About the service: Penrose Care Ltd is a domiciliary care agency that provides personal care and support to older people in their own homes in and around North London. People receiving a service included those with physical disabilities, learning disabilities, acquired brain injuries and health issues relating to the progression of age. At the time of this inspection the agency was providing a service to 16 people out of which nine people received the regulated activity of personal care.

People’s experience of using this service:

The agency provided exceptionally good care to people who used it. All stakeholders we spoke with, including people using the service, their family members and external health and social care professionals gave consistently positive feedback about the agency. They thought the agency was very well run and was very responsive to people’s needs. They described staff as very skilful and having an exceptional level of commitment to supporting people and facilitating their improvement.

Staff were exceedingly committed to providing best support to people. Therefore, people’s wellbeing and activity levels had been noticeably improved. Staff were consistently commended for their kindness, patience and professionalism. Staff provided empathetic care and adapted this to meet the rapidly changing needs of people.

Staff knew people well. Without exertion staff supported people in enhancing their lives so people felt valued, empowered and fully included in their care. Staff continuously involved people in making decisions about their care and supported them to have their voice heard. With staff thoughtful support, people could participate in the community events, socialise, follow their hobbies, travel and lead independent lives as much as possible. Feedback from various stakeholders clearly attributed people’s improved wellbeing to staff support, encouragement and commitment. They thought, because of staff support, that people were achieving better than expected outcomes and they could live the best life possible with their health conditions.

Motivation to meet people’s needs well was at the heart of the agency’s exceptional performance. The agency worked closely with other professionals to develop bespoke care packages for each person using the service. This helped to ensure the care and support provided to people suited their often very complex and highly demanding needs. People’s care plans had comprehensive information related to care needs and how care should be provided. People, relatives and external professionals thought the agency was very flexible in their approach and could provide high quality additional support even at short notice.

Staff received regular mandatory and additional training to ensure they had sufficient skills and experience to support people in a safe and effective way. Regular supervision, appraisal and managerial spot checks ensured that staff were appropriately supported and that they provided care in the way that matched people’s needs.

The agency provided safe care. People told us they felt very safe with staff who supported them. There were effective safeguarding systems in place that helped to protect people from harm. Appropriate recruitment practice protected people from unsuitable staff.

An ongoing risk assessment and management process helped to minimise the occurrence of and effects of risks relating to people’s health, activities and environment. This included places people visited. People received their medicines as prescribed. There were robust procedures in place to ensure medicines were managed safely.

There were sufficient staff deployed to support people. People said staff were always on time and they never missed a planned visit. People and relatives were confident care would be provided as planned.

People were supported to have enough food and drinks and have a balanced diet that matched their needs and preferences.

The agency was working within

This inspection took place on 2 June 2015 and was announced. We gave the provider 48 hours’ notice of this inspection to ensure that the registered manager would be available to support us with the inspection process. At our last inspection of the service, carried out on 20 May 2014, the service was meeting the regulations that were looked at during that time.

Penrose Care Ltd is a small domiciliary care agency that provides personal care and support to older people in their own home in and around North London. People receiving a service included those with physical disabilities, learning disabilities, acquired brain injuries and health issues relating to the progression of age. At the time of this inspection the agency was providing a service to seven people. The agency provided a variety of visits ranging from a minimum of ninety minute calls to waking nights and sleep in’s depending on people’s individual needs. In addition to the provision of personal care as a regulated activity, the agency also provides additional services which include companionship, domestic support, support with shopping and escort services.

During our visit the registered manager was present. 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 and relatives that we spoke with were highly complementary of the service that they received. They spoke very highly of the registered manager and the care staff team that supported them. Care staff were aware of people’s individual needs and how they were to meet those needs. People and relatives also commented on how responsive the service was with regards to providing additional care even at short notice.

The agency had a number of policies and procedures which were available to help ensure people were protected from abuse and the risk of abuse. These included risk assessments that considered people’s individual potential risks, a robust recruitment process, staff training and guidance and direction on how to identify abuse and the actions to take if abuse was to be suspected.

The agency ensured that care staff were equipped with the skills and knowledge needed to deliver high quality care. A number of methods were used to deliver the training which included face to face training as well as on the job experience alongside a more senior and experienced care staff.

The registered manager also told us about an innovative and dynamic training project which they had developed based on feedback they had received from people using their service. The programmed looked at training and developing the fine skills of its care staff in order to meet the more holistic needs of the people who used the service.

Care staff told us they enjoyed working for the agency and felt well-supported by the registered manager. Care staff received regular supervision as well as group reflective supervision conducted by one of the directors of the agency.

Penrose Care Ltd believes that to ensure people who use the service received continuity of care and a high quality of service, care staff should be trained well and should receive an appropriate wage which takes into consideration the type of work they do and the amount of time it takes them to travel between people’s homes. With this in mind the agency paid its care staff according to the living wage and also for the time they spent travelling.

We saw suitable and safe arrangements in place in relation to the administration and recording of medicines.

People received personalised care that was responsive to their needs. Care plans were person centred, detailed and specific to each person and their support needs. Care plans were reviewed on a regular basis. People and relatives confirme

Our inspection team was made up of one inspector. They answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with two relatives of people who used the service, the registered manager and two care staff. We also reviewed records relating to the management of the home which included, four care plans, daily care records and two staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

There were appropriate staffing levels to support people using the service. Staff were knowledgeable in safeguarding vulnerable adults procedures and were able to recognise signs of potential abuse. The service had a system to respond to allegations of abuse and had details of the local safeguarding team.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted.

Is the service effective?

The staff had the skills and experience required to meet the needs of people who used the service. The team had access to training courses to update their knowledge and become familiar with any changes in policies or procedures.

The service undertook assessments with the person who used the service or a relative to identify their support needs.

Is the service caring?

People who used the service or a relative was involved in decisions about their care and support. Staff supported people and advised them but allowed the person who used the service to make the final decision. Staff told us, "we always ask [people who used the service] what they want."

A relative of a person who used the service told us “they take a lot off of my shoulders, they are marvellous.”

Is the service responsive to people's needs?

The service liaised with other health professionals to meet the needs of people who used the service. The service had recently been in contact with a general practitioner about changes to the administration of medicines for one person using the service.

Is the service well-led?

The service was working to the strengths of individual staff members and using the skills and knowledge of staff to provide the required service to meet people's needs.

Staff told us they felt very involved and supported in their roles. They said that the manager of the service was accessible and approachable. They had regular supervision sessions and were able to meet with the manager as needed if they had any questions or concerns.

There were processes to monitor the quality of the service and to improve the quality of service delivery.

Since its registration with CQC, the agency had provided service to only one person. We noted that the agency had systems and staff in place to provide personal care to people using the service.

People were satisfied with the care and support provided by staff. They commented that they were “very happy [about the service]” and staff were "very caring”.

The provider had policies and procedures including safeguarding, health and safety, and equality and diversity. Staff told us that they had attended induction and training programmes which they found it useful in caring for people.

Appropriate checks were undertaken before staff began work. This ensured that people were cared for by staff who were appropriately vetted.

People’s care plans were based on their assessment of needs. This ensured that people received care that reflected and met their needs. The provider had a system in place for involving people who used the service or their carers to ensure that their views were taken into account in the way care was provided.