This announced inspection took place on 13, 16 and 17 January 2017. Gold hill homecare is a domiciliary care agency which provided care to people in their own homes.

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.

Overall we found the service to be well managed. Staff appeared to be committed to offering a good service and had confidence in the senior staff and registered manager. People received medicines from staff who had been trained. However, they did not always comply with the requirement to record what medicines they had administered to people. Despite several attempts by the registered manager to address this problem, it was still ongoing. We spoke with the nominated individual following the inspection, and measures were to be put in place to ensure this situation was improved with immediate effect.

We also had concerns that when a medicine error occurred, medical advice was not always sought for people. We have made a recommendation to the provider to improve their practice in this area.

Prior to care being provided an assessment of people’s individual needs was carried out. From this information a care plan and risk assessments were drawn up. Some people told us they were involved in reviewing their care. Documents verified this. Through talking with staff it was apparent staff were familiar with the individual needs of the people they supported.

People spoke positively about the care they received and the skills and knowledge of the staff. Where people were being cared for by regular staff it was clear that strong relationships had developed. People were pleased to have regular carers. Where visits to people may have been delayed, staff telephoned people to inform them of the situation. An on call facility was available for people and staff to call outside of office hours for support or guidance.

Prior to staff being employed the necessary checks were carried out to ensure their safety and suitability to work for the service.

People told us they believed staff were sufficiently trained to meet people’s needs. Training records showed 78% of staff were up to date with the training deemed mandatory by the provider. Staff received induction training and continuous support throughout their employment. This took the form of supervision, spot checks, competency checks, staff meetings and appraisals.

The service was complying with the Mental Capacity Act 2005 (MCA). We found mental capacity assessments had not always been completed appropriately, for example they were not time or decision specific. The registered manager implemented a new form which highlighted these areas and would improve their accuracy.

Where people required support with food and drink this was provided by staff. People were also supported to maintain good health, with staff being vigilant in noticing health changes in people and responding appropriately.

People told us staff were caring. Staff projected a caring nature when we spoke to them. Staff knew how to protect people’s privacy and dignity, and placed value in doing this. People told us staff were kind and compassionate. Staff knew the importance of supporting people to be as independent as possible. There was evidence staff had gone over and above what was expected of them in the course of their work, to support people and show kindness and sensitivity.

People told us they knew how to complain but they had never needed to. The provider had a complaints procedure in place, and records showed it was used effectively.

Both people and staff told us they felt the service was well managed. It was apparent in the records the provider had actively soug

People told us they were involved in making decisions about their care, comments included ‘’they always include me in any decisions about my care needs." Similarly a relative said “I am always kept informed and they do whatever my mother asks of them.”

We found people’s needs were assessed and their care and support was planned and delivered in line with their care plan.

The service had a system in place to ensure people were protected against the risk of abuse. Staff we spoke with understood their duty of care and responsibilities in relation to safeguarding people from harm. People told us they felt safe with the staff who entered their homes to provide them with support and knew who to speak to if they had any concerns.

People described staff as “very obliging, friendly, meticulous and professional." One person told us “I have no concerns about the Gold team in actual fact I treat them as my friends.”

People experienced care and support that met their needs. However, there was inconsistency in assessing risks and providing guidelines for staff to follow. This had the potential of placing people's welfare and safety at risk.

We spoke with four people who used the service, three members of staff and the registered manager. People said they were happy with the care and support they received. They made positive comments about the care staff, and about the office staff. One person said "The carers are always on time, and are kind and friendly." Another person told us "The carers are reliable, and they turn up when they are meant to. The people in the office are friendly and efficient." A relative told us she was pleased with the service given. She felt she could rely on the staff to deliver a good service to her relative.

People told us they had signed general consent forms for information about them to be shared appropriately. Each file we reviewed confirmed this had been done, and consent had been correctly documented.

Staff told us that there was enough detail in the care support plans to be able to assist each person.They said they always read the information and checked verbally with people that nothing had changed.

We heard there had been very few complaints about the service. We reviewed the complaints file and saw they had been dealt with efficiently and in a timely manner.

There was a recruitment process in place to ensure that staff had the right skills and qualifications to work with vulnerable people.

Records were usually accurate and fit for purpose. They were securely stored and the provider had a policy for retention and destruction.