This was the first comprehensive inspection of this service since the provider registered with the Care Quality Commission (CQC) on 30 June 2015. This inspection took place on the 18 July 2018 and was announced we telephoned people who used the service and their relatives on the 20 and 23 July 2018 to obtain their views on the service provided.

Gaddesden Row Office is a domiciliary care agency. It provides personal care to people living in both their own houses, flats in the community and also in specialist housing. It provides a service to adults with learning, physical disabilities and older people, including people living with dementia who live in their own homes. At the time of our inspection there were 47 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

The registered manager could not demonstrate they had completed audits to monitor call logs.

We found that a reportable incident had occurred. However, this was not reported to CQC as required by the regulation.

The provider had policies in place to monitor any concerns and complaints raised by people who used the service or their relatives. The manager investigated and responded to complaints. However not everyone felt the communication was effective. Some people felt that their complaints or concerns were not always managed satisfactory.

Evidence provided demonstrated that risk assessments in care plans gave guidance to staff on how to manage these risks

There was enough staff available to meet people’s needs. People and their relatives told us that the care and support provided by Gaddesden Row Office was appropriate to meet people's preferred preferences.

Staff helped and supported people to take their medicines safely. Staff received training in safe administration of medicines and knew how to make sure people received their medicines safely.

People felt safe using the service. Staff demonstrated they had a good understanding of abuse and were able to escalate concerns when required. The provider had safe recruitment practices in place.

Staff received training to enable them to carry out their role effectively and safely.

Staff sought people's consent to care. People received support to access healthcare appointments if needed.

People and their relatives told us they were satisfied with the staff that provided their care. Staff members often took the time to have a chat and support people with their needs. People were fully involved in making decisions about their own care. People felt staff treated them with dignity and respect.

People and their relatives told us they had been involved in developing people's care plans and felt that staff listened to them. The manager demonstrated a good knowledge of the staff they employed and people who used the service. Staff understood their roles and responsibilities.