The inspection took place on 21 and 26 July 2016. We gave the provider 48 hour notice of our intended inspection to make sure that appropriate staff were available to assist us with the inspection. The service had not been inspected since they registered with the Care Quality Commission on 15 April 2014. Joy Caring Services is a small domiciliary care agency and is registered to provide personal care and support to people who lived independently in their own homes. At the time of our inspection there were seven people using their services. Most of the people supported by the service were living with a life limiting illness or they were nearing the end of their life.

There was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. In this instance the registered manager was also the provider.

People felt safe and were happy with the way they were supported in their homes. Staff had received training in how to safeguard people from the risk of abuse and knew how to report concerns both within the organisation and externally if necessary. Recruitment practices were safe and effective to help ensure that all staff were suitable to work with people in their own homes.

People who were being supported by the service and their relatives were positive about the skills, experience and abilities of staff who worked in people’s homes. Staff told us they had training and regular updates which helped them develop their knowledge and skills to support people effectively. Staff had regular supervisions and told us they felt well supported by the registered manager and the care managers.

The registered manager developed a good working relationship with other community palliative care teams and district nurses teams to ensure people were supported to maintain good health and had access to health and social care professionals when necessary. People were supported to take their medicines and meals where necessary.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff established what people’s wishes were and obtained their consent before providing personal care and support, which they did in a kind and compassionate way. People`s family carers told us staff looked after them as well as they looked after the people using the service. They praised staff and the registered manager for their kindness and compassion they showed to people.

People were involved in the planning, delivery and reviews of the care and support provided. Care plans were written and reviewed by people or their rightful representative. People’s personal information was securely maintained within the office.

The registered manager visited every person who used the service at least once a week to ensure the support people received met their needs. They also asked people, relatives and staff for their feedback about the quality of the service provision.

Health and social care professionals told us they felt Joy Caring Services were reliable and offered a safe and effective service to people with complex health and social care needs.

People, their relatives, and staff were complimentary about the management team and how the service was run and operated. People told us staff were never late and never missed a visit. There were systems in place to monitor the quality of services provided. The registered manager carried out regular spot checks to observe the quality of the care provided by staff an