This inspection took place between 28 June and 23 July 2018. We carried out two announced visits to the provider’s office on 28 June and 4 July 2018 and carried out telephone calls to people on 29 June, 7 and 23 July 2018.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults.

The Urgent Response Service is the local authority’s rehabilitation and reablement service. It is registered to provide personal care for adults, and supports people in their own homes for up to a six-week period. The number of people using the service fluctuates, but at the time of inspection there were 131 people using the service. The aim of the service is to give people the opportunity to relearn or regain some of the skills for daily living that may have been lost because of illness, accident or disability.

There was a registered manager in place. 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.

The provider had a proven track record of producing outstanding outcomes for people. This included helping to reduce failed hospital discharges or avoidable hospital admissions and providing care in people’s homes to avoid the need for residential placements.

Many people started working with the service with a high level of care needs around their daily living skills. The provider worked with people in a highly focussed way to build people’s skills and reduce their need for ongoing care. At the end of their commissioned six weeks of care, people’s care needs were reviewed with most people requiring significantly less or in some cases no ongoing care at all.

People were placed at the heart of The Urgent Response Service. The registered manager and staff were passionate in their drive to help people regain their skills after illness or injury. There was a conviction and clarity about how these outcomes would be achieved and how obstacles and challenges could be overcome.

Staff had received a wide range of training in their role. Where people had specific needs, the registered manager ensured staff had the training, support and guidance to meet these needs.

There was a culture of embracing learning and development within the service. Many staff had taken on additional training or qualifications to become ‘champions’ in key areas in their role. This increased the overall skills of the staff team which complemented the delivery of high quality care.

Staff were involved in the development of the service. The registered manager kept them involved and informed about how the service was performing, which gave them focus and drive on making improvements and the confidence to reflect on their own working performance and behaviours.

The registered manager monitored the service’s performance against a set of key performance indicators, which focussed on achieving positive outcomes for people. The provider had regularly met or exceeded these targets, which was reflected in the overwhelming amount of cases where people’s quality of life had improved because of the care provided.

The provider worked in partnership with people, healthcare professionals and social workers to optimise the effectiveness of care. Through these partnerships, people’s needs were thoroughly assessed and care plans were pinpointed to identify the key areas where people required support. The provider could draw on a range of expertise and resources meaning that changes to people’s wellbeing were responded to promptly.

The provider had achieved outstanding results in referring people to assistive technology, which helped them carry out everyday tasks they would otherwise struggle with. This promoted their rec

The inspection took place on 19 and 24 November 2015 and was announced. We gave 48 hours notice of the inspection because the location provides a domiciliary care service and we needed to be sure that records would be available.

City Care First Support service is the local authority’s rehabilitation and reablement service. It is registered to provide personal care for adults, and supports people in their own homes for up to a six week period. The number of people using the service fluctuates but tends to be between 160 and 180 at any given time. The aim of the service is to give people the opportunity to relearn or regain some of the skills for daily living that may have been lost as a result of illness, accident or disability.

There was a registered manager at the service. 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.

People said they felt safe with the staff who visited them. People were supported by suitable staff because the provider followed robust recruitment procedures and ensured satisfactory pre-employment checks were completed. The provider had policies and procedures in place designed to protect people from abuse and staff had completed training with regard to safeguarding adults. Risks were identified and managed so that people were protected but able to improve their physical abilities. The team was managed and rostered on duty in a way which meant people were supported by the same staff. People were supported with their prescribed medicines by staff who were trained to do so.

The aim of the service was to enable people to continue living at home. The staff therefore supported people in a way which promoted their independence and increased their mobility and personal care abilities. Staff were supported in their role through induction, training and supervision. However, staff were not always able to access refresher training within the timeframe set by the provider.

Staff supported some people to eat and drink as part of their task plan. Staff also liaised with healthcare professionals, seeking advice when necessary.

Staff formed positive caring relationships with people they supported and spoke about people in a caring way. People made every day decisions such as how they liked to be supported and what they liked to wear. Staff knew how to respect people’s privacy and dignity when supporting them with personal care.

The service provided care and support to meet individual needs. Staff visited people to discuss their preferences with them and to undertake an assessment of their needs. There was a complaints procedure in place and people felt able to complain. Complaints were investigated and people received a response.

The management team promoted a positive culture that was open, inclusive and empowering. Staff were clear that the culture was one of team work which included the management. The ethos of the service was to provide the best quality care and the registered manager ensured they sought views from people using the service as well as staff.

Prior to the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.