This inspection took place on 27 and 30 November 2017. This was an announced inspection as Gardiner’s is a Domiciliary Care Agency (DCA) and we needed to be sure someone would be at the office. A DCA is a provision that offers specific hours of care and support to a person in their own home.

At the time of the inspection a registered manager was 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.

The service was rated at the previous inspection of September 2015 as safe and remained safe. Sufficient staff were employed to manage people’s needs, and enable them to engage in activities of their choice, through appropriate risk management. Staff knew how to safeguard people from abuse and were aware of the protocols to follow should they have concerns. Staff reported that they would not hesitate to whistle-blow if the need arose. Where staff were involved in medicine management this was managed safely. Staff were competency checked annually and audits were completed monthly to ensure people were supported by staff with the necessary skills to keep them safe.

The service remained effective. Support was delivered by a highly trained staff team, who were able to respond appropriately to people’s changing needs. Staff were supervised and supported by an effective management team, who made certain they were available to staff at all times. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service remained caring. Staff were reported to be polite, respectful and ensured they maintained people’s dignity when supporting them. They encouraged open communication and worked on motivating people to increase their independence. Evidence of using systems of communication that reflected the person’s choice highlighted that staff communicated with people in the way they wished.

The service remained responsive. Care plans were individualised, focusing on people’s specific needs. The service took necessary action to prevent and minimise the potential of social isolation. Activities were arranged and co-ordinated by the service to increase community engagement, and increase well-being. People reported having accessed the community after considerable length of time of not doing so. This reportedly made them feel a sense of belonging. People and staff were protected from discrimination. The service understood the importance of ensuring Equality Diversity and Human Rights (EDHR) was met, and that people’s protected characteristics were not discriminated against. Measures were in place to allow people to be treated equally, with systems continually being reviewed to ensure exemplary practice was maintained. Systems to monitor and investigate complaints were in place.

The service had developed exceptional methods of good governance that provided real time evaluation of practice. A thorough quality assurance audit was completed annually with an action plan being generated, and followed upon. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments and complaints that illustrated transparency in management. Staff spoke highly of the registered manager’s skills and how these were shared with staff to continually help them grow and achieve good practice. The service focused on developing relationships with the community and with relatives of people, so to ensure good practice was maintained for the person continually. The service was considering offering family carers the opportunity to attend training that would enable them to have an insight into their loved one’s lives and how t

There were effective recruitment and selection processes in place and all of the appropriate checks were undertaken before staff began work. We looked at the personnel records of the 10 most recently recruited members of staff. All of the records contained a full employment history, together with a satisfactory written explanation for any gaps in employment. We did not speak to people who use the service as part of this inspection.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with five people who use the service. They told us staff always asked for their consent. One person said staff “wouldn’t do anything without asking me first" and another told us “I would be able to object if I wanted to”. Staff were able to describe how they would seek consent from people who use the service and what they would do if a person withdrew consent.

We looked at the personnel records of 10 members of staff. All of them showed evidence that most of the relevant checks such as Disclosure and Barring Service (DBS) enquiries, and references, had been undertaken before staff began work. However, seven of the records did not contain a full employment history including satisfactory written explanations for gaps in employment.

People we spoke with told us they were happy with the services provided by the agency. They told us they felt safe, cared for, respected and listened to by staff. One person said they were, “completely satisfied” with the care they received. Another said “I think they are absolute angels”.

People told us they were involved in their care planning and could raise any concerns with staff. We looked at people's care plans, supporting documents, and individual risk assessments. We found care plans clearly documented people's needs, and how those needs should be met. Staff we spoke with were familiar with people's specific health and personal care needs and involved people who use the service in making decisions about their care.

There were enough suitably qualified and experienced staff to safeguard the health, safety and welfare of people who use the service.

People told us they knew how to raise concerns with the provider. The provider had effective processes in place for addressing complaints. There were also systems in place for collecting feedback from people who use the service.

This inspection took place on 8 and 10 September 2015. This was an announced inspection as Gardiner’s is a Domiciliary Care Agency (DCA) and we needed to be sure someone would be at the office. A DCA is a provision that offers specific hours of care and support to a person in their own home.

At the time of the inspection a registered manager was 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.

Staff knew how to keep people safe by reporting concerns promptly through a procedure that was taught as part of the induction process and further followed through in the staff handbook. Systems and processes were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met. Staff were matched to meet people’s needs as per experience, knowledge, age and general personality.

People using the service said they were very happy with the support and care provided. People and where appropriate their relatives confirmed they were fully involved in the planning and review of their care. Care plans focussed on the individual and recorded their personal preferences well. They reflected people’s needs, and detailed risks that were specific to the person, with guidance on how to manage them effectively. The care plans were going through a process of being updated. We found that the new documents contained detailed specific guidance.

People told us communication with the service was good and they felt listened to. All people spoken with said they thought people were treated with respect, preserving their dignity at all times. They were confident to recommend Gardiner’s stating that this was an “outstanding” DCA service.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely. We were unable to find the protocols for PRN medicines; this was raised with the registered manager, who assured us these would be written as priority. PRN medicines are used on an as need basis.

People who could not make specific decisions for themselves had their legal rights protected. People’s care plans showed that when decisions had been made about their care, where they lacked capacity, these had been made in the person’s best interests.

People received care and support from staff who had exceptional skills and knowledge to care for them. All staff received comprehensive induction, training and support from experienced members of staff. Gardiner’s had created a room to replicate a person’s to whom support is provided and used this to train staff in moving handling. Using live examples provided evidence of personalisation in training, staff reported that this was useful when working with people. Staff reported feeling supported by the registered manager and said they were listened to if they raised concerns.

The quality of the service was monitored regularly by the provider, and the managing director, who is the nominated individual. A thorough quality assurance audit was completed annually with an action plan being generated, although this was not always followed up on. The registered manager advised shorter audits were completed monthly, although a formal report was not always prepared. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments and complaints that illustrated transparency in management .