We carried out this unannounced inspection of Home Instead Senior Care Limited (Home Instead) between the 26 & 27 September 2016. We last inspected in January 2014 and found the service was meeting the legal requirements in force at that time.

There was a registered manager employed. 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.

Home Instead is a domiciliary care agency based in the High Lane area of Stockport currently providing services within four of the surrounding local authority areas. The service provides support to approximately 120 older people who may have a learning disability, mental health problem, physical disability, sensory impairment or dementia.

The feedback we received from people using the service and their relatives was excellent. One relative told us, “Home Instead have been a godsend when I did not know where to turn. I also am aware that if I need more help then they can provide it for all aspects of my (relative's) care which means she can indeed stay ‘home instead’ of having to move to a care home. People told us that they were consistently looked after by staff that were exceptionally caring, understanding and compassionate. People felt like they mattered, they told us that staff were patient, and demonstrated a huge amount empathy in how they looked after them.

Staff made "huge efforts" to ensure people had all their needs and wishes catered for when they had been diagnosed at the end of their life. One person had been helped to draw up a "bucket list" and staff went to great lengths to ensure that all these wishes where met for that person. A relative of a person at the end of their life was given informal respite and breaks to help them cope.

We saw the service had a very strong, visible person-centred culture. All staff were passionate about caring and supporting people in ways that mattered to the individual. The owner said, “It’s all about delivering the best care we can possibly give. We empower the staff so that they can make a difference to people's lives." With this in mind the company had a policy of only accepting only one hour visits as a minimum. This was very important in ensuring that people felt respected and that their dignity was upheld by visits that could be paced to suit the needs of each person and that people never felt rushed. One person said, “There’s always plenty of time for chats. I can honestly say I’m not as lonely now.” We found that people were treated with a great deal of dignity and respect.

People were supported in their own homes by well-trained staff that were able to meet people’s needs safely. The agency had robust systems to ensure that there were sufficient numbers of staff employed to meet people’s assessed needs. A family member of a person in receipt of the service told us, “They are the only care agency I would trust my own family with. I have no concerns. It’s been a relief to find them”.

Home Instead took people’s safety very seriously. They carried out comprehensive risk assessments to reduce and manage the risks to peoples’ health and welfare. There were systems in place to make sure that people were supported to take medicines safely and as prescribed. A supervisor had a specific role of medicines coordinator to ensure staff were trained, confident and competent to handle medicines safely.

People who use 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. People told us they felt safe and were well cared for. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns.

Newly re

When we inspected Home Instead Senior Care Limited we talked with four people who used the service. Two of these people allowed us to visit them in their homes. People told us “The staff are well-trained. Brilliant”. and “I am well satisfied. Excellent. Excellent”. People told us that they felt that Home Instead Senior Care Limited involved them in their care.

We also talked with two relatives of people who used the service. They told us “They (the provider) go the extra mile – I have no concerns”. One relative said “I have confidence in Home Instead Senior Care Limited – it is the professionalism of the staff they employ. They provide a fantastic service in the community. Brilliant”.

We talked with four members of staff and met another two who were working in people's homes. We looked at the arrangements for safeguarding at Home Instead Senior Care Limited and found that the staff understood their responsibilities. We checked the arrangements for support staff and found that there were arrangements in place for supervision, appraisal and training. Home Instead Senior Care Limited had systems in place which allowed them to monitor the quality of service being provided and obtain feedback from people about their satisfaction with this.

When we visited Home Instead Senior Care Limited we saw the office staff, the Manager, and the Owner of the service working together in a modern open plan office with good administrative facilities. We noted that some of the staff worked split duties between the Office and providing care in peoples’ own homes which allowed for good communication between the different parts of the organisation.

We interviewed three of the people using the service, and one relative of a further person using the service. People told us that they were very satisfied with the service provided by Home Instead Senior Care Limited. When we visited people in their own homes we saw how the carers working for Home Instead Senior Care Limited provided a high degree of person-centred care to the people who use the service.

Home Instead Senior Care Limited is a world wide franchise which operates as High Peak Senior Care Limited and was newly registered in April 2010; this was the first review of the service.

When we asked the managers of the agency to complete the provider compliance assessment forms which give us information on how the service operates they returned them well within the timescale we had given them. We have found the managers and caregivers who we have spoken with to be cooperative during our review.

When we asked the people who used the service if the caregivers respected their privacy and dignity all agreed that they did.

The people we spoke with told us that the caregivers mostly arrived on time and if they were going to be late someone always called them to let them know and they made the time up.

The following were direct comments we have received from the people who used the service and the care givers;-

‘Very thorough (in providing information), very reassured by what they (the service) were offering’.

‘Given information during the first visit which was good;’

‘I made decisions about care and treatment – so nice to be asked what we wanted rather than be told what we could have.’

‘I have an information pack which details what was asked for, a copy is in the folder.’

‘The care plan is signed and any changes are countersigned;’ ‘feel service is being run in a proper manner – signed agreement for care to be provided;’ ‘care plan signed and agreed’.

‘Amount of care package varies throughout the week, flexible service, can ring up and get someone at short notice;’ ‘care plan very extensive and informative, has information about multiple sclerosis;’ ‘level of support and care excellent; allow independence, supported to do things’.

Of the people we spoke with not everyone had help with meals. Of those that did they told us; ‘prepare occasional meals as requested;’ ‘meals are a combination of sandwiches and heating up ready meals;’ ‘prepare lunch from fresh ingredients and person helps with this;’ ‘tray made ready for tea;’ ‘am pleased with how food is managed i.e. covered in cling film and labelled, everyone works to the same system’.

‘Very flexible and that it is possible to ask for and receive a caregiver at short notice;’ ‘visit once a day but when problems come up will visit more often, very flexible;’ ‘amount of care package varies throughout the week but on average twice a day, flexible service.’

‘Give 110% and go that extra mile;’ ‘caregivers are very efficient, so caring, staff fantastic;’ ‘brilliant, marvellous, fantastic and wonderful;’ ‘feel service is being run in proper manner;’ ‘very thorough, very reassured as to what they were offering;’ ‘level of support and care excellent; allow independence, supported to do things’.

‘The manager visits and checks things regularly, the 2 managers are brilliant, couldn’t ask for nicer people, so caring;’ ‘director nice chap meet up with him;’ ‘very approachable,’ ‘had questionnaires to complete;’ ‘nothing to small that they will not listen to’.

The people we spoke with said that they had no complaints nor had any concerns. Any they may have had were dealt with immediately. Comments we received were; ’no complaints whatsoever;’ ‘not really complained about anything;’ ‘when mention anything not quite right service responds, no complaints, service satisfactory;’ ‘had no reasons to express any concerns;’ ‘any problems sorted out immediately’.