Gilder Care Ltd is a domiciliary care agency. It provides personal care and support to people living in their own home. There were 35 people receiving support at the time of our inspection.

At our last inspection the service was rated as Good; on this inspection we found the service remained Good. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service had a registered manager in place at the time of our 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.

At our last inspection we rated the outcome for safe as Requires Improvement due to some recruitment files not containing all required references. At this inspection we found that this had quickly been addressed and recruitment files contained the required pre employment checks, meeting current requirements.

People received safe care. Risks to people’s health and wellbeing were assessed before any support was provided. This was regularly reviewed to ensure people continued to be assisted in a safe manner.

The staff understood how to protect people from harm and how to report such any concerns. Some people received assistance with taking medicines and records were kept to ensure that this was undertaken safely and in line with current procedures.

There were safe recruitment procedures in place to ensure new staff were suitable to work with people.

Staff were supported and trained to ensure that they had the skills to support people effectively. When people needed assistance to eat and drink, the provider ensured that this was undertaken in the way the person preferred. People were able to make decisions about how they received their support and care. This ensured their health needs were met in personalised way.

The quality of care and support people received remained good. Care was planned and reviewed with people. The provider ensured that people’s choices were followed and clearly recorded on their support plan. People’s privacy and dignity was respected by the staff supporting them. People felt comfortable with the staff they knew and satisfied with the support they received.

The service remained responsive. The support plans reflected people’s individual needs and preferences. Clear descriptions of how people wished to be supported were set out in support plans, and this was reviewed.

People felt comfortable raising any issues or concerns directly with staff and there were arrangements in place to deal with any complaints. Information was being reviewed to ensure it this was accessible to all people who used the service.

The service remained well led. Staff felt supported by the registered manager. Regular quality checks were completed and people could comment on the quality of service provision. People and staff were encouraged to raise any views about the service to consider how improvements could be made should this be needed.

Gilder Care provides care for people in their own homes. The service can provide care for adults of all ages. It can assist older people, people who live with dementia and people who have a physical disability. At the time of our inspection the service was providing care for 42 people most of whom were older people. The service has its office in Grantham. It covers Grantham and villages within 10 miles of the town.

Background checks had not always been completed before new staff had been appointed. Staff knew how to recognise and report any concerns so that people were kept safe from abuse. There were enough staff to complete all of the planned visits, people were helped to avoid having accidents and they were assisted to safely use medicines.

Staff knew how to care for people in the right way and they had received all of the training and support they needed. People had been supported to eat and drink enough and to access any healthcare services they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This law is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, promoted people’s dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive. Staff had offered people the opportunity to maintain their independence and to pursue their interests. There were arrangements in place to quickly and fairly resolve complaints.

Regular quality checks had been completed and people had been consulted about the development of the service. The service was run in an open and relaxed way, there was good team work and staff were enabled to speak out if they had any concerns about poor practice. People had benefited from examples of staff acting upon good practice guidance.

The summary is based on our observations during the inspection and speaking with two people who used the service and with six relatives. In addition, we spoke with the manager and four members of staff who provided support. We looked at the records of the support provided for three people and examined other documents including time sheets, staff rosters and policy documents. We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

People said that staff were respectful, kind and attentive. They observed that they looked forward to staff calling to see them because the visits provided them with assistance, company and reassurance.

Is the service responsive?

We saw that people's individual needs for support were assessed and met. Staff knew about each person’s individual support needs, choices and preferred routines. People said that their support needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person’s changing needs and wishes. Relatives said that staff consulted with them. This helped to ensure that staff organised their work to complement the care already provided by relatives. These measures meant that people received an efficient, flexible and coordinated response to their support needs at home.

Is the service safe?

Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse. There were reliable systems for staff to follow when handling money on people’s behalf. There were robust systems in place to identify and respond to the needs of people who lacked capacity and needed help to make decisions. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. These measures helped to keep people safe from abuse and to promote their welfare.

Is the service effective?

People were helped to stay safe by avoiding risks to their health and safety. Staff had assessed and managed potential risks. This included following safe working practices when helping people with reduced mobility so that there was a reduced likelihood of people experiencing falls and accidents. Robust arrangements had been made for staff to access and leave people’s homes so that the accommodation was kept secure. Visits to people’s homes had been undertaken on time, staff had completed the required tasks and they had stayed for the correct time. These measures contributed to people receiving a service that provided them with effective care at home.

Is the service well led?

People had been consulted about their experience of using the service. There was a clear line of management. This meant that important decisions about organising someone’s care were made by senior staff while carers could use their own judgement to provide a flexible service. Quality checks had been completed to ensure that people’s support needs were met in a safe and reliable way. These included checks to make sure that visits were being completed as planned and that record keeping accurately described the assistance being provided. However, some of these checks had not been completed in an organised way or recorded. This increased the risk that shortfalls would not be identified and that problems would not be addressed.

As part of the inspection we were accompanied by the registered manager and visited four people who used the service. We spoke with two relatives on the telephone for their views and spoke with the registered manager and three care workers. We looked at service information and care plan files for five people.

People gave consent to their care and support which we found met their needs. People told us they were asked for their views and wishes about the care and support they wanted. Comments included, “The manager visited before we started to use the service. We signed documents to say we agreed to the support we would receive.”

We found some concerns with the pre assessment process. People’s health care needs were not formally assessed or recorded. We also found that people’s capacity to consent had not fully been considered.

People received the support they needed to take their medication. Comments included, “The girls (care workers) prompt me to take my medication. I like to take it when they are here so I know I’ve had it.”

All the people we spoke with said they felt the care workers were well trained to carry out their duties. Comments included, “They (care workers) are all excellent. My carer is very knowledgeable; I know they do a lot of training.”

We saw the provider had internal quality, monitoring and audit systems in place. We saw the complaints procedure and the compliments received in the last 12 months.

People expressed their views and were involved in making decisions about the support they received. One person told us, “I couldn’t wish for a better service, the girls (staff) do as they say they will do.”

The people we spoke with told us they received information explaining all about the service including details about the complaints procedure.

One person said, “I had a visit from the manager who discussed with me all about the service and left an information pack. This included contact details and how to make a complaint.”

People’s needs were assessed and support was planned and delivered in line with their individual care plan.

One person told us, “All the girls (staff) are wonderful, they visit at the times stated on the care plan but if they are running late I get a phone call.”

All the people we spoke with talked positively about the service they received, no one raised any concerns about safety. One person told us, “I completely trust the girls (staff) I sometimes have a break from my caring role and the girls (staff) visit more, I feel I leave my relative in safe hands.”

People who used the service were asked for their views about the support they received and they were acted on. One person told us, “If I have any problems I know the manager will sort it out, she is always asking if everything is ok, she is on the ball.”