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People we spoke with told us they felt their relatives using the service were kept safe. The service conducted appropriate checks on people before they were offered employment and tried to recruit people who they believed would fit in with the families they would be supporting.

Once recruited, staff underwent comprehensive training including training in the use of medical equipment that people they were supporting would use. Care workers told us they did not feel rushed during the training and felt they would not be signed off as competent until they were ready. All staff were signed off by the clinical lead once they had completed their induction and staff had their competency reassessed at least annually to ensure they were maintaining good practice.

People we spoke with told us they had the same team of care workers most of the time and that these were usually sufficient. Some people we spoke with commented that because of the in-depth training new care workers underwent it sometimes took a while for care workers to be replaced when they left.

The service had good oversight of the use of medicines by care workers and medicine administration records were regularly audited to ensure care workers were following good practice.

People were involved in the support planning process. The operations manager of the service told us the transition process from when a person was referred to the service to them starting with the service would take between six and twelve weeks during which time the person's support plan could be drawn up and agreed with family members and other healthcare professionals.

People's cultural and religious needs and choices were included when support plans were agreed.

The service worked well with other organisations to try and ensure a smooth transition between healthcare settings. This included people being visited in hospital by care staff so they could get to know each other and where people were already receiving support, care workers visited them in hospital to provide social support for them.

People we spoke with told us they felt their relatives were treated with compassion and respect. People felt confident in the care workers' abilities to look after their relatives.

Many of the people they were supporting were not able to communicate verbally but as the care workers

knew the people they were supporting well they were able to understand the non-verbal communication of the people.

Relatives of people using the service told us they were involved in regular reviews of the support their relative was receiving and felt their views were listened to and included in any revised support plans.

The service encouraged people to share their views with them and where people had complained they told us they had received a prompt reply and an apology. People told us their complaints had been listened to and things had improved as a result.

The management team had a clear vision of the service they wanted to deliver. Care workers we spoke with largely shared their vision although some people we spoke with felt they didn't hear from senior management frequently enough.

Care workers we spoke with told us they felt able to speak up when things weren't right and felt confident the management of the service would listen to their concerns. The managers of the service told us they were always looking to improve and welcomed feedback. We saw records where suggestions had been investigated and changes made as a result.

The service had 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 registered manager showed a clear understanding of their responsibilities and recognised where the skills of the other members of the management team complimented their own. The management team held regular meetings to review the service and other members of the management team told us their strengths were recognised and their views were listened to.

The service demonstrated good working relationships with other agencies such as commissioners of care, specialist hospitals and other healthcare professionals to try to ensure good outcomes for people using the service.

The five questions we ask about services and what we found