About the service: Home Instead Senior Care Greenwich and Bexley is a domiciliary care agency that provides personal care and companionship and domestic help to people in their own homes. The service was providing personal care to 23 people at the time of the inspection.

People’s experience of using this service:

• At this inspection we found that the service was outstanding in empowering people to have as much control over their lives as possible and to achieve their maximum potential.

• People's care was consistently personalised to their needs. We found multiple examples to demonstrate the staff and management team were passionate about providing an innovative, responsive and excellent service to people.

• Relatives felt the care was highly personalised and that the staff team worked well to deliver an excellent level of care. The feedback we received from people was extremely positive throughout. People expressed great satisfaction and spoke highly of all staff and services provided.

• People were supported in making healthy lifestyle choices for themselves and to maintain good health. Staff supported people to access healthcare services and liaised with health and social care professionals promptly when required.

• The service had established excellent links in the local community and had worked in partnership with key organisations including local authorities and other agencies that provided social care services to improve people's opportunities and experiences.

• The service had an open approach to feedback and encouraged people and staff to be actively involved in service development. The provider had a robust quality assurance system in place and lessons learnt from audits or accident and incidents were used to continuously develop the service.

• People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. There was a registered manager, director and nominated individual in post who understood their role and responsibilities and at the same time empowered and developed staff. Staff understood their individual roles, responsivities and the contributions they made to the service.

Rating at last inspection: Good (Report published 25 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found the service continued to meet the characteristics of Good in Safe and Effective and were Outstanding in Caring, Responsive and Well Led.

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

We carried out this inspection on 31 May 2016 and the inspection announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service who are often out during the day; we needed to be sure that someone would be in.

Home Instead Senior Care Greenwich and Bexley provides care and support including personal care to people in their own homes. At the time of our inspection there were 20 people using the service.

The service had a registered manager. 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 regulation about how the service is run.

People received their medicines safely. The service had systems in place to ensure people’s medicines were administered in line with their prescriptions. People who required prompting with their medicines had their needs clearly documented in their care plans. Staff received training in safe medicines management.

People’s health care needs were documented and updated to reflect any changes. Care plans were person centred and detailed peoples health needs, preferences, history and mobility needs. Where possible people were encouraged to participate in the development of their care plans.

People were protected against the risk of abuse. Staff were aware of the different types and signs of abuse and demonstrated sufficient knowledge on how to report any concerns of harm and abuse. Staff received training in safeguarding adults. People were protected against identified risks. Risk assessments were in place that documented the identified risk, level of risk and the support method to minimise the risk.

Staff had adequate knowledge of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] and their legal responsibility in supporting someone whose capacity was fluctuating. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

People were encouraged to make decisions about the care they received. Staff were aware of the importance of ensuring people’s consent was sought and respected prior to care being delivered. People were offered choices in a manner they understood.

The service had robust procedures in place to ensure suitable staff were employed. Staff personnel records contained, Disclosure and Barring Services [DBS] checks, three references, proof of address and photographic identification. Staff received a comprehensive three day induction process that set out their roles and responsibilities. Staff received on-going support through shadowing experienced staff and were required to complete a set of work based competencies, prior to working unsupported. There were adequate numbers of staff available to meet people’s needs.

People received care and support from skilled and knowledgeable staff. Staff underwent training to ensure they had the knowledge to support people effectively. Training included, safe medicine management, MCA, DoLS, safeguarding and first aid. Staff were able to request additional training should they feel it was needed.

People received support from staff that reflected on their working practices. Staff received supervisions from the registered manager. Supervisions looked at what staff did well and any areas required for improvement. Staff