About the service: The Great Hospital Domiciliary Service is a historic charitable service. The service provides support with personal care solely to people living in a variety of housing on The Great Hospital site and as such is more comparable to a supported living scheme. At the time of our inspection the service was providing a service to 29 people living within its grounds.

People’s experience of using this service:

People were positive about the service provided and felt privileged to be part of it. There was a strong community feel and ethos.

Risks to people were responded to and well managed.

Staffing levels and arrangements were such that the service could be flexible and responsive to people’s individual needs.

People were supported to access and manage their health needs, this included in relation to their nutritional needs.

People were supported by long standing and consistent staff who knew them well. This helped ensure the service provided met people’s individual needs and preferences.

Staff were kind, caring, and respectful. This included involving people in discussions about their care and seeking their consent.

The service had a strong commitment to ensuring people at the end of their lives were well supported.

The service had strong relationships within the local community and used these to tackle and address social isolation.

The service was well managed, staff knew what was expected of them and were happy working in the service.

Rating at last inspection: Good published 6 October 2016.

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated as Good.

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

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

This was an announced inspection that took place on the 19 and 20 September 2016.

The Great Hospital Domiciliary Service is a historic charitable service. The Great Hospital Domiciliary Care Service provides support with personal care solely to people living in a variety of housing on The Great Hospital site and as such is more comparable to a supported living scheme.

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. 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 were safe living in the service. Risks to people were identified and staff took action to manage risks to peoples’ safety. Staff demonstrated an awareness of adult safeguarding and knew how to report concerns.

Most areas of medicine administration were managed safely. However, there was no guidance in place for staff regarding when ‘as required’ medicines should be administered and handwritten entries on medicines administration records were not counter signed. The registered manager told us they would take action to address these areas.

There were sufficient staff to meet people’s needs, and staff had been recruited following safe recruitment practices. Staff had the knowledge and support to meet people’s needs effectively. They received regular training and staff felt supported by their colleagues and the registered manager to provide effective care.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA. Staff and the management team understood the MCA and how this impacted on the support they provided.

People were supported to maintain their health and staff ensured they could access relevant health care professionals when required. Staff supported people with their meals when needed.

People and relatives were complimentary about the kind and caring nature of the staff. Staff knew the people they supported well. People and relatives felt listened to by staff. They felt able to raise concerns and complaints if needed. People were treated respectfully and their independence supported.

The support provided was individual and responsive to people’s needs and took in to account people’s diverse needs. This included the support provided to people to access social opportunities.

Care records did not always contain sufficient guidance for staff, there was no information regarding people’s personal preferences and how they wanted their support to be provided. The registered manager told us they will make changes to the care plans to address this.

The service promoted close positive relationships and a sense of family. This helped promote a sense of feeling from staff and people using the service that they looked after each other.

People and staff felt involved and knew what was happening in the service. People, relatives, and staff were positive about the support and leadership of the registered manager. There were quality monitoring processes in place to help monitor and identity issues that might affect the quality of the service provided.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? This is a summary of what we found.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us that they felt their rights and dignity were respected. One person told us, "The girls are good and polite."

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. Regular audits were in place to ensure that risk management systems were effective.

This inspection established that there were no concerns that people were being deprived of their liberty. The providers were aware of their responsibility in this area should such concerns arise.

Is the service effective?

People told us they were happy with the care and support they received. One person told us, "If I need help I can press my buzzer and they respond quite quickly."

People's health and care needs were assessed with them and they were involved in writing their plans of care. People said that their care plans reflected their current needs. One person said, "Staff sit beside me and we go through the care plan. I know what's in it."

Is the service caring?

We spoke with four people using the service and we asked them for their opinions about the staff who supported them. Feedback from people was positive with one person saying, "The staff always ask if it is all right. They ask permission."

The staff we spoke with were able to demonstrate a good understanding of the needs of the people living at The Great Hospital. We discussed the qualifications they had obtained so that they understood and were able to meet the individual needs of people. All the staff we spoke with made it clear that they genuinely cared for the people they supported.

People using the service and their relatives completed an annual satisfaction survey. The most recent survey was due to be evaluated in June 2014 and we saw some of the responses from the questionnaires that had been returned. The majority of the comments were very positive with one person writing, "The carers are sensitive to our point of view.”

Is the service responsive?

People knew how to make a complaint if they were unhappy. The service had not received any complaints within the last year but we could see from the complaints policy that investigations would be completed and action taken as necessary.

People told us that they felt the service was responsive to their needs. One person told us, "I know that if I need more help I can ask for it."

Is the service well led?

The service had a quality assurance system and audit records showed that any identified problems were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We talked to four people out of the 21 who received support from this domiciliary care service provided by The Great Hospital. The four people we spoke with were complimentary about the care and support they received. They told us that the staff were kind and caring. One person said, “I cannot fault them. They are marvellous.” Another person said, “I have a regular visit from carers and they help me with what I need.”

We read four individual care plans. Each one had an assessment of need and a care plan and risks had been assessed. The information read was detailed and suitably tailored to the different needs of the individual person the plan belonged to.

Medication was ordered, delivered, stored and administered safely by staff who were trained and competent. However, some recording systems could be improved upon.

Staff were supported to carry out their roles with qualifications gained and training provided. However, support with supervisions and staff meetings required improvement.

The service had systems in place to monitor the quality of the service. Complaints and concerns would be addressed and acted upon. The people we spoke with did not have any complaints.

During our visit we saw that staff treated people with respect, such as knocking and waiting for a response before entering their property. People with whom we spoke told us that staff were always kind and cheerful and that they were not intrusive. One person said “They will do anything I need them to do.” Our review of a sample of people’s records confirmed that care and support was assessed, planned and reviewed appropriately and that risks to people were managed proactively.

At the last inspection we noted some isolated incidents of poor staff practice in relation to infection control. At this visit we found that improvements had been made and we did not identify any poor practice.

People with whom we spoke said that the care staff were very kind and ‘lovely’. They said the staff helped and supported them in the way that had been agreed and recorded in their care plans. People said they were involved in planning the care and support they need and also in the regular reviews.

People told us they were very happy and one person said it was ‘like being in Heaven’. They knew how to complain although everyone we spoke to had no complaints to make. They were very pleased with their accommodation although one person was looking forward to being able to move into a flat with a separate lounge and bedroom.

People told us they were consulted about things that affected their daily living. They felt listened to and said their views and opinions were taken into consideration.