We inspected Laurel Leaf Support Limited on 22 November 2018 and the inspection was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in Witney area. It provides a service to adults and younger adults living with various learning disabilities, autistic spectrum disorder or sensory impairment. On the day of the inspection the service was supporting four people.

There was a registered manager in place who was also the provider. 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, the service was rated Good.

At this inspection we found the service remained Good in Safe, Effective and Caring domains. There was overwhelming evidence available that demonstrated further improvements had been made that met the criteria for an Outstanding rating in the Responsive domain. The significant improvements of people's experiences were achieved because of excellent leadership provided by the management. We therefore also rated the Well-led domain as Outstanding and the service was rated Outstanding overall.

The registered manager had a personal experience of a close family member living with a severe learning disability for whom the service was originally set up. This had enabled the provider to have an invaluable insight of what quality of support they wanted to provide to people. We found the provider had an imaginative vision and they ensured innovative ways of putting people at the centre of the service delivery. Because of this the service was very much led by the people and people had exceptional opportunities created for them.

The provider’s governance was well-embedded and there were effective assurance systems that ensured ongoing compliance. The provider welcomed any form of input and since our last inspection they created a new post for a quality and safety officer to provide an additional layer of auditing. They saw any feedback as an opportunity to reflect and further improve the quality of the service for people. The team continuously looked for and created innovative ideas on how to have a positive influence on people’s lives and how to adapt the service delivery to the changing needs of people receiving support.

People, relatives and professionals were extremely positive about the service. People referred to the registered manager as ‘my friend’. People’s relatives spoke about the registered manager highly and told us the staff “listened to people and clearly put people's needs first”. External professionals were equally complimentary. Comments from professionals included, “I am impressed with how Laurel Leaf is run. I would, and do, highly recommend them to other service users and their families”, “I would be happy for them to care for anyone I know” and “I would recommend them without hesitation as being responsive, safe, effective, caring and well-led. The well-led element is especially strong”.

Staff remained positive about the team work and support they received from the registered manager and about the empowering culture that was promoted by the service. Staff complimented the training provision and the support received from the senior team. There was a high level of satisfaction and a sense of pride of working at the service demonstrated by the team.

People received care and support that in words of their relatives and professionals was ‘life changing’. We had feedback that reflected that even when people themselves felt they had no opportunities and lost their confidence with the perseverance and encouragement of Laurel Leaf staff they flourished. One professional said one person, “Was now in a better (place) than we could have hoped for”. One

We inspected Laurel Leaf Support Limited on 11 May 2016. This inspection was announced. Laurel Leaf Support Limited is a domiciliary care agency which provides support to adults living in community. Support can range from a few hours each week to twenty four hour support for all aspects of personal care and daily living. At the time of this inspection six people were supported by the service.

There was a registered manager in post at the service. 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.

People told us they felt safe. The staff knew how to safeguard people and protect them from harm and risk of abuse. Staff had a good understanding of their responsibilities to report any suspected abuse. There were sufficient numbers of staff deployed to meet people’s needs. Records relating to the recruitment of new staff showed relevant checks had been completed before staff worked unsupervised at the service.

The provider had systems in place to ensure safe administration of medicines. People’s individual risks were managed and reviewed. Where people were identified as being at risk, management plans were in place and action had been taken to manage these risks.

Staff knew people they supported well and had access to development opportunities to improve their skills. Staff received regular supervision and were confident in their roles. Staff received training specific to people’s individual needs.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) and the principles of the Deprivation of Liberty Safeguards (DoLS). This protected the rights of people who may not be able to make important decisions themselves. People benefitted from staff who understood and implemented the principles of the MCA. People told us they were asked for their consent before care was carried out.

People were supported to maintain a healthy diet and their nutritional needs were assessed and recorded in support plans. People were supported to maintain good health and received support with accessing health care services. The registered manager worked in partnership with a number of external professionals to ensure people’s needs were met.

People consistently described the staff as ‘good’ and ‘caring’. People and their relatives told us people were treated with kindness and their privacy and dignity were respected. People benefitted from positive relationships they were able to form with the staff.

People told us they were involved in their care. People’s needs were thoroughly assessed prior to commencement of the service to ensure their needs could be met. People’s care records contained details of people’s personal preferences, likes, dislikes and health needs.

People were supported to live their lives as they wanted and the staff ensured that where possible, people’s aspirations were achieved. People were cared for by the staff that encouraged them to retain and gain skills to promote their independence.

The registered manager sought people’s opinions through a yearly quality satisfaction survey and regular meetings. The records confirmed provider acted on the feedback received from people. People told us they knew how to raise concerns but they had no reasons to do so. The registered manager ensured any complaints were recorded and responded to in line with the provider’s policy.

The registered manager ensured regular audits were carried out to monitor the quality of service. Audits conducted covered all aspects of the service delivery and information gathered was used to improve the service.