Home Instead Senior Care is a domiciliary care agency which provides personal care to people living in their own homes. It provides a service to older people and younger adults as well as people who may be living with a learning disability or autistic spectrum disorder, dementia, mental health needs, a physical disability or a sensory impairment.

This inspection took place on 1 and 8 November 2017 and was announced. The provider was given 48 hours’ notice of our inspection, because we needed to make sure someone would be in the location office when we visited. At the time of our inspection, the service supported approximately 90 mainly older people who lived in Harrogate, Ripon, Thirsk and the surrounding villages.

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 Regulations about how the service is run.

At the last inspection in July 2015, the service was rated ‘Good’. At this inspection, we found the service remained ‘Good’.

People told us they felt safe with the support staff provided. Systems were in place to ensure sufficient numbers of suitable staff were deployed to meet people’s needs. Risks were identified and assessed. Care plans and risk assessments provided guidance to staff on how to safely meet people’s needs. People were supported to take their prescribed medicines. More robust audits had been introduced to monitor and address shortfalls in the records relating to the support provided with people’s medicines.

Staff received on-going training and support to enable them to provide effective care in line with evidenced based guidance. 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. Staff supported people to ensure they ate and drank enough and, where necessary, to access healthcare services.

Staff were kind, caring and compassionate. Staff supported people to have choice and control over how their care and support was provided. People told us staff were good at maintaining their privacy and dignity and treated them with respect.

Care was person-centred and tailored to meet people’s needs in line with their individual preferences. People told us they felt able to raise any issues or concerns and we saw action was taken in response to feedback to improve the service provided.

The service was well-led. People told us management were approachable and supportive. We found the provider and registered manager were committed to providing high quality care and support and to continually improving the service. The provider was proactive in sharing their knowledge and expertise with those in the wider community.

Further information is in the detailed findings below.

We undertook this announced inspection on the 21 July 2015. At the previous inspection, which took place on 16 September 2013 the service met all of the regulations that we assessed.

Home Instead Senior Care, is a domiciliary care agency, providing personal care to people in their own homes. The service supports people who live in Harrogate, Ripon, Thirsk and surrounding villages. At the time of our inspection there were 90 people who received a service from the agency.

The service employed a registered manager who had worked at the agency since October 2014.  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.

Care and support was provided to people in their own home and in accordance with their needs. People who received care and support from the agency and their relatives provided us with positive feedback. They told us that staff were caring, kind, friendly, understanding, compassionate and treated them with respect. People told us they felt safe in the way staff supported them and that they trusted the staff who visited them.

Recruitment checks were in place. These checks were carried out to make sure staff were suitable to work with vulnerable people. The training programme provided staff with the knowledge and skills to support people. This also included the induction training for new care staff. We saw systems were in place to provide staff support. This included staff meetings, supervisions and an annual appraisal. The agency had a whistleblowing policy, which was available to staff. Staff told us they would not hesitate in using it and felt confident that appropriate action would be taken if they raised concerns.

The service had safeguarding vulnerable adult’s policies and procedures which were understood by staff. Staff received training in safeguarding vulnerable adults and all those spoken with confirmed that they would report back to their line managers should any aspect of poor care be observed. Staff we spoke with told us how much they enjoyed their work and that they were committed to providing an excellent service for people.

People we spoke with told us that there was a regular and consistent staff team who visited them and that they received a good service from the agency. People said that there were only changes made to their regular staff when they were either on holiday or on sick leave.

Risks to people’s safety and welfare had been assessed and information about how to support people to manage risks was recorded in people's plan of care. We also spoke with care staff, and they were able to identify and understood individual risks to people and worked with them to minimise these risks, whilst also supporting them to remain as independent as possible.

Some of the people who used the service were supported with taking their prescribed medication and staff told us they were trained and competent to assist people with this.

Staff had regular contact with other healthcare professionals at the appropriate time to help monitor and maintain people’s health and wellbeing. People were provided with care and support according to their assessed need.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 which is in place for people who are unable to make decisions for themselves. The legislation is designed to ensure that any decisions are made in people’s best interests. People gave consent to their plan of care.

Systems and processes were in place to monitor the service and make improvements where they could. This included internal audits and regular contact with people using the service to check they were satisfied with their continuing care packages.

The agency had received complaints and we saw that they had dealt with them appropriately. People we spoke with told us that they had not had to make any complaints about the agency and knew who they needed to contact if they felt the need to do so.

Before people received any care or treatment they were asked for their consent and the service acted in accordance with their wishes. The records viewed showed that people's care records were signed and dated by the person receiving care and/or their representative and a member of staff from the agency.

People expressed a high level of satisfaction with the care provided. We were told that care staff turned up at the correct time and stayed for the time allocated to them. The majority of records showed and people confirmed that they had a regular group of care staff that looked after them. People said this was important to them. Comments from people included “I think it is very good", "The staff fill you with confidence" and "I am very satisfied." We were told that the care delivered was in line with the agreed care plan. This helped to ensure that people's needs were being met.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All the people we spoke with told us they felt safe when the care staff went into their or their relatives home.

We saw appropriate checks were undertaken before staff began work.

Records showed that complaints were appropriately recorded and investigated. People were provided with information on how to complain when they first started to receive support.

We spoke with six people who used the service. We were told that the care which was to be provided was agreed before the service started. One person said, “I needed help with housework and bathing and this was agreed.“

All of the people we spoke with said they were satisfied with the care they received. Comments they made included, “They (the care staff) are polite and helpful.” Another person said, “They always ask me before they do anything.” We saw evidence of the care packages being reviewed and these was signed by the person who received care or their representative. This showed that people were central to care delivery.

People told us the care staff always had enough time to support them and this helped them to feel safe. In addition we were told that they always had the same carer and at holiday times one person said,” It is negotiated with me who will be coming to help me.”

We found that the provider had systems in place to assess and monitor the quality of the service provided. This included an annual ‘satisfaction survey’ which was sent to the people who used the service and their relatives. This was to gain information about how they see the service and what, if any changes they would like to see.