This inspection took place on 9 and 10 October 2017 and was announced. At the last inspection on 24 August 2015 we found the service was rated 'Good' in all key questions and overall. At this inspection, we found the service was Outstanding in the Responsive and Well-Led domains.

SweetTree is a domiciliary care agency which provides home and live in care across London. At the time of our inspection, the agency provided support to a range of people. These included elderly and people living with dementia, people with brain injuries and neurological conditions and people with learning disabilities. Each area of the service provision had its own specific care team led by a member of the management team.

At the time of our inspection there was no registered manager appointed. 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 and associated Regulations about how the service is run. The previous registered manager had left in September 2017 and the agency had planned to appoint three new managers for each area of the service provision. This was to ensure that section of the service would be managed by a skilled and experienced manager. Following the inspection, the Director on Operations informed us, that three new managers were appointed and they would be submitting their individual applications for registration with the Care Quality Commission (CQC).

Although there was no registered manager at the time of our inspection, the agency continued to deliver seamless and professional care. This was due to the senior management team, including both managing directors and respective service directors and managers, having an exceptional understanding of all the matters related to providing care to people who used the agency. Our conversations with members of the senior management team confirmed that they knew the service very well and they were able to manage it to the high standard. Therefore, we were reassured that the exceptional service would not be affected even if the registered manager was not in post at the time of our visit.

At the time of our inspection, SweetTree provided the registered activity of personal care to approximately 380 people and employed approximately 500 staff members including 64 members of the office team.

The agency was exceptionally well led. There was strong leadership at all levels. The senior management team had been actively involved in all aspects of service provision and had very good knowledge about the business needs of the service provided and the satisfaction level of people who used it. This had been achieved through a variety of robust quality monitoring systems. These included internal and external quality audits and quality questionnaires completed by staff, people who used the service and their relatives.

Staff told us they were well supported by the management team and they thought they could approach them with any issues related to their professional roles and responsibilities. The senior management team had recognised staff efforts and their positive contribution to the quality of the service. They had introduced “The Jairo Medina Award”, to honour the memory of an ex-employee who had tragically lost his life in August 2016. Monthly Sweet Awards, a staff good practice recognition rewards scheme, were presented to staff to acknowledge positive feedback given to staff by people they supported and their family members.

There were a number of partnership initiatives. The aim was to continuously improve the positive experience of people who used the service and their families and increase awareness of the challenges and positive outcomes when working with people who need the support of others. This included the development of a National Dementia Carers Day in partne

SweetTree is a home care agency based in North London which provides domiciliary and live in care predominantly across London.

At the time of our inspection the provider employed a registered manager. 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 and associated Regulations about how the service is run.

The provider took the appropriate steps to ensure that staff were safe and suitable people to provide care and support. Keeping people safe was important to the service and people we spoke with had confidence in the ability of the service to keep them safe and to respond to any concerns if they arose.

We looked at the training records of eight staff. We saw that in all cases essential training had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff supervision was provided using a system called facilitations which combined staff supervision with on-going appraisal.

People’s human rights were protected and the service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with. Proper consideration and consultation took place to protect people’s human rights.

People who used the service had a variety of support needs, in some cases highly complex needs, and from the nine care plans we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed, and the action needed to minimise risks was recorded. We found that risk assessments were updated regularly.

During our review of care plans we found that these were tailored to people’s individual needs. Communication, methods of providing care and support with the appropriate guidance for each person’s needs were in place and consent to care was obtained.

We found that staff respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. From the conversations we had with people, our observations and records we looked at, we found that people’s preferences had been recorded and that staff worked very well to ensure these preferences were respected.

From the discussions we had with people using the service, relatives and other stakeholders we found that people were usually highly satisfied with the way the service worked with people. There was confidence about contacting all staff at the service to discuss anything they wished.

Records which we viewed showed that people were able to complain and felt able to do so if needed. People could therefore feel confident that any concerns they had would be listened to and the service was open about action taken and changes made as a result.

People were treated with respect and dignity. They told us staff were "just fabulous" and they treated people "properly" with "respect" and "dignity". People indicated that care and support was provided in a manner which ensured their privacy. We noted that staff had appropriate skills and experience to meet people's needs.

People's needs were assessed and reviewed regularly. We noted that staff arrived on time and completed all the tasks before they left. The agency had a sufficient number of staff to ensure that shifts were covered and people's needs were met.

The agency had systems in place to ensure that people who used the service were protected from harm. People told us that staff were "not patronising" or "condescending". They told us they felt "safe" using the service. People and their relatives told us that they knew how to make a complaint if they were not happy about the service.

One person told us SweetTree were “absolutely amazing” and another person told us “everyone is ready to listen”. One relative told us they were reassured by the regular contact with the provider. People who used the service had an assessment which identified their needs and preferences before the service started. We looked at nine files of people who used the service and found care plans were regularly reviewed, updated and signed by people who used the service or their relatives to ensure that their consent was obtained. Care workers we spoke with felt supported and had thorough ongoing training provided by SweetTree.

We saw that care workers were aware of safeguarding policies and that they were able to identify concerns and take appropriate action as necessary. One care worker told us that “the training is really good”. Care workers we spoke with felt supported and felt able to raise concerns with their managers when necessary. There were regular opportunities for the people who used the service, their relatives and care workers to feed information back to the service. There were robust complaints procedures and complaints had been dealt with well.

We spoke with a small number of people who use the service. People spoke positively of the care staff who visit them. People commented that they could not remember having an initial assessment of their care needs, as this happened a long time ago.

People we spoke with confirmed that a care plan file is kept in their home and that care workers make a record of the visit.

People we spoke with said that if they had a concern or a complaint they would feel confident to raise this with the staff that work with them or report this to a manager. People indicated that they were satisfied with the response of the service.