This inspection took place on 8 December 2016 and was announced. The provider was given 48 hours because the location provides a domiciliary care service; we need to be sure that someone would be available in the office.

The Rosemary Foundation provides end of life personal care and support for people in their own homes. At the time of this inspection they were providing a service to 43 people, 10 of whom were receiving direct personal or nursing care. The other people were receiving emotional support and advice. The Rosemary Foundation was providing a service to people in Petersfield and surrounding towns and villages.

The Rosemary Foundation had a registered manager and management team who each had specific management responsibilities. 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.

People and relatives could not praise the service enough and consistently told us about the outstanding care they received from The Rosemary Foundation. They said that without a doubt they would recommend the service to their friends and family, if they ever needed to. Words people commonly used to describe their care included, “absolutely brilliant” and “exceptional”. People or their relatives told us that staff interacted with them in a compassionate, respectful and caring manner and took time to maintain their dignity and privacy.

People received care that was tailored to their individual needs. People were treated as equal partners in determining their care and treatment plans and their rights, wishes, preferences and diverse needs were respected. People, their families and staff felt that they mattered and that their views were taken seriously and acted on.

People were supported to receive end of life care that met with their needs and wishes and to achieve a private, dignified and pain free death. People, their families and staff were provided with the emotional and bereavement support they needed. People’s medicines were safely and effectively managed.

People were protected from harm and abuse and robust recruitment procedures were followed for people’s safety. There were sufficient staff to meet people’s individual needs and to respond flexibly to changes and unforeseen emergencies. Systems were effective to manage known risks associated with people’s care and treatment needs; for example, to protect them from the risks associated with medicines, falls, pressure injuries or related to symptoms they may experience.

People told us they felt safe and secure when receiving care. Staff received training in safeguarding adults, knew how to recognise and respond to abuse and understood their responsibility to report any concerns. Staff felt supported and received regular supervision and training.

Staff followed and understood the requirements of the Mental Capacity Act 2005 and people’s rights around consent to care. This ensured, where appropriate, that decisions about people’s care were made in their best interests when they were unable to do this for themselves.

Staff worked closely and in partnership with external health and social care professionals and providers and also health commissioners and national organisations concerned with palliative and end of life care. This helped to ensure that people received the right care at the right time and that knowledge was appropriately shared and used to influence best practice for people’s care.

Clear governance and management strategies were employed. This helped to ensure clear management oversight and scrutiny of the service in line with recognised practice and guidance. People and their families, staff and key stakeholders, views were used to continuously inform service improvements and to influence

During our visit we heard that people were being treated with dignity and respect and people's independence was encouraged. People told us that they were spoken to in a respectful way. One person told us "they really make you feel comfortable in your own home and that can be difficult with so many agencies coming into your personal space". Another person told us "just knowing that a willing and sympathetic person was available to give advice and support, especially out of hours, was very reassuring".

Records that we looked at evidenced that people were involved in choosing how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. Care plans that we looked at evidenced staff supporting people to maintain their routines and promote their independence. Care plans evidenced the support people required and the choices offered when support was declined. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

A family member told us "before they came, I was not getting any help and I was at my wits end. I contacted them and they came over the same day and got me through it. They are fantastic" and another said "the staff are friendly and they calm you down. They are supportive and the standard of care is very high. I would not change anything".

People who received care and support form The Rosemary Foundation told us they were happy with the service provided. We were told “the level of care and compassion is amazing” and “I don’t know what I would do without them. They are most helpful, I wouldn’t be without them”.

We spoke with other care organisations who the Rosemary foundation worked in partnership with. We were told “They are an amazing team. If we need any help we can go to them” and “The hospice in general has worked with the Rosemary Foundation over a number of years and has a very positive relationship.”

We found that members of staff were provided with the relevant training and emotional and clinical support to be able to provide the care and support people using the service needed.

There was a process for assessing people needs, involving them in the development of their care plans and continual review of their care. This ensured that people’s needs continued to be met as their care needs changed.

There was a process followed to assess the quality of the service provided and make changes to improve the service.