Horsfall House Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. Horsfall House Homecare provides a service to older adults and people with disabilities. At the time of our inspection 80 people were using the service.

At our last inspection on 5 February 2016 we rated the service as overall ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’. 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.

People were kept safe. Risks were identified, managed and reduced. Staff were recruited safely and they were trained and supported to meet people’s needs effectively. People’s medicines were managed safely and they received these as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People’s nutritional wellbeing had been maintained and they continued to have access to health care professionals when needed.

People’s needs were assessed, care plans were developed and care was delivered in a way which met their needs and preferences. People were treated equally and their individual preferences and wishes were respected. Relatives were provided with opportunities to speak on behalf of people who used the service if the person indicated a preference for this.

Staff were kind, caring and compassionate. There were arrangements in place to help people feel included and to take part in social activities. Staff had the skills and knowledge to support people’s end of life needs. No-one using the service was receiving end of life care. However, the registered manager explained that they had plans to slowly and informatively speak to people individually about their end of life care and wishes and document their views

The service was well managed and the registered manager ensured people’s needs and wishes were the primary focus. Effective and appropriate systems, processes and practices ensured the service ran smoothly and that necessary regulations were met. Complaints could be raised and these were investigated and addressed. All feedback was welcomed and used to improve the service further.

Further information is in the detailed findings below.

People who we spoke with said “I am quite content with the service I receive. I get the help I need”, “I am very satisfied. They (the care assistants) do everything that is on my list” and “I have help twice a day and I would not be able to manage without my carers". We also spoke with two relatives who were also positive about the service provided by Horsfall House Homecare service.

We received the following comments about the care assistants who supported them. “I have two main carers but all the staff are very good”, “the staff are marvellous, they even managed to get to me through the snow” and “the carers are kind and thoughtful and always ask if there is anything else they can do”. Care assistants we spoke with told us that they had received medication administration training.

People we spoke with told us that if they were unhappy with the service they received they would feel able to raise concerns with the manager, the team leader or the care coordinator.

We spoke with three people who went to the day centre at Horsfall House, and two people on the telephone. All said that they were happy with the service they received from the agency. They said that staff were kind and treated them with respect.

People told us that they had regular staff who arrived on time and knew how to provide the care they needed. One person said "the staff are very good." Another said "I am very happy with the care.”

The inspection was announced. Forty-eight hours’ notice of the inspection was given to ensure that the people we needed to speak with were available. The inspection was undertaken by one inspector.

Horsfall House Homecare is a run by a registered charity and a group of volunteer trustees. The service provides care and support to people living in their own homes within a six kilometre radius of the village of Minchinhampton, Gloucestershire. At the time of the inspection they were supporting 78 people with a service. Some of those people did not receive a personal care service and therefore did not come within the remit of their Care Quality Commission registration. The service currently had 27 care staff.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The registered manager, team leader and care coordinator and the staff team were all knowledgeable about safeguarding issues, knew the appropriate actions to take if concerns were raised and who any concerns should be reported to. All staff received safeguarding adults training. Robust recruitment procedures were followed to ensure only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

People were kept safe because any risks were well managed. Assessment were made of people’s homes to ensure they and the care staff were not placed at risk. This included a review of fire safety in the household and a safer handling plan where care staff needed to assist people to move or transfer their position.

The level of support a person needed with their daily medicines was detailed in their care plan where this was appropriate. Staff completed safe medicines administration training before they were able to assist people and their competency to follow safe practice was rechecked regularly.

Staff were well trained and provided with training opportunities to enable them to carry out their job. New staff had an induction training programme to complete within 12 weeks of employment. All other staff had a programme of essential training and refresher training to complete. Staff were expected to complete additional qualifications in health and social care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions. Where people had been assessed as not having the capacity to make a decision or had no verbal skills, best interest decisions had been made involving others who knew the person well.

People were supported to have sufficient food and drink. Where people needed support with meal preparation this was detailed on their care and support plan. People were supported to see their GP and other healthcare professionals as and when they needed to do so.

The staff, care coordinator and team leader had good, kind and friendly working relationships with the people they were looking after. Staff ensured people’s privacy and dignity was maintained at all times.

The assessment and care planning processes in place ensured that people received a service that was tailor-made to their particular care and support needs. People were looked after in the way they preferred and were involved in having a say about the service. People were encouraged to express their views and opinions about how things were going and what they would like to happen.

All staff endeavoured to provide a high quality care service that was safe, effective and compassionate.  Measures were in place to monitor the quality of the service and action plans were in place where improvements had been identified.  Learning took place following any accidents, incidents or complaints to prevent further occurrences.