This comprehensive inspection took place on 24 July 2017 and was announced. Rural Care is a small domiciliary care agency situated in Bideford. It was registered with the Care Quality Commission (CQC) in July 2016 but did not commence business until September 2016. This was its first CQC comprehensive inspection.

The service provides personal care and support to older people in their own homes. The service currently covers the rural surrounding areas of Bideford.

At the time of our inspection, the service provided a service to approximately 14 people. The times of people’s visits ranged from one hour to one and quarter hours. The frequency of visits ranged from one visit per week to 21 visits per week dependent upon people’s individual needs. The service employed three care workers, two of whom were employed and one who was self-employed.

The service has two joint registered managers who were present during the inspection. 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.

People and relatives expressed satisfaction with the management of the service, knew the registered managers well and spoke highly of the care workers. They valued the close, friendly and loving friendships that have developed. People felt staff often went ‘the extra mile’ for them and were complimentary of the service. One relative commented, “They (staff) are angels without wings … we have fallen on gold here.”

The service cared for people and their relatives by keeping them at the heart of the service. The focus was to deliver care in a compassionate, kind, caring and respectful way. Feedback from people and relatives was unanimously complimentary and very positive comments received. For example, “I couldn’t live without them … I thank God every day for them … life took a decision for me and sent these girls to me … it’s very special having people you like who do anything I ask”, “If you took them (care workers) away from me, I’d be ‘pushing up the daisies’ … they are my lifeline” and “Would always highly recommend Rural Care. We feel very confident with the care given.

The service provided a high level of care to people towards the end of their life. They liaised with the local specialist hospice to home health care team to provide the appropriate care and support to enable people to remain in their own homes if they wished. They worked closely with the family and other professionals. One care worker said, “This is what my job is all about.” A care professional said, “They are very dedicated … I wouldn’t hesitate to let them look after me … they strive for such a high standard.”

People benefitted from care workers who were safely recruited, trained and supported to do their jobs properly. They felt the care was very good and there were never any missed visits. People felt their needs, preferences and wishes were the focus of the service and the care workers who supported them. They received consistent care from a small team of staff who knew them well and also cared for their family members. Meaningful and strong relationships had developed over time. Comments included: “The staff are absolutely amazing"; “The staff are brilliant, so kind and helpful”; “We very much appreciate the sensitive, good humoured but professional care provided”, and “They are kind, thoughtful and cheerful.”

Care and support was planned and focussed on people’s individual needs, choices and preferences. The minimum care visits offered was one hour which the registered managers believed was necessary to give quality care. The service responded positively and quickly to any changes in people’s conditions. People and relatives gave us examples of how the service had responded to meet people’s individual need