw that the provider operated an out-of-hours phone line in case of unforeseen circumstances.

We saw that adequate numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks to ensure they were suitable for the role.

We saw that no medicines errors had been made on the Medication Administration Records (MAR) we sampled and that the provider regularly audited this aspect of the service, as well as regularly assessing the competence of people administering medicines.

We found that staff received an induction that included training incorporating the latest National Institute for Health and Care Excellence (NICE) guidelines regarding care provided in people’s homes and Care Certificate standards. Training included safeguarding awareness, moving and handling, infection control, health and safety, first aid and handling medication.

We found consistent and comprehensive liaison with external healthcare professionals and other agencies in order to ensure people’s healthcare needs were met.

We found the provider delivered outstanding levels of care and put the person’s needs at the forefront of care planning and decision making. People who used the service, relatives and healthcare professionals were unanimous in praising the compassionate, dignified and effective care provided by staff. People who used the service had developed meaningful, trusting relationships with those who provided care. People who used the service and staff felt having care calls of a minimum of one hour enabled these relationships to develop.

People told us that that consent was sought both at the initial care planning stage and when care staff visited people who used the service. When we asked staff questions about the subjects they had been trained in, for example, mental capacity, they were able to give detailed responses to a range of questions about how the training influenced the care they gave.

We saw that staff supervisions, appraisals and staff meetings all happened regularly and that staff felt supported to perform their role, as well as to develop their careers in the sector through additional vocational training.

We saw that people were encouraged and supported to contribute to their own care planning and review, with family members similarly involved.

We saw that personal sensitive information was stored securely.

Care plans were reviewed regularly and, where people’s needs changed, these reviews were brought forward and care provision amended accordingly. People who used the service and healthcare professionals told us staff were accommodating to people’s changing needs and preferences.

People’s hobbies and interests were encouraged, with people supported to pursue their preferred activities as independently as practicable.

The provider had a complaints policy in place. People who used the service were made aware of the complaints procedure and told us they knew how to make a complaint and who to, should the need arise.

People who used the service, relatives and healthcare professionals we spoke with were consistent in their praise of the leadership of the service. The owner, registered manager and all staff we spoke with were consistent in their understanding of the principles of the service, as set out in the Statement of Purpose, and passionate about the care they provided to people. We found leadership of the service to be outstanding.

We found a strong and highly efficient auditing and quality assurance regime had been established within a culture that was positive, open to challenge and always took people’s preferences as the starting point for decision-making.

Care planning, delivery and training were all informed by aspects of industry best practice, regarding which the owner and registered manager were well informed.

The owner, who was a dementia champion, and registered manager, maintained excellent community links and local media to raise awareness of dementia, risks to vulnerable adults, but also championed the role of caring within a community.