What life is like for people using this service:

People were safe in their home and there were enough staff to fulfil the visits to people.

People received the medicines they needed safely.

Staff understood their responsibilities about keeping people safe.

Risks were identified and managed well. Incidents and accidents were monitored to inform practice and make improvements to the service.

Staff understood their responsibilities to prevent the spread of infection whilst working between people’s homes.

Staff had received the training and support they needed to carry out their roles well. People had confidence in the staff and were content with the care they received.

Risks associated with nutritional needs were identified and managed. People received the support they needed to have a healthy diet.

People were supported to access health care services when they needed to. Staff described positive working relationships with health care professionals.

Staff supported people to remain independent and promoted their dignity. People's privacy was respected and their personal information was kept securely.

There was a clear management structure that supported staff well.

Governance arrangements were embedded within practice. Regular audits identified any shortfalls in provision of care.

More information is in Detailed Findings below

Rating at last inspection: Good (report published June 2016)

About the service: Alexandra House Diamond Life Healthcare Limited provides care and support to people in their own homes.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was carried out on 19 May 2016 and was announced.

Alexandra House Diamond Life Healthcare Ltd is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our visit the agency was providing a service to 62 people. The frequency of visits and duration across the service varied dependent on individual needs and circumstances.

There was a registered manager in post who was present during the inspection. 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 were supported safely by staff who knew how to protect them from the risk of harm or abuse. Staff were knowledgeable about the different forms of abuse and how to report concerns of abuse or poor practice. Staff had access to care plans and risk assessments which informed them about the level of support and equipment people needed to support them safely.

People were supported by regular staff who were allocated enough time to meet their needs and travel between calls. Staff usually arrived on time and notified people if they were running late. The provider ensured that prospective new staff were suitable to work with people before they started work with them.

Where required staff ordered, collected and administered people’s medicines. Staff competency to administer medicine was regularly assessed to ensure ongoing safe management of medicines. Staff were aware of what action to take if they found people unwell when they visited and would support people to attend medical appointments where required.

People were supported by staff who had the skills and knowledge to meet their individual needs. Staff received training that was relevant to their role. Staff were well supported by the management team and could contact them at any time for support or guidance.

Staff sought people’s consent before supporting them and gave them choices to enable them to make day to day decisions. Where people were unable to make decisions for themselves, decisions made for them were made in their best interest by people who knew them well.

Staff were aware of people’s dietary needs and encouraged them to eat and drink enough to meet their nutritional needs. Staff prepared and served meals and drinks for people where required.

People received support from staff who were kind and considerate. Staff had built up good working relationships with people and their families. Staff treated people with respect and showed empathy for them. Staff promoted people’s dignity and independence.

People were supported by staff who knew them well. Staff provided individualised care that respected people’s needs and wishes. People received a flexible service which was responsive to changes in their needs or circumstances.

People had not had cause to complain but were happy to raise any issues with staff or management and were confident that they would be listened to. The provider had systems in place for dealing with complaints and we saw that complaints received were dealt with appropriately.

People and their relatives found the registered manager and staff friendly and approachable. There was a positive working culture where people, relatives and staff alike felt listened to by the management team. The registered manager was keen to gather people’s and staff views on how to develop the service. The registered manager had checks in place to monitor the quality and safety of the care provided and used the information to improve the service.

The management had improved recruitment and selection procedures. Policies and procedures had been amended so staff had clear instruction to ensure effective recruitment.

Management were now conducting the check that ensured applicants were not barred from the care sector, before staff were employed. This meant that people using the service would be more protected from the risk of harm.

We spoke with who received care from the agency about how staff supported them. People told us that staff were kind and caring in their approach. Some said that the staff were, "fantastic" and described the care as, "Excellent, I really look forward to their company".

Staff supported people to make decisions for themselves, and made sure that people had agreed to their care plan. Where people were unable to make decisions for themselves, staff knew how to ensure that decisions were taken in people's best interests.

People told us that they felt safe and well cared in their own home. Records showed that people's needs were assessed and care was planned so that it met each person's individual needs.

The management had not fully followed effective recruitment and selection procedures. Management had failed to conduct the barring check before staff were employed. This meant that people using the service may not have been protected from the risk of harm.

Staff received training and professional development to give them the skills and knowledge they needed to meet people's needs.

The provider had monitored the quality of service that people received. Systems were in place to fully monitor, manage and improve the service to people.

People shared positive experiences of the care and support they received. Comments included, “I have no complaints, I am very well looked after. The staff are very helpful in every way.”

People told us they felt involved in the planning of their care and were able to choose how they wanted care to be done. People told us that staff respected their privacy and dignity.

People said they felt safe with staff from the agency. One person commented, “The staff treat me well”. Staff told us they had received training in keeping people safe. They demonstrated an understanding of the different forms of abuse and knew the procedure to follow if they suspected abuse.

People told us they liked that staff were kind and caring. One person said, “The staff are brilliant and so professional.” Staff told us they had attended a range of training courses to equip them with the knowledge and skills to effectively carry out their duties.

People who used the service said they felt able to raise any issues or complaints they had with the staff. The service provided people with information at the assessment stage which gave details of how to use the complaint process. The provider had systems in place to log and respond to complaints and monitor trends.