The inspection took place on 12 and 20 October 2016. This was an announced visit because we needed to make sure the registered manager was available and that people’s care records were available in the office for us to look at.

Prior to this inspection this service was inspected on 6 August 2014 where all standards inspected were met.

The Home Care Connection is a domiciliary care agency that specialises in providing live- in care staff. There is a registered manager in post. A registered manager 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.

The agency was well organised and managed. The registered manager and office staff were well informed about people who used the service and had a close working relationship with the care staff. There were robust systems of monitoring to ensure the service given was of a high standard. People and their relatives were encouraged to contact the office and asked to provide feedback about the service they received.

All users of the service including people, relatives and professionals spoken with spoke very highly of the agency and the service they provided. People and relatives told us the continuity of care provided by the agency was a strength of the service. The agency had systems in place to ensure there were appropriately skilled care staff to live in people’s home and provide a good level of care and support. The service had a robust recruitment process to ensure the care staff were safe to work with people. Care staff received a thorough induction and ongoing training and supervision to support them to undertake their role. Care staff were employed at different levels to reflect their knowledge, experience and skills. The care agency aimed to match people with suitable carers and completed introductions prior to commencing and agreeing a package of care. Care staff demonstrated they understood their responsibilities to report abuse under safeguarding adult’s legislation and obtained people’s consent before providing care and support acting in line with the Mental Capacity Act 2005.

The agency had an ethos of keeping people as independent as possible in their own homes. Care plans focussed on what the person could do for themselves and identified where they required assistance from the care staff. Care staff were knowledgeable about the people they cared for and ensured they received appropriate support from health care professionals. Care staff had received training to support them to administer medicines in a safe manner and were knowledgeable about the medicines and their use. All people and relatives spoken with found the care staff very caring and respectful and spoke highly of their competency in managing the care provided.

People were supported with their diverse needs and care plans were person centred with care given tailored to meet the needs of each person. Care plans and risk assessments were reviewed and updated on a regular basis and if people’s circumstances changed. People or their relatives were involved in care planning and signed care plans to show they agreed with the care and treatment provided.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw there were risk assessments in place to ensure people’s care was delivered safely and effectively. All care workers and managers we spoke with demonstrated a good knowledge of the principles of safeguarding. We saw records which showed all staff had attended training in safeguarding adults and the Mental Capacity Act (2005). The staff we spoke with understood the procedures they needed to follow to ensure people were safe and relatives told us they knew what to do and who to contact if they had any concerns.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People had an individual care plan which set out their care needs. We were told by people who used the service and their families they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Staff were aware of people’s preferences, interests, aspirations and cultural and spiritual needs and supported people to meet these.

The service had systems in place to monitor and improve the care provided and to ensure people were happy with it.

Is the service caring?

People we spoke with said they felt staff treated them with respect and dignity. We saw staff introducing themselves and talking and listening to people in a respectful and warm way. Care workers showed patience and gave encouragement when supporting people. People told us "the staff are very helpful" and "they're very kind". People told us they felt safe and secure and this was confirmed by friends and relatives. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Information about the service was provided to people and their relatives both verbally and in writing and focused on people having choices and on helping them maintain their independence. People told us they had been given opportunities to ask questions and had any concerns listened to and acted on. Relatives told us the service took suggestions seriously and implemented them promptly.

The service worked well with other agencies and services to make sure people received the right care. People told us they were involved in reviewing their plans of care when their needs changed.

Is the service well-led?

The service had quality assurance systems, and records showed to us identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities, in particular the challenges of living in someone else's home. They had an understanding of the ethos of the service and the quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

We looked at five care plans and found all were person-centred and covered areas such as nutrition, medication and activities of daily living. We spoke with five care workers and all were able to explain about the care they were giving and why.

All five relatives that we spoke with confirmed that the agency had completed thorough assessments with the support of health and social services professionals, before their relatives were accepted by the agency.

The people that were able to talk to us over the phone said they felt safe with their care workers. One said, “I know my care worker’s name and I feel very safe with her both inside and outside my home.”

We saw that appropriate checks were undertaken before staff began work. The manager had files on each staff member. We looked at five staff files. All had signed a contract with the agency. Criminal record checks had been completed.

Relatives of people who used the service confirmed that regular checks were carried out by the agency to make sure that people received the quality of care they expected. They were happy with the service and confirmed they felt consulted.

We spoke with one person who uses the service, three relatives, and a healthcare professional, along with considering the results of the agency’s last quality survey of people. Everybody was happy that people’s care needs were met by the agency. “They know what to do, and do a brilliant job,” said one relative. “They’re very good so far,” a person who uses the service told us.

Everybody told us care workers and senior staff treated them with respect, and listened to and acted on their views and preferences. The agency had systems to ensure its staff were appropriately supported to deliver care to people, including through supervision and training. “I would recommend them especially for the quality of care workers provided,” commented a relative.

Senior staff and the manager undertook regular checks of the services provided at people’s home. They monitored the standard of care provided, to ensure it met people’s needs. They used a number of audit tools for this process. “I can only praise the commitment of the carers and the management in the monitoring they carry out at people’s homes,” a healthcare professional told us.

The agency’s last annual survey of stakeholders and people who use the service, from the start of 2012, found high levels of satisfaction amongst people. Where any dissatisfaction was expressed, the management team took action to address matters.