We inspected this service on 19 December 2016.This was an announced inspection and we telephoned the week prior to our inspection in order to arrange home visits and telephone interviews with people. The service provides care in people’s homes to older people and people with debilitating illness and long term conditions such as dementia. The service is available in the east side of Derby. The organisation is a family run business. The members have split the responsibilities of the roles, one member is the registered manager and the other member the responsible individual. Both are involved in the running of the business and both were present at the inspection. At the time of the inspection 250 people were being supported by the service. Our last inspection took place in 2014 and at that time the provider was compliant with the areas we inspected.

There was a registered manager in post. 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.

We had not received notifications relating to aspects of the service. Some people’s care folders did not have all the paperwork relevant to the care needs for that person within the home.

Staff rated the service as a good place to work and people we spoke with would all recommend the service. The staff told us they felt supported by the manager and they had received ongoing supervision.

The staff had received training in a range of areas to enable them to carry out their role and had been given the opportunity to access further training. New employees received the relevant checks to ensure they were safe to work with people and they were provided with an induction to support their role.

People felt safe and the staff knew how to report any concerns to ensure people were protected from harm. When concerns had been raised we saw these had been addressed. Risk assessments had been completed for the environment and specific needs. The assessments identified guidance and ways to reduce any identified risk.

There were sufficient staff to support people’s needs and people told us they received support from a regular group of staff which they found reassuring. Where people required support with their medicine this was completely safely and in line with the appropriate training and guidance.

People were given choices and supported to make decisions. Healthcare professionals had been contacted when requested to support people’s health and wellbeing. Some people received support with food preparation, when this happened people were given choices on their meal.

People told us staff treated them with kindness and compassion. Their dignity was respected in aspects of the care they received. We saw the service was responsive and provided a flexible approach to support people’s care needs and any changing situations.

The provider and manager completed a range of audits to use to maintain the quality of the service or to make improvements. The provider worked with the local authority to provide commissioned care. Any complaints which had been received had been responded to. People and staff were asked their opinion on the service and we saw that they had been responded to continue to make improvements.

We did not need to speak to people who use the service to establish whether this standard had been complied with by the agency.

We did not speak with people who used the service during this visit.

We found that the provider had made the following improvements to the service.

Procedures were in place to protect people against the risk of abuse, and to ensure that staff understand and respond appropriately if abuse is alleged or suspected.

Recruitment procedures have been strengthened to ensure that people are cared for by suitably qualified, skilled and experienced staff.

Staff were receiving appropriate support and training to enable them to meet peoples' needs, although staff had yet to receive an appraisal of their work.

We spoke with six relatives and people who used the service.

People told us they were happy with the care and service they received. People found the service to be reliable as they received the help they needed at their preferred times. People said that they usually received care from regular staff who knew their needs. One person told us ‘’the staff do a great job; I could not cope without them. They do everything I ask them to do’’. A further person told us ’’ I have good relationships with the staff and my main carer is wonderful’’.

People felt listened to and able to express their views and raise any concerns with staff if they were unhappy. People told us that their privacy, dignity and independence was respected.

People said they liked the staff that supported them as they were honest and reliable.

Relatives told us they were happy with the care and support their family member received. One relative told us ‘’the service has some exceptional staff that have the skills and experience to meet my family member’s needs; there is nothing to fault about the care’’. Another relative told us ‘’the care is fabulous and the staff are lovely’’.

We spoke with three people using the service and we received many positive comments about the quality of the service provided. One person told us, “Excellent service, quite superb, the staff could not be nicer.” Another person told us, “I am more than happy with the service.” A further person added “I am very happy with everything, the carers are lovely.” We also spoke to a relative who told us “I think the care given is fantastic, the staff are all lovely.”

All three people using the service we spoke with told us that the staff always stayed for the allocated time they were supposed to and completed all the tasks as set out in their care plan before they left. They told us that on the rare occasion that staff were late they received a telephone call to let them know this. In addition, one person told us “They are always on time and never rushing to leave. They always do what they need to do.” A relative that we spoke to told us “The staff always staff for their allotted time. There has been the odd mix up, but when I’ve phoned the office and they’ve sorted it straight away.”

One person using the service were supported by staff to take their medicines and they told us that staff gave the appropriate support and gave them their medicines when they were supposed to.

We spoke with five people who used the service and three relatives.

People told us they were happy with the service they received, and felt that their needs were being met. Comments received from people included ‘’I have never had a bad carer; all staff score 11 out of 10, the service is great, I can’t fault them, my main carers are excellent and I have good relationships with the staff; I enjoy their visits’’.

People also said that staff respected their privacy, dignity and independence.

We found that the service was flexible and centred around individual needs and preferences. People usually received care and support from regular staff that were aware of their needs and preferences. Although on occasions certain individuals did not receive care from regular staff.

Relatives told us they were generally happy with the care their family member received, and felt involved in decisions about their care and treatment.

Arrangements were in place to ensure that peoples' medicines were handled properly. People told us that they received them at the times they needed them.

People felt listened to and able to raise any concerns about the service with staff. We found that the service was generally well managed, and that clear lines of responsibility were in place.

Arrangements were in place to ensure that staff received appropriate induction training and supervision, although staff had yet to receive an appraisal of their work.