About the service:

Reevey Gate Cottage provides personal and nursing care to people who require end of life care in their own homes. At the time of the inspection there was one person using the service.

People’s experience of using this service:

• People received safe and effective care which enabled them to live in their own homes.

• People’s relatives praised the care staff and spoke positively about the care their family member received. They told us staff were both professional and caring. Relatives also commented that staff provided them with emotional support and advice when supporting people who required end of life care and support.

• The care people received was flexible and personalised to their needs. They had been fully involved in their initial assessment and decisions about their care.

• Relatives felt involved in the care of their loved ones and spoke positively about the communication from the service and the relationships they had with staff.

• Staff were responsive to changes in people’s needs and worked closely with other health care professionals when further support or advice was required. Health care professionals commented on the caring manner and professionalism of staff.

• Staff were trained and supported to carry out their role. They had received additional training in subjects relating to good end of life care practices. Staff meetings enabled staff to reflect on their practices, share information and keep themselves informed.

• Relatives were confident that their views or concerns would be listened to and acted on.

• The registered manager and care coordinators knew people well and had a good understanding of the quality of service provided.

• However improvement was needed in the recording of the monitoring actions they undertook to ensure the quality of the service was being sustained and that regulatory requirements were met. This would assist the registered manager to have an audit trail of their monitoring of the service and the actions taken to address shortfalls.

• The registered manager took prompt action to review recording of their monitoring systems; more time was needed to ensure records relating to the management of the service would always be available.

Rating at last inspection: Good (Last report was published on 7 September 2016).

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Good rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 14 June 2016 and was announced. Reevey Gate Cottage provides personal and nursing care to people who live in their own home. At the time of our inspection there were two people being supported by nursing and care staff from Reevey Gate Cottage. Reevey Gate Cottage is Funded by the League of Friends for Fairford Hospital. They provide nursing and personal care to people who live in Fairford, Lechlade and surrounding villages. Most of the care they provide is referred to them by district nurses. They provided support for people who needed short term care, or required additional nursing care at the end of their life. As a service they have close links with the League of Friends and a local hospice.

We last inspected this service in September 2014. At this inspection we found the provider was meeting all of the requirements we inspected.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People received safe and effective care which enabled them to live in their own homes. People and their relatives praised the care and nursing staff and expressed their gratitude for the care they received. The care people received was personalised to their needs, wishes and goals. The provider and registered manager worked with local hospices, district nurses and people’s GP’s to provide consistent and considered care. People told us they felt listened to and could not fault the service.

People were cared for by nursing and care staff who were supported by the registered manager and provider. Nursing staff had access to professional development through the provider or through their other employment. The registered manager and service co-ordinators knew the needs of staff and had systems to ensure staff had access to the training and support they needed. All staff told us the registered manager was incredibly supportive.

The registered manager had systems to monitor the quality of service people received. Care was tailored to people’s individual needs, with nursing staff being carefully matched to the people they cared for. The registered manager and provider (The League of Friends of Fairford Hospital) had clearly identified a need for the service in their area. People also had access to additional services through the provider which was not provided by Reevey Gate Cottage.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

At the time of our inspection the service was not providing any care or treatment due to a gap in referrals. We were therefore unable to speak to people currently using the service. However, we spoke with a person who had previously used the service and two relatives of a person previously supported by the service. We spoke to the registered manager, deputy coordinator, administrator, one care staff and two nursing staff. We spoke with a GP, a district nurse, and the team leader of a local hospice at home service. We reviewed records related to the management of the service, which included referral, staffing and quality assurance records.

Below is a summary of what we found.

Is the service safe?

People were referred to the service from the district nursing team and the provider followed the care plans and instructions of the district nurses. Information about risks to people's health, safety and welfare were recorded at referral and discussed prior to any care or treatment being delivered. A district nurse told us, "They (provider) always follow instructions from us and the standard of care is excellent".

People we spoke to told us they felt safe with the provider's staff. Staff we spoke with understood their responsibilities to safeguard people from abuse and how to report concerns.

Is the service effective?

People told us they were satisfied with the care they received and felt their needs had been met. A person said, "They came so quickly at very short notice, the care was excellent I couldn't fault it". A person's relative said, "They came to give us a break at night, they watched and tended my relative which was really appreciated". The provider cooperated with other providers to ensure people received safe and coordinated care. A district nurse said, "This service means people can remain at home, working with us and others empowers the patient to achieve this. It can mean the difference between meeting people's wishes to die at home or having to go into hospital".

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with told us about their commitment to the service one staff member said, "I love what I do, it's exactly what I want to be doing". A person said, "They even came back to see if I was OK after I had finished using the service, I thought that was very nice, they were so helpful". Staff told us that they spent the time required to meet people's needs and people we spoke with confirmed this. A district nurse said, "They (staff) go above and beyond".

Is the service responsive?

A GP told us, "In the modern NHS this service is able to provide the continuity that other services can struggle with. Their value is in meeting the gaps between services and providing consistent and responsive care". People’s needs had been assessed before they received care and treatment and care was delivered to meet people's desired outcomes. A district nurse said, "They are very easy to contact and can tailor what's on offer to individual need". A person's relative told us how the provider had responded promptly to a request they had made.

Is the service well led?

Records showed people and/or their representatives were asked about their satisfaction with the care provided and this was complimentary. Staff we spoke with told us they were well supported by their managers. A staff member said, "I think this is a really good organisation, quite unique there is very effective communication between managers and staff". Another staff member said: "I feel the service is very well run, no qualms or quibbles it all runs very smoothly".

When we inspected, the service was providing support to two people. There were six Registered Nurses and two Care Assistants employed, mostly on a part time basis, as the majority of staff hold other substantive posts, mainly within the local health trusts.

We spoke with a retired general practitioner, who was involved with the service and was a member of the board of trustees of The League of Friends of Fairford Hospital. This person also provided support and guidance to the service and was actively involved with the monitoring of the performance of the staff. This person told us that the service provided was incredibly valuable to the local area.

Care records were not kept at the registered premises as the care provided was directed by the district nursing teams who assessed and planned the care required for the people referred to the service. The district nursing teams assumed responsibility for the safe keeping of the care plans.

Staff supported people if required with their medication, again, under the direction and guidance of the district nursing team. Care staff clearly understood their responsibilities with regard to supporting people with medication when they had completed the required training.

The feedback from a District Nurse and the families of people using the service was exceptionally positive, with comments such as "everyone was very kind to me" "they are absolutely excellent" and "they are very well trained".

The service supplemented the care given by the local GPs and district nurses for people who wished to remain at home because they were very ill. In addition to home nursing the service had a contract with a local hospice. This gave people at the end stages of their life access to the full range of services provided by the hospice.

A relative we spoke with said they found the service to be a “great help”. We saw comments in completed satisfaction surveys that showed that people were satisfied. One person stated the “care provided was thought out” adding “the service provided was most helpful and gratefully received”. Another person wrote, the service “helped me a lot emotionally in coming to terms with looking after my dying relative. I cried a lot during their visits and they supported me well”.

A GP involved with the service told us that they supported the service 100% and felt the service was “excellent” and “bridged the gap in services that statutory organisations are not able to provide”. They said that the service provided “local staff providing services to people in local communities, I am a fan”.

Staff spoke proudly about the service describing it as “an excellent service” and a service that was “valuable to families”. One member of staff told us how the service ensured “continuity of care” and another told us they had just worked a night shift and that the relative of the person they supported had been “thankful” for the respite it had given them.