The inspection took place on 11 January 2018 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.

We last inspected Home Instead Senior Care Newcastle in September 2015, at which time it was rated good. At this inspection we rated the service as outstanding.

Home Instead Senior Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. At the time of our inspection the service provided personal care to 25 people, the majority of whom required help to maintain their independence at home.

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 registered manager had extensive experience of working in the social care sector.

People who used the service were confident in the ability of staff to keep them safe. No concerns were raised from relatives or external professionals and there was evidence of appropriate action taken following previous incidents.

Risk assessments were in place (and regularly reviewed) to ensure people were protected against a range of risks. Staff had received safeguarding training and were able to describe types of abuses and what they could do to protect people.

Medicines administration was safe and regularly audited, with competencies monitored by senior staff.

There were sufficient staff to meet people’s needs safely, with travel time included and spot checks undertaken to ensure staff completed care visits as agreed. A telephone call monitoring system tracked when staff arrived and departed from people’s homes.

Staff were trained in core topics such as safeguarding, first aid, moving and handling, dementia awareness, infection control and food hygiene. Additional training was in place or planned in areas specific to people’s individual needs.

Staff had a good knowledge of people’s likes, dislikes, preferences, mobility and communicative needs. People we spoke with confirmed this to be the case.

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. People who used the service gave us consistently exceptional feedback about the attitudes of all staff members.

Care plans were sufficiently detailed and person-centred, giving members of staff and external professionals relevant information when providing care to people who used the service. Person-centred means when the person receiving care is central in developing their care and their preferences are respected.

Care plans were reviewed regularly and with the involvement of people who used the service and their relatives.

The registered manager displayed a sound understanding of capacity and the need for consent on a decision-specific basis. Consent was documented in people’s care files and people we spoke with confirmed staff asked for their consent on a day to day basis.

People’s changing needs were monitored, identified and met through liaison with a range of external health and social care professionals.

People we spoke with and rela

We considered our inspection findings to answer questions we always ask:

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills and had received the training in order to meet the person's support requirements.

Risk assessments were in place. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Records were in place to show the agency carried out effective recruitment and selection processes to ensure that suitable staff were employed by the agency to support people. These processes included carrying out regular checks to ensure that staff continued to be suitable to work after they had begun working for the agency.

Information was available to show that the service worked with other agencies to try to prevent admissions to hospital wherever possible.

Is the service effective?

People we spoke with were very complimentary about the service provided. People commented how helpful and caring the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. All people said they were fully aware of the care plans which were kept in their house.

Staff we spoke with were knowledgeable about people's care needs. They told us they were introduced to a person before they started to work with them and received enough information to ensure they provided individual care and support to the person. They told us any change in people's care was passed on to them through the agency's office. Staff said; "Communication is brilliant and we are given good information about people's needs." People who used the service told us they were nearly always seen by the same staff who knew them and their needs well. One person commented; ”The staff are very reliable", another commented, "They are really helpful." And "They sometimes stay over their time, they never leave early."

Staff said there were excellent training opportunities and their training was up-dated when required.

Is the service caring?

Staff were matched with people who required a service to ensure they were compatible and shared the same interests, where possible with the person who required care and support. Staff members were introduced to the person before they started to work with them and they received detailed information to ensure they provided safe and effective care.

All people and relatives spoken with talked highly of the level of care provided by staff. Comments included; "The staff are wonderful, nothing is too much trouble." Another commented; "My carer takes time to listen to me." We found people were encouraged to be involved in daily decision making. Staff were helpful and offered people information and support about their care. People said they could ask questions if they were not sure what was happening to them or raise any concerns with staff who were all very approachable.

People who used the service were always accompanied by a person to hospital, if a visit was necessary, and the worker stayed with them until a family member arrived or they were admitted to a ward. This was to ensure that hospital staff could be given all the appropriate information and to support the person during their hospital appointment or admission.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence in the setting they lived in. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Referrals for specialist advice where made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.

Information collected by the agency gave staff some insight into the interests and areas of importance to the person. It helped with the provision of social activities people may wish to be involved with. The agency matched the care giver with the person who used the service, for example a person who wanted to continue to play bridge was matched with a care giver who had the same interest and played bridge.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service.

Is the service well-led?

There was a clear focus from management on the provision of individual care and support to people who use the service. Staff were knowledgeable about the support needs of people and the agency's ethos of maintaining the dignity and involvement of the person whatever their level of need.

Both staff and people who used the service said communication was excellent. People who used the service had regular contact from office staff to check their well-being and the quality of service provided by the care givers. This was in the form of telephone calls and visits by managers. These visits provided an opportunity to discuss the person's views of the service they received, the way care was provided and any areas of improvement.

Staff received regular supervision and commented they felt supported by the management team and advice and support was available at any time due to the on-call system provided by the managers.

People we spoke with confirmed they had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues and felt confident they would be listened to. One person said; "I know who to contact if I have a problem."

This was an announced inspection. We visited the provider’s offices on the 8 and 9 September and made calls to people using the service and their relatives on the 16 and 17 September. The last inspection was in March 2014 and the service was compliant with the regulations in force at the time.

Home Instead Senior Care is a domiciliary care service that is registered for the regulated activity of personal care. The service provides care and support to people in their own homes. At the time of inspection there were 31 people using the service.

There was a registered manager who had been in post since registration in 2012. 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.

We found that people’s care was delivered safely and in a way of their choosing. They were supported in a manner that reflected their wishes and supported them to remain as independent as possible.

People’s medicines were managed well. Staff watched for potential side effects and sought medical advice as needed when people’s conditions changed. People and their family carers were supported to manage their own medicines if they wished.

Staff felt they were well trained and encouraged to look for ways to improve their work. Staff felt valued and this was reflected in the way they talked about the service, the registered manager and the people they worked with.

People who used the service were matched up with suitable staff to support their needs, and if people requested changes to their care hours these were facilitated quickly. People and relatives were complimentary of the service, and felt included and involved by the staff and registered manager. People felt the service provided met their needs and supported them as individuals.

There were high levels of contact between the staff and people, seeking feedback and offering support as people’s needs changed quickly. People and their relatives felt able to raise any questions or concerns and felt these would be acted upon.

When people’s needs changed staff took action, seeking external professional help and incorporating any changes into care plans and their working practices. Staff worked to support people’s long term relationships and kept them involved in activities that mattered to them. Relatives thought that staff were open and transparent with them about issues and sought their advice and input regularly.

The registered manager was seen as a good leader, by both staff and people using the service. They were trusted and had created a strong sense of commitment to meeting people’s diverse needs and supporting staff. Staff felt the ethos and values of the provider supported them to do their best.