About the service: Guardian Care and Support Limited is a domiciliary care agency. This service provides care and support to young disabled adults and older people, either living with their family, in care or independently. They can provide companionship and assistance with household tasks, everyday activities, and personal care. There were 35 people being supported at the time of our inspection.

People’s experience of using this service: We received very positive views from people about the support provided to them. Without exception, people said they felt safe and staff were respectful.

People received their medicines safely and on time and their health was well managed. Staff had positive links with healthcare professionals which promoted people’s wellbeing.

People said they received care in a timely way from a regular team of care staff. Relatives said the service was reliable and efficient. They had good communication with the office and were given information about which staff would be making their visits each week.

Staff had received appropriate induction, training and support to enable them to carry out their role.

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.

The registered manager and care manager worked with the staff team and led by example to ensure people received a good service. People, relatives and staff told us the management team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection: Good (report was published 24 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 23 June 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the location offices when we visited.

At our last inspection on 1 April 2014, the registered provider was meeting the regulations that were assessed.

The registered provider is registered to provide personal care to people who live in their own homes. The registered provider is registered to provide services to:- Learning disabilities or autistic spectrum disorder; Mental Health; Older People; Sensory Impairment and Younger Adults. The registered provider primarily supports people in the Tadcaster and outskirts of York. At the time of our inspection, there were 53 people receiving a service from Guardian Care and Support.

There was a registered manager at the service. 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 what action to take to ensure that people were protected if they suspected they were at risk of abuse. There were sufficient numbers of staff to provide care to the people using the service.

Risks to people’s health, wellbeing and safety had been assessed and actions had been taken to reduce any identified risks.

Recruitment procedures ensured that only suitable staff were employed to work with people using the service.

Arrangements were in place to ensure that people were supported and protected with the safe management of their medication. The agency had a medication policy and staff received training which included a practical test to demonstrate competency.

Members of staff were trained to provide effective and safe care which met people’s individual needs and wishes. Staff understood their roles and responsibilities. They were supported by the manager to maintain and develop their skills and knowledge through on-going support and regular training. The staff were in contact with a range of health care professionals to ensure that care and support to people was well coordinated and appropriate.

The registered manager had a clear knowledge and understanding of their roles and responsibilities of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. Where a person had a lack of capacity to make their own decisions the registered manager was able to explain how the service worked with other health and social care professionals and family members to ensure a decision was made in the person’s best interests.

Staff had received training on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People who used the service told us they gave consent to their plan of care and were involved in making decisions around how their support was provided. People’s care plans were reviewed to meet their changing needs. Staff told us they felt well informed about people’s needs and how to meet them.

People told us they were introduced to staff prior to them providing support and described staff as kind and considerate. People told us that they were treated with dignity and respect.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainants. People felt able to raise concerns with the staff at any time.

The registered provider had effective quality assurance processes and procedures in place to monitor the quality and safety of people’s care. People and their relatives were able to make suggestions in relation to the support and care provided.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? The inspector gathered information from people who used the service by telephoning them or their relatives.

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with people who used the service, or their relatives. We also spoke with the staff that supported them and we looked at records the service held.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Staff knew about risk management plans and showed us examples where they had implemented them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Recruitment practice is safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice can be identified and therefore people were protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in developing their plans of care. People said that their care plans were up to date and reflected their current needs.

We found there was a system in place to ensure there was sufficient staff to enable effective delivery of care and support.

We spoke with other agencies such as community nurses and social services who told us they worked collaboratively with the provider to ensure people’s needs were met.

Is the service caring?

We spoke with ten people who were supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was very positive, for example; “They, the staff, are fantastic.”, “They , the staff, are special. They are intuitive.” “ I just ask and they do it. They are very flexible, especially when I have a hospital appointment, they change my time, it’s not a bother to them!”, “I would miss them if they didn’t come.”, “I don’t feel rushed by the staff when they are with me.” “They are consistent and professional.”

When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People can be assured that complaints would be investigated and action taken as necessary.

The service worked well with other agencies and services to make sure people received care appropriately. We were told “They go above and beyond, when supporting people with palliative care needs.”

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. We were told by one professional we spoke with “The staff they employ meet the ethos of the company.” This helped to ensure that people received a good quality service at all times.

We spoke with three people who used the service and one relative. They told us they had received sufficient information for them to decide if the service was what they needed. One person said “This is a really good service.”

People told us that the care was of a high standard. They said they were happy and satisfied with the care and support provided. Comments included "The staff are very efficient" and "I would certainly recommend this service.”

We reviewed the recruitment and selection processes and found them to be robust. This ensured that people were supported by suitably qualified, skilled and experienced staff.

We spoke with staff and they told us they had received sufficient training in safeguarding and whistle blowing to enable them to protect the people who used the service.

This was the first inspection of this agency. We found that suitable arrangements were in place to monitor the quality of the service provided. This included policies and procedures and quality monitoring systems.