The inspection took place between 21 November and 3 December 2018 and was announced. We gave the provider 48 hours’ notice because the service is a domiciliary care agency and we wanted to make sure someone would be at the office to assist with the inspection.

Westmorland Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to mostly older adults. Not everyone using the service receives the regulated activity personal care. The Care Quality Commission (CQC) only inspects the service being received by people provided with personal care such as help with tasks relating to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of this inspection, the service provided personal care to 96 people. The majority of the people that received care from the provider had made the choice to use the service as it was either privately funded or through the use of their direct payments. A small number of people were funded through adult social care or by NHS continuing healthcare funding.

The service registered with CQC in October 2017. This is the first inspection of the service.

The service had a registered manager who was also the nominated individual. 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.

The service was owned and run by three directors; two were medically trained and experienced doctors. One had previous experience of being the registered manager of a domiciliary care agency that had been rated as outstanding.

People and relatives were extremely positive about the caring nature of staff and the responsiveness and reliability of the service. Everyone we spoke to, without exception, told us how the service exceled in delivering a service that met their needs. One person told us, “They are passionate about giving great service and being the best carers. It’s the whole package, they do everything right."

People were supported to continue to live independently within the community and through positive risk taking so that people could live fulfilling lives whilst still remaining safe. The service had set up a contract with an independent physiotherapist to help people maintain and regain skills to ensure they remained safe in their own homes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were skilled and proactive in recognising and reducing risks.

Reliability had been a key factor in people rating this service so highly. The service had an unbroken track record of no missed visits and guaranteed that no one would receive a visit from a care worker they had not met before. People told us they had a set team of care staff and that this was extremely important to feeling safe and well cared for.

Safeguarding had a high profile in the organisation and staff were highly skilled and trained in protecting vulnerable adults from abuse. The service had developed innovative training using drama students to act out scenarios to make the safeguarding training for staff come to life and to be more meaningful.

Staff were highly motivated and reflected pride in their work. The values and culture of the service was exemplified by all the staff who worked in the service. People using the service used the term "go the extra mile" frequently to described staff support. Staff recruitment was robust and the selection process very competitive to ensure that staff had the right attributes, skills and experience.

A well-structured staff development programme resulted in a prof