Caretree Limited

At our last inspection we rated the service outstanding in to areas and overall. At this inspection we found the service was outstanding in all areas and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Outstanding.

The service had 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 2008 and associated Regulations about how the service is run.

The leadership and management of Caretree Limited continued to be outstanding and the provider aspired to be a role model in the domiciliary care industry. The provider was always thinking of ways to highlight better ways of working in co-ordination with relevant parties such as the local authority and health services. With this in mind, steps had been taken to develop ways to improve hospital discharge with clearer communication and co-ordination. This was to avoid people being affected by delays with returning to their homes. This vision and values of the organisation were mirrored by care staff who were motivated to make a difference where they could, often acting outside of their contracted hours. The impact of this meant people felt valued and cared for and their feedback reflected this.

People's safety was paramount and due to the low turnover of staff it meant people's safety was enhanced. This was because staff knew people well and could note any changes in their condition and alert as necessary. Staff also undertook tasks related to people's safety in respect of taking action to identify any infections so they could be treated as early as possible. Some of these tasks involved going to the pharmacy and dropping off samples to surgery's often in their own time. Caretree Limited had devised their own IT system which linked visits to specialist tasks required and staff training. We saw the management of medicines was excellent with staff having an awareness of what medicines were for, side effects and a facility to call a pharmacy for advice if necessary. All these measures helped to fully optimise people's safety.

Staff had been well trained and in ways that met their learning style to ensure they had a full understanding

of what was required in their roles. Staff were supported well and their health wellbeing had been considered with recognition of the challenges their jobs could bring. Staff received both formal support meetings but could always contact the provider or office staff at any time for assistance and advice. This ensured that staff were able to deliver the best possible care to people and were motivated to carry out extra small tasks in their own time where they felt that would help someone.

People and their relatives repeatedly praised the kindness of staff. Everyone we spoke with praised the exceptional care that they received from the service and used the word 'outstanding' on many occasions. We were given numerous examples of times when staff had gone above and beyond people's expectations to provide truly personalised care. People and their relatives recognised and appreciated these efforts which allowed them to receive their support in a way that made them feel individual and cared for.

People were protected by the robust recruitment systems in place which ensured only suitable people were employed to support them. The registered manager was committed to only accepting new care packages where she was confident that the service had sufficient care staff with the right skills to care for them appropriately. As such people told us that staff had never missed a call and that their care staff usually arrived on time and always stayed for the entire time allocated.

People's health needs were met consistently well. This was enhanced by the provider having a current nurse registration and access to all the up to date and best practice advice. When people were unwell, the service had systems in place such as ensuring any symptoms were addressed early with efficient communication with health staff. This helped to avoid people's conditions deteriorating and potentially being admitted to hospital.

Where people received assistance with their food and drink, care staff had been trained to consider small details such as presentation of food to tempt appetite and encouragement to help with the cooking. Where concerns were noted about finances potentially affecting individuals immediate action was taken and referrals to relevant agencies made to ease the situation.

The service had good systems in place to ensure that people's needs were properly assessed at the start and kept under ongoing review. People and their relatives described how responsive staff had been to their needs. All levels of the service demonstrated a strong commitment to providing a personalised and holistic service. The registered manager had excellent and sustained relationships with other professionals and worked alongside them to deliver the best possible care to people. People told us how they felt fully involved in their care and care staff talked to us about the things they did to support people to be as independent as possible.

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.

The five questions we ask about services and what we found