About the service:

Grace at Home Limited is a privately-owned home care agency providing care and support to people in their own houses and flats in the community. The service has one location with a small office in Woking and provides care and support to people living in the nearby surrounding areas. At the time of the inspection Grace at Home were providing personal care to 10 people. Those receiving a service were older adults in the age range of 80 plus.

People’s experience of using this service:

¿ Improvements were required that related to the recording of audits, staff supervision and recruitment. We have made a recommendation around this.

¿ People who received care from Grace at Home told us that all staff were very caring and that care was of a high quality and consistent standard. One person said, “They are all lovely, they will do anything you ask, you just have to ask.”

¿ People and relatives using the service told us they felt safe and were reassured with the care provided. One relative said, “I absolutely feel my mother is safe in their care.”

¿ Relatives and families told us that the service was caring, and well led and respected individuals needs and preferences. One relative said. “The agency is very caring, both the individual carers and the manager.”

¿ People liked the size of the agency as it was small, and personal. One person said, “They don’t rush in and out, they spend time with you.”

¿ People’s care was personalised to their individual needs. People received their care from regular staff who knew their care needs well. Staff spoke positively about working for the agency. They felt supported and they could talk to the registered manager. They felt the registered manager was extremely caring and had people’s best interests at the heart of the business. They said that the ethos of the agency was providing the best possible care for people.

¿ Staff felt valued and happy in their work.

More information for each of the key areas of Safe, Effective, Caring, Responsive, and Well-led can be found in the full report.

Rating at last inspection:

¿ At our last inspection the service was rated as Good. The report was published on 14 June 2016.

We found at this inspection, the service was rated Good.

Why we inspected:

¿ This inspection was part of our routine scheduled plan of visiting services to check the safety and quality of care people receive.

Follow up:

¿ Following our inspection the registered manager supplied information we requested. We have used this information to support us with our judgements.

¿ We will continue to monitor the service as per our published inspection methodology to ensure that people receive safe, high quality care. Further inspections will be planned for future dates.

The inspection took place on 29 April 2016 and was announced. We gave the provider 48 hours notice of our visit because we wanted to ensure they were available to support the inspection.

Grace At Home Limited provides care and support to people in their own homes. The service provided personal care to seven people at the time of our inspection.

Sandra Findlater is registered with the CQC as the Responsible Individual for the provision of personal care. A Responsible Individual is a person who has the legal responsibility for meeting the requirements of the law. Sandra Findlater manages the service on a day-to-day basis and is referred to in this report as ‘the provider’.

People felt safe when staff provided their care because their care workers understood their needs and any risks involved in their care. Relatives were confident their family members were safe when receiving their care. People told us that they could rely on their care workers. They said their care workers had never missed a visit and the agency contacted them to let them know if a care worker was running late. The provider had identified those people most at risk if their care was interrupted and had developed plans to prioritise the delivery of their care in the event of an emergency.

Staff received training in safeguarding and recognising the signs of abuse. The provider carried out risk assessments to ensure that people receiving care and the staff supporting them were kept safe. Where an incident or accident had occurred, there was a record of how the event had occurred and what action could be taken to be taken to prevent a recurrence. People were protected by the provider’s recruitment procedures. The provider carried out pre-employment checks to ensure they employed suitable people to work at the service.

People received their care from regular care workers who knew their needs well. New care workers were always introduced to people by the provider before they began to provide their care.

The provider understood the importance people placed on having regular care workers and ensured people received a consistent service from familiar staff.

Staff had access to the training and support they needed to fulfil their roles. All staff attended an induction when they joined the agency and shadowed experienced colleagues until the provider was confident in their ability to provide people’s care safely and effectively.

The agency worked co-operatively with people’s families to ensure they received the care they needed. Relatives told us staff were observant of any changes in their family member’s needs and said the provider contacted them if they had any concerns about people’s health or welfare.

People’s nutritional needs were assessed during their initial assessment and any dietary needs recorded in their care plans. Where people needed assistance with eating and drinking there was a care plan in place to outline the support they required.

People were supported by kind and caring staff. People told us their care workers were polite, courteous and treated them and their property with respect. They said they had developed good relationships with their care workers and looked forward to their visits. Relatives told us that care workers were compassionate and sensitive to their family members’ needs. They said staff knew how their family members preferred their care to be provided and genuinely cared about their welfare.

People received a service that was responsive to their individual needs. The provider assessed people’s needs before they began to use the service to ensure the agency could provide the care they needed. People were encouraged to be involved in the development of their care plans and the provider reviewed plans regularly to ensure they continued to reflect people’s needs. Relatives told us their family member’s care plans had been developed in a way which gave them as much choice and control over their care as possible.

People had

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

• Is the service safe?

The provider had effective recruitment and selection processes in place and carried out appropriate checks before staff began work.

Staff had access to appropriate training to enable them to deliver care safely and consistently.

Staff were given sufficient information about a person’s needs before they began to support them.

• Is the service effective?

People provided positive feedback about the service they received from the agency. They said that their care workers arrived on time and stayed for the correct amount of time, which meant that they did not feel hurried when receiving their care.

People told us that they received their care from regular staff, which was important to them. One person told us, “We’re delighted with the care. We couldn’t be happier” and another said, “They give an excellent service. I’d recommend them to anyone.”

• Is the service caring?

People spoke highly of the care provided by the agency’s staff. They told us that care workers were kind, courteous and helpful. People also said that staff were diligent and hard-working and had a positive approach to their work. One person told us, “Nothing’s too much trouble for them. They do anything that needs doing.” Relatives also provided positive feedback about the care provided by staff. One relative told us, “The staff are superb. They’re extremely capable, helpful and polite.”

• Is the service responsive?

People told us that staff were willing to adapt the support they provided to meet their needs. One person said, “They’re always willing to be flexible to meet our needs” and another told us, “I’m very pleased with them. They do anything I ask of them.”

• Is the service well-led?

There was no registered manager in place at the time of our inspection as the previous postholder had recently left. The provider told us that they would submit an application for registration as manager of the service within two weeks.

Staff told us that they received good support from the provider and that they had access to the training they needed to meet people’s needs.

People told us they were confident that the provider monitored the quality of the service effectively. One person said of the provider, “She’s got her finger on the pulse; she monitors it all very closely.”

People told us that the provider encouraged them to give their views about the service they received and had responded appropriately if they had requested changes to their care. One person said of the provider, “She’s very proactive in finding out if we’re happy with things.”

At the time of this inspection there were three people receiving a service from the provider and they employed three staff members. We visited two people receiving a service and their relatives, accompanied by one staff member. We spoke with another staff member on the telephone and met with the provider in the office of the service. We read the support plans for three people, staff files for three staff members and read other records for specific information.

People who received a service told us they were “very satisfied” with the service they received. One person told us the staff were “marvellous” saying “they are all excellent and very caring.” Another person told us the staff were “kind and helpful.”

People told us they felt included in the decisions made about their care needs and how staff should help them. Staff were seen to include people in choices regarding their support.

There were plans of how a person should be supported and these included how to promote independence and choice and the protection of dignity and safety.

Staff were aware of how to protect people from abuse and the actions to take should they have any concerns.

The information required to ensure staff were safe, fit and physically and mentally able to do their work had not been obtained, for all staff, prior to them starting work.

Systems were in place to monitor the quality of the service provided.