Hempstead House is a domiciliary care agency. It provides care and support packages including personal care to people living in their own houses and flats in the community across Hertfordshire. This part of the service was referred to by the provider as the outreach service.

Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This service also provides care and support to people living in a number of ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. The supported living schemes were located in Hertfordshire, London and Middlesex.

At the time of our inspection 53 people were being supported by the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 using the service felt safe. There were systems in place to safeguard people from the risk of possible harm. Staff were aware of the risks to people’s health and well-being and ensured that risk management plans did not restrict the activities people engaged in. Personalised risk assessments were completed and updated regularly.

Accidents and incidents were reported and recorded promptly and action was taking to reduce the risk of reoccurrence. Any learning from any accidents or incidents was shared with staff.

People were supported with the prescribed medicines, where assessed as required. There were effective infection control procedures in place, with staff receiving training and being provided with personal protective equipment.

There were sufficient numbers of staff employed at the service who were effectively deployed to meet the needs of people in each scheme and the outreach service. The service had robust recruitment procedures in place.

Staff were knowledgeable and received training that provided them with the skills to meet people’s needs. Staff felt supported in their roles and received regular supervision and annual appraisals. These were consistently completed for all staff and were used to give feedback on performance and plan future personal professional development for staff at the service.

Staff were kind, helpful and maintained people’s dignity and independence throughout their care and support. Positive relationships existed between people and staff. Staff were knowledgeable about the people they were supporting and provided personalised care.

Assessment processes and care planning provided staff with the information they needed to support people effectively and meet their needs. People were involved in planning their care and deciding in which way their care was provided. Support plans were comprehensive and detailed people’s needs, preferences, background and history. People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice.

People and staff knew who to raise concerns to and information regarding the com

We carried out an announced inspection of this service on 9 December 2015.

The service provided personal care to adults in their own homes. At the time of our inspection, 22 people were being supported by the service. This included people receiving personal care on an outreach basis and people living in supported living schemes across Hertfordshire, London and Middlesex.

The service had a registered manager in post. 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’s care plans were detailed and reflected people’s needs, choices, likes and dislikes. Care plans were person-focused and set clear objectives and developmental goals for people. People and their relatives were involved in the planning and review of their care. Risk assessments were in place to help keep people safe from and the service had systems in place to safeguard people from any risk of harm. Staff had a good understanding of safeguarding and received appropriate training.

Medicines were managed appropriately and people were supported to maintain their health and well-being. Staff showed a good understanding of people’s individual needs and the service provided personalised healthcare plans which helped ensure people had access to appropriate services and that they were supported to make themselves food and drinks

People were positive about the care they received. Staff were kind and caring and people were supported by staff they knew and liked.

Staff were well supported by the service and enjoyed working for them. They had received appropriate training and induction and were regularly supervised by management. Staff had opportunities to contribute to people’s care planning and the development of the service.

There was an effective system for dealing with complaints. People were encouraged to share issues and regular team meetings were held to provide staff with the opportunity to feedback and be involved in discussions regarding the development of the service.

The service had auditing systems in place and used these to drive improvement. Managers undertook regular audits of each supported living service and people were asked for their views on care they received.

We talked with three people who used the service and a relative and all were very positive about the care and support they received. One person said, “I am really happy (with the service)”. Another said, “Everything is very positive. They listen to us and are very flexible”.

We saw care was planned in accordance with people’s wishes and they were protected from harm. There were procedures in place to enable people to give valid consent and staff knew what to do when people were unable to give valid consent.

There were adequate numbers of appropriately skilled staff in place to provide safe and effective care.

Quality assurance processes were in place to monitor the effectiveness of the care and services provided. There was also a clear complaints procedure in place and people were provided with the information necessary to make a complaint.

People we spoke with were complimentary about the service and the care provided. A person said that they were well cared for, and that the staff were 'fine'. Another person commented, "The staff are always willing to help, and change things around if needed. I couldn't do without them. I am very lucky to have such lovely people looking after me." The same person added that they were 'very happy' with the service.

Several relatives we spoke with said that they were very pleased with the care and service provided. A relative said that the person using the service was 'very happy and settled' since Hempstead House cared for them.

People and their relatives felt very involved in planning care packages. A relative said that the person using the service had two regular staff who took turns to help them. The relative added that the staff had been very good in encouraging the person to do things, and accompanied them to social activities.

We were told that the management staff had visited people in their own homes regularly to check if people were happy with the service, and to ensure that appropriate care was being given. The management visit was also an opportunity to check on and support the care staff.