This inspection took place on 19 and 21 September and was announced.

At our last inspection we rated the service Good. At this inspection, we found the evidence had improved to support the rating of Outstanding, with an improved rating of Outstanding in caring and well-led. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

The service is a domiciliary care agency. It provides personal care to older and younger people who may have learning impairment, a dementia related condition or a physical disability and live in their own houses and flats in York and the surrounding areas.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of this inspection the service was not supporting any persons with a learning impairment.

Not everyone using Home Instead Senior Care 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. At the time of this inspection 111 people were receiving a service and of those 58 received a regulated activity.

People and their relatives were extremely satisfied with the care and support they received. People told us that staff paid attention to the little things that mattered to them, working above and beyond their normal duties to support them. One relative advised they had travelled home thinking about the bedding being on the washing line in the rain. When they arrived home, the care worker had taken the initiative to bring the washing in and fold it up. This meant the relative could spend more time with their loved one, rather than rewashing all the bedding. Where people had interests they felt unable to pursue, staff would explore them and find either similar interests to adapt to their current circumstances or get creative with people to spark their enthusiasm. Staff clearly cared deeply for the people they supported.

Staff described how people were supported to remain as independent as possible, whilst having an awareness of their human rights. Care plans contained detailed information about people’s levels of independence to support staff knowledge and practices. People and their relatives told us staff were conscientious and promoted the utmost dignity at all times. Staff told us they treated people like part of their own family and were extremely considerate of people’s privacy.

Communications across the service were excellent and people’s needs, choices and preferences were considered. Information was available to people in different formats and staff had a good awareness of how to support people with sensory impairments. The provider had also completed research in the local areas to ensure information was available on local services to which promoted people’s independence and well-being.

The provider had developed excellent strategies in line with CQC’s approach of safe, effective, caring, responsive and well-led. Innovative ideas were suggested, actioned and shared with other organisations and local authorities to promote exceptional community links. This reflected the changing needs and preferences of people whilst improving care outcomes.

People and their relatives felt the management and leadership worked exceptionally well to deliver high quality support tailored to their individual requirements.

The management and staff team had a positive and inclusive culture. They listened to people and empowered them to have a voice in all aspects of their care and the running of the service. This resulted in high quality and extremely person-centre

People we spoke with said that they were informed about the service they could receive and were able to ask questions before they gave their consent to receive a service.

We saw that people had individualised care records and risk assessments in place which helped the caregivers to understand and meet people's needs. A person we spoke with said “The staff provide all the help I need.” A caregiver said “I have had the same clients since I started. I have a really good relationship with them. They trust me, you get a bond developing. We go the extra mile to make sure people are well supported.”

People we spoke with during our visit confirmed that there was enough staff to support them. A person said “The staff arrive when they say they are going too. There seem to be enough staff. It is a reliable service.” Staff we spoke with said they received training which helped them to provide care to people in a safe way.

People's views were being sought about the quality of the service being provided. There were systems in place to deal with any complaints. An issue was raised with us during our visit. We saw that this was acted upon to help to make sure that people would remain satisfied with the service they received.

We spoke by telephone with five people who use the service. The majority of the comments were very positive. We also looked at the customer satisfaction survey comments, recently completed by people using the service and found these to be mostly very positive too.

The comments from people we spoke with included “The care-givers are very friendly. They always visit on time. I have no complaints at all.” Another told us “The girls (care-givers) who visit are very kind to my relative. They talk with X whilst they are providing care. They definitely wouldn’t try and get X to do something if they didn’t want to. They’re very respectful like that.” And a third talked positively about the service, saying “Overall I’m delighted with the care. The care-givers are top notch. I feel very safe and would trust them with my life.”

One person made a suggestion as to how the service could be improved and we passed this comment on to the provider. Another person, whilst saying that the staff were generally ‘pleasant and competent’ said that once or twice the care-givers visiting them did not have the experience to meet their needs. They had met with the senior managers to discuss their concerns.

We inspected this service on 15 and 22 December 2015. The inspection was announced. The provider was given 24 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.

New York Care Limited t/a Home Instead Senior Care 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 to people. At the time of our inspection the service supported approximately 100 people although only 40 were receiving support with a regulated activity.

The service was last inspected in July 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 there were systems in place to ensure that care workers were able to identify and respond to signs of abuse to keep people using the service safe. We found that people’s needs were assessed and risk assessments put in place to reduce risks and prevent avoidable harm.

The service had a safe recruitment process to make sure only people considered suitable to work with vulnerable client groups were employed and we found that there were sufficient care workers to meet people’s needs.

Care workers were trained to administer medications and people using the service told us this was done safely.

There was an effective induction process and on-going training to equip care workers with the skills and knowledge they needed to carry out their roles effectively. Care workers received regular supervisions and annual appraisals.

People were supported to make decisions and consent to care and treatment was sought in line with relevant legislation and guidance.

We found that people using the service were supported to eat and drink enough and to access healthcare services where necessary.

We received positive feedback about care workers. People using the service told us they were kind, caring and treated them with dignity and respect.

People received care and support from a small number of care workers who had been individually matched based on shared interests and hobbies. Care workers did not visit for less than one hour and people received support from a small number of care workers. This enabled people to develop positive caring relationships and friendships with their care workers.

We found that people’s needs were assessed and person centred care plans developed. Care plans were reviewed and updated regularly. Care workers we spoke with showed a good understanding of person centred care.

There was a system in place to manage and respond to compliments and complaints.

The service was well-led. People using the service and care workers we spoke with were overwhelmingly positive about the management of the service. There was clear organisation, good communication and effective processes in place to monitor the quality of care and support provided.

New York Care Limited t/a Home Instead Senior Care had been awarded ‘Small Business of the Year 2015' by the local newspaper and a ‘Top 10 Agency Award 2015’ based on recommendations made to an independent website which reviewed domiciliary care agencies. A care worker had been a finalist in a national ‘CareGiver of the Year 2015’ award. These awards evidenced strong leadership, with processes designed to provide a high standard of care and support to people using the service.

We observed that there was a strong person centred ethos within the service and a clear and overriding emphasis on developing and improving the quality of care and support provided for the benefit of the people using the service.