Gemstone Care Limited is a domiciliary care agency (DCA) which provides twenty-four hour care and support across four supported living locations to people with a learning disability. At the time of our inspection eight people were using the service who were supported in their own homes.

The inspection took place on 4th July 2016 and was announced. 48 hours' notice of the inspection was given because we needed to be sure that the registered manager would be available. The last inspection of this service took place on 6th December 2013 and at that time the service was meeting all the required standards inspected.

At the time of inspection there was a longstanding registered manager in post who was also the registered provider. '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.

The service was extremely well led. The provider demonstrated passion and dedication towards improving the lives of the people the service supported. Using their years of experience in the field of learning disability they were creative and innovative in their approach to support staff to empower people to lead meaningful and fulfilling lives.

Staff felt well supported by the provider who took a hands-on approach and was always accessible and visible within the service. A consistent support system of regular supervisions, appraisals and competency checks meant that staff felt confident and competent in their roles. A comprehensive programme of training was provided with opportunities for specialist training relevant to meeting the needs of the people and professional interests of staff.

The provider was highly valued by people, relatives, staff and professionals and was described as someone who always gave a hundred and fifty per cent. Despite actively encouraging people, staff and professionals to raise complaints or concerns, annual satisfaction surveys to monitor quality and drive improvements were relentlessly positive with the service described as 'brilliant' and ‘faultless.’

People felt safe and were happy at Gemstone as the provider had managed to strike the right balance between protecting people from harm whilst at the same time promoting their freedom and independence. People were given opportunities to take acceptable risks in their lives with the right level of support provided by staff. Activities were planned around what people wanted and not restricted because of the potential for harm.

Where necessary the provider took action to reduce any risk of harm whilst at the same time helping the person to do what they wanted. Any incidents or accidents were fully investigated with the emphasis on what could be learnt to reduce the potential for harm whilst not restricting people's personal development.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. People were supported to manage their medicines and be as independent as they could be. Safe recruitment practices were adhered to and there were sufficient numbers of staff employed to safely meet people’s needs. People were included in the recruitment process as their opinions and feedback regarding new employees was valued and acted upon.

Staff and the provider had an excellent understanding of the principles of the Mental Capacity Act 2005 and empowered people to make their own decisions wherever possible. People were supported to make choices about what they wanted to do in their day to day lives including exploring interests, education and job opportunities and maintaining and developing relationships that were important to them. Consequently, people’s confidence and abilities had grown since they started using the service. Rel

People we spoke with praised the service provided by Gemstone Care. One person said, "They come highly recommended; they are really caring and really look after people. They go the extra mile."

Care plans were developed in agreement with people who used the service and their representatives. A relative of a person who used the service told us, "When [my relative] first started to use the service I was involved in helping with the care plan. They make it easy for people to understand because there are pictures and large print."

A relative told us, "They have been very good, they have supported [my relative] to attend the dentist, doctor and hospital appointments." They said, "The manager keeps me in the picture; she put me in touch with an advocate to help me get the right support for my relative."

We saw quality questionnaires completed by people who used the service, their families and representatives and staff. These showed that the manager monitored the quality of the service in an effective way to ensure the health, safety and welfare of people who used the service.

There was a system in place to ensure that people's comments and complaints were listened to and acted on, without the fear that they would be discriminated against for making a complaint. A relative of a person who used the service told us, "If I had any complaints my first port of call would be the manager. I am sure she would sort it out for me, but if not I could go to the local authority."

Subsequent to the inspection visit we spoke with relatives of people using the service and social care professionals involved in the care and support of people.

People told us that they felt their relatives were being cared for in a safe and appropriate manner. One person told us, “My relative is really happy with the service they receive from Gemstone Care. They work with people 1:1 which means my relative gets to live their own life, it is brilliant.” Another family member said, “I can’t say how impressed I am, since my relative has been using the service they have been so happy it is unbelievable. I can’t explain how comforting it is to know that my relative is living their life so happily.”

Social care professionals told us they had found the service to be, “Very professional, they engage with people well and they really understand the needs of people with learning disabilities.”

We found that care records and supporting risk assessments were clear, detailed and kept under regular review. This meant that support staff had the relevant information on how to safely meet people’s needs and preferences. Training records we viewed confirmed that support workers were provided with the appropriate and up to date training necessary to carry out their role effectively and safely.