Independent Home Living (York) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone who uses the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service is registered to support older people, people living with dementia, learning disabilities or autistic spectrum disorder, mental health needs, physical disability and younger adults.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. People and staff spoke positively about the management of the service.

Risks to people were assessed and action taken to reduce them. Staff were able to explain different types of abuse and were aware of action they should take if they had any concerns. A safeguarding referral had been made appropriately. There were safe systems in place to support people with their medicines.

Appropriate recruitment checks were undertaken before staff started their employment, to ensure they were suitable to work with vulnerable people. There was a system in place to plan care visits and most people told us staff usually arrived on time. Staff received an induction, training and supervision to give them the skills and knowledge they needed to care for people effectively.

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.

People received support with their nutritional needs where required and people were satisfied with the support they received to prepare meals. Staff sought advice from healthcare professionals when they had any concerns about people’s health.

Staff treated people with dignity and respect and supported people to maintain their independence. We observed caring interactions between staff and people who used the service. It was evident staff knew people well.

Care plans were in place to give staff the information they needed to support people in line with their preferences and needs. The provider had a policy for responding to any concerns and complaints. People told us they would feel comfortable reporting any concerns and were confident these would be addressed.

There was a quality assurance system in place to monitor the quality of care provided. Feedback from staff indicated there was a positive, person-centred culture within the service.

Further information is in the detailed findings below.

The inspection took place on the 22 February 2016. The inspection was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the location offices when we visited.

Independent Home Living Yok is a domiciliary care agency which is registered to provide personal care to people in their own homes. The service supports people living in York and the surrounding villages and provides assistance with personal care, domestic help and companionship. At the time of our inspection the service supported approximately 60 people although only 31 were receiving support with a regulated activity.

The service was last inspected in June 2013 at which time it was compliant with all the regulations we assessed.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

We found that people supported by Independent Home Living (York) were safe. All staff received training in safeguarding adults from abuse and they were clear of the process and policies to follow should an allegation or any concerns be raised.

People were supported to take risks and, where any restrictions were in place to support people’s safety, these had been appropriately documented and agreed.

People spoke highly of the staff and said that they generally arrived on time, although they recognised that there were occasions where staff may be running late. The agency had systems so that this could be monitored and people contacted where necessary. Recruitment checks were completed before staff commenced work so that only suitable people were employed.

People received their medication as prescribed and we saw that medication reviews were undertaken to ensure that people were receiving the medication they required.

Staff received induction and training to support them in their roles. They had access to a range of training and staff we spoke with confirmed that this supported them in carrying out their roles effectively. Staff received regular supervision and all confirmed that they received good support from the registered manager.

People were supported to make decisions and choices. Staff received training on the Mental Capacity Act 2005 and were aware of the importance of using this legislation should any decisions need to be made.

Some people told us they received support from staff with shopping, cooking and domestic tasks. They were involved in choosing what items they wanted staff to buy or what they wanted making.

People’s health needs were kept under review and professional advice was sought where necessary. Staff knew and understood the people they supported, which meant that any changes in health were quickly identified and responded to.

We observed a positive warm and friendly relationship between staff and people being supported. People we spoke with provided positive feedback regarding the care they received. People were involved in discussions regarding their care and signed their agreement to their care records.

Equality and Diversity issues were considered and supported. People were provided with information about the agency when they started to use the service. People had access to external advocacy support where this was required.

Records were stored securely at the office and copies also held in people’s individual homes. Staff were aware of the importance of maintaining confidentiality.

Staff demonstrated a clear understanding and gave examples of how privacy and dignity was promoted and maintained. T

People told us they were asked for consent before care was given and that they were able to express their wishes about how they wanted to be supported. In general people were happy with the support they were receiving. One person told us “The support is good quality and it meets my needs”. Another person told us “Overall I am happy”.

The provider was carrying out appropriate checks when recruiting new staff and levels of staffing were closely monitored to ensure that calls were covered. However, some people we spoke with did comment on late arrival of carers.

There were robust processes for assessing the quality of service in place and people who used the service were able to feedback and felt confident that action was taken. People were informed of the complaints system which was followed appropriately by the service. Records were found to be accurate, detailed and regularly reviewed.

We carried out an inspection on the 18th of September 2012 to follow up actions from the inspection carried out in June 2012. We looked at records of people who used the service, spoke to staff, and looked at other documentation.

This was a follow up visit so we did not speak to people who use the service again, as we had spoken to them during our previous inspection. The action taken by the provider since our last visit was positive, and matched what they had told us they would do in the action plan they had submitted following our last inspection.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector, who was joined by an “expert by experience” - a person who has personal experience of using, or caring for someone, who uses this type of service.

We used telephone interviews and home visits to people who use the service and to their main carers (a relative or friend) to gain views about the service. We spoke to 29 people in total, three relatives, four members of staff, the manager and carried out four home visits.

People who used the service were given appropriate information and support regarding their care or treatment. People told us they had been involved in planning their support/care package and had chosen the level of support they needed. The agency was described as ‘very good’ and 'first class' by two people. People told us they were addressed by their preferred name, some people said they remembered being asked about this during their first meeting with staff from the agency. All the people we talked with were happy with staff from the agency and said that they felt they were respected and involved in decisions about their care.

One person told us, "The support plan is very flexible, they can make changes to the arrangements without fuss.” Other people said they were satisfied with the carers who visited them. One person said the staff were, ‘professional in the way they do things, they get on with it but include me too.’ One person told us, "They encourage me to be independent. That is important to me."

All of the people we spoke with said they felt supported by the agency staff.

One person we visited told us that the staff had been ‘wonderful' and that they ‘wouldn’t know what to do if they stopped coming.’ One person told us how they thought staff understood their needs and delivered care in the way they chose.