The inspection site visit took place on 21 May 2018 and was announced to ensure staff we needed to speak with were available. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, some of whom may be living with dementia, people with a physical disability and younger adults.

Not everyone using Acqua Doria receives regulated activity; the Care Quality Commission (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. On the day of the inspection, 23 people received the regulated activity.

The service had a registered manager. A registered manager is a person who has registered with 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.

Processes, policies and staff training were in place to keep people safe from the risk of abuse. Staff had identified and assessed a variety of potential risks to people including from their environment. Where risks were identified, action had been taken to manage them for people’s safety. Staff supported people to eat and drink sufficient for their needs.

Processes were in place to investigate and learn from incidents. People were kept safe from the risks of infection. People received their medicines safely from trained and competent staff. Processes were in place to monitor if people had received their medicines as prescribed. The provider operated robust recruitment processes to ensure suitable staff were recruited. There were sufficient staff to meet people’s needs and staff underwent relevant pre-employment checks to assess their suitability for their role.

People’s needs had been assessed with them and their care was provided in accordance with legislation and good practice guidance. Staff received a thorough induction to their role, to enable them to provide effective care. Staff received on-going professional support in their role, through training, supervisions and professional development. Where required staff accessed additional training to ensure they could meet people’s specific care needs. Staff had undertaken palliative care training, to ensure they had the knowledge and skills to support people who required end of life care.

Staff worked both together within the service and across organisations to deliver people’s care and treatment. People were well supported by staff with their healthcare needs.

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 told us they were content and happy with the care and service they received. Staff were instructed to involve people in decisions about the delivery of their day-to-day care. People were provided with information about the service to inform their decision-making. Staff respected people and their homes and strove to uphold their independence wherever possible.

Staff understood people’s individuals care needs, their preferences and what was important to them. Staff supported people to pursue their interests where commissioned to provide this type of care. The provider was in the process of introducing electronic care plans, which will increase the responsiveness of the service following changes in people’s care needs. Staff worked in partnership with key organisations to ensure the effective provision of people’s care.

Staff were passionate about their work and feedback from people about the quality of care provided was very positive. The service had a clear management structure and staff understood what was expe