This was an announced inspection that began on 30 October 2018 and finished on 1 November 2018.

Prestbury Care provides personal care to people in their own homes. It provides care to older people. At the time of inspection 20 people were receiving care from the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People receive safe care from Prestbury Care. Staff had knowledge of how to keep people safe and there were checks in place to reduce the risk of employing staff that were not suitable to work in the service.

Staff received a comprehensive induction including training and shadowing more experienced staff. There were regular checks to ensure staff were competent to carry out their role. Staff were supported in supervisions and staff meetings.

Staff were trained in the administration of medicines and could describe how to do this safely. We reviewed the records of medicines and the auditing and found that while people are given their medicines safely, auditing systems need to be improved. The provider has since reviewed their auditing of medicines.

Care plans were detailed and risks to people were identified and assessed. An electronic system enabled staff to have easy access to care plans so that they had the information that they required to support people appropriately.

There was a positive culture within the organisation, with good communication that promoted positive team working and a desire to continually improve the quality of care. Staff worked well together to meet people’s care needs.

People were supported to access other healthcare services and the service worked well with other professionals.

People were supported to eat and drink. Staff completed food hygiene training and details of allergies and specific requirements were made clear in the care plans.

Staff were kind and caring and treated people with dignity and respect. There was an ethos of promoting people’s independence and encouraging people to be involved in their local community. People were supported to follow their interests and hobbies.

Staff told us that they have time to support people in a person-centred way and chatted to people while they were delivering care to get to know them better. People were happy with the service and there had not been any complaints. People told us they knew how to raise concerns if they needed to, and felt that these would be addressed.

The registered manager and the board share a clear vision for the service to focus on quality rather than quantity. This vision was understood by both staff and people using the service, all of whom spoke highly of the management.

The service contacts people using the service monthly to get feedback and review care plans. They have plans to carry out surveys with people and staff before the end of their first year of operation to contribute to improvement. The service listened to feedback and used this, along with their own audits, to inform the future development of the service and to improve systems and processes. The service has regular board meetings where progress of key areas of the service are monitored. All this information feeds into a quality improvement plan.

We found that some of the systems are not yet sufficiently robust to cope with future growth. At the moment the service is small enough that the managers know individuals, understand people’s care needs and are able to respond and make changes when necessary. This will not be the case as the number of people using the service increases. The service has already taken steps to address this and created a new position of client relations manager, as well as invest