The inspection took place on the 29 and 30 May 2018 and was announced.

This is the first inspection of the service since their registration on 13 June 2017 with the Care Quality Commission.

Gravesend is a domiciliary care agency and provides personal care to people living in their own houses and flats in the community. It provides a service to older people, younger adults and people with complex needs such as diabetes, dementia and physical disabilities.

Not everyone using Gravesend receives regulated activity; 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. There were nine people receiving personal care at the time of the inspection.

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. The registered manager was also the provider.

The service had safeguarding and whistle-blowing procedures in place. Staff had received safeguarding training and understood their responsibilities to report any concerns and incidents of alleged abuse.

There was enough staff available to meet people's care and support needs. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met.

Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals.

Safe recruitment procedures were followed before new staff were appointed. Appropriate checks were undertaken to ensure staff were of good character and were suitable for their role.

Staff had the necessary skills, knowledge and experience to support people in their own homes. Staff completed an induction when they started work and they received training relevant to people's needs.

Staff received training in infection control and food hygiene and they were aware of the steps to take to reduce the risk of the spread of infections. Staff carried personal protective equipment like disposable gloves and aprons.

Assessments of people's care and support needs were carried out before they started using the service. Their care and support were reviewed on a regular basis to ensure their needs continued to be met by staff.

People's care files included assessments relating to their dietary support needs. Staff supported people to maintain a balanced diet and monitor their nutritional health.

Staff worked in partnership with health care professionals which helped improve the outcomes of people's health and well-being. Staff made referrals to health care professionals when people's care needs changed.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). 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 that their choices and preferences were fully considered and the care records provided evidence of their involvement.

Staff treated people in a caring, respectful and dignified manner. People communicated their needs effectively and understood information in the current written format provided.

People and their relatives could raise concerns and appropriate actions were taken by the service to resolve their concerns.

Staff had access to out of hours on-call system that ensured management support and advice was always available for staff when they needed it and this allowed people’s care to continue at all times.

People, their relatives and staff spoke positively of the leadership and