Four Hills is registered to provide personal care to people living in their own home. The services provided included support with personal care such as assistance with bathing and dressing. It also included support with eating and drinking, administering medicines and end of life care. At the time of our inspection 16 people were using the service.

This inspection took place on 4 April 2017 and was announced. The provider was given short notice because the location provides domiciliary care services. We wanted to make sure the registered manager would be available to support our inspection, or someone who could act on their behalf. This also gave us the opportunity to ensure people and staff would be available to talk with us. The inspection was carried out by one inspector. This service had not been previously inspected.

A registered manager was employed by the service who was present throughout the inspection. The registered manager is also the provider. 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 used up to date technology to help them provide a service that was responsive to people’s changing needs. This gave staff access to electronic information they needed to meet people’s needs, including receiving regular up to date information.

People received care and support from staff who had gotten to know them well. Staff knew how to protect people’s privacy and told us how they would support people with intimate care in a way which maintained their dignity. Staff told us people’s care was not rushed enabling them to spend quality time with them.

Staff knew the different types of abuse and what constituted poor practice. They knew how to report any concerns raised and had confidence they would be listened to and appropriate actions would be taken by the registered manager. Measures were in place to manage the risk of harm to people.

People received care and support from staff who were regularly supervised and their performance and ability to do the job was checked. People were supported by staff who knew them well and understood their needs. Staff received training appropriate to their role and were able to access additional training where required.

People who required support with their medicines were supported by staff to receive them safely. Staff had received training in the safe handling and administering of medicines and had their competency assessed by a senior member of the team. People’s health and wellbeing were monitored and recorded in daily records. Any concerns were raised with the registered manager, appropriate health professional and where appropriate the person’s relative.

The service was working within the principles of the Mental Capacity Act 2005. Staff had an understanding of the Mental Capacity Act 2005 and explained how they supported people to make decisions regarding their daily living. People told us staff sought permission before undertaking any care or support.

The registered manager sought feedback from people to ensure the quality of care was maintained. People, their relatives and staff were supported and encouraged to share their views. The registered manager investigated complaints and concerns. Quality assurance systems were in place to monitor the quality of care and service being delivered.

The registered manager was passionate about wanting to provide people using the service with high quality care and support, which included end of life care. These values were strongly shared by the staff we spoke with. There was a very positive and open culture within the service.