Gemstone Care Ltd

People’s experience of using this service and what we found

People, their relatives and professionals routinely described the staff as knowing people exceptionally well, and the care people received as being exceptional, excellent, brilliant and wonderful.

Innovative and creative ways were used to deliver bespoke and personalised care and support to people. People's health and wellbeing was closely monitored to ensure they received timely and appropriate treatment. Transitions between services continued to be effectively managed and was meticulously well planned.

People were encouraged to live as full a life as possible and supported to achieve the best possible outcomes. Staff had formed positive relationships with the people they supported and looked for ways to make them feel valued. People were genuinely encouraged to express their hopes and dreams and the service looked for ways to make these a reality. Staff knew people really well and used this knowledge and support them to achieve their goals. Staff were considerate of people's feeling at all times and treated people with the utmost respect and dignity.

People received highly personalised support from staff who knew them well. People were encouraged and supported to reach their goals. People's confidence, independence and health outcomes had improved since they began using the service. People's achievements were recognised and celebrated. People were enabled to maintain relationships with those who mattered to them.

Staff were aware of safeguarding procedures and knew the correct action to take if they suspected abuse had occurred. There were enough staff to meet people's needs in an inclusive way. Prospective employees had been recruited inclusively, with people who used the service. People were supported by a consistent staff team who were aware of the risks to people and knew how to manage these safely. Medicines were administered, stored and disposed of safely. Infection control practices were robust and promoted the principles of individual awareness and ownership.

The level of care and support given to people enabled them to have an excellent quality of life. Staff understood and knew how to apply legislation to help people make decisions and give their consent to treatment. Where restrictions were in place this was in line with appropriate guidelines.

People were supported by staff who had exceptional skills and knowledge to meet their assessed needs. People had enough to eat and drink and arrangements were in place to identify and support people who had been identified as being nutritionally at risk.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to a wide range of personalised and group activities and were supported to have a say in all aspects of how the service was delivered. People were supported to have as many opportunities as possible, so they could gain new skills and live more independently.

People benefitted from a service that had a dedicated registered manager whose experience and qualifications were used to support people to lead full and meaningful lives. The values of the provider were consistently demonstrated by staff in their interactions with people and with each other. People's views were sought out and acted upon.

Robust quality assurance processes ensured the safety, high quality and effectiveness of the service. People felt listened to and their views were taken into account. These were used to shape the service.

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

Rating at last inspection (and update) The last rating for this service was outstanding. (27 January 2017)

Why we inspected This was a planned inspection based on the previous rating.

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

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. Relatives had noticed that people had become more assertive, making more decisions for themselves and had become much more independent and capable and were thriving under the nurturing care and support they received.

People received individual one to one support from staff and the provider so were able to take part in a wide range of activities that were important and relevant to them, both inside and outside of their homes. They were protected from social isolation because of the high level of support and opportunities made available through the service.

People received a high level of support to maintain their health and wellbeing. The service worked extremely effectively with healthcare professionals and were pro-active in referring people for assessment or treatment. The provider kept thorough and highly detailed health records and shared this information appropriately with relevant health and social care professionals. This meant that people’s health was closely monitored to ensure they received any treatment they required in a timely fashion.

Staff upheld the vision and values of the service which placed people at the heart of all that they did. Staff treated people with the utmost dignity and respect and looked for ways to help people feel valued and to promote their independence. This resulted in people forming very positive relationships with staff who were valued and held in high regard by the people and families they supported.

The care and support people received was personalised and tailored to meet their individual needs and preferences. People, and their representatives, where appropriate, were involved in making decisions about how the support was delivered so they felt listened to and included.

People were integral in shaping the service and making decisions about the way it was run. The provider and staff team recognised the importance of placing people at the heart of the service and empowering their involvement. There were effective systems in place to monitor the service and people benefited from an open and transparent culture where their views were sought and acted upon.

People were cared for by staff that knew them really well and understood how to support them to attain their goals. Staff respected people's individuality and encouraged them to live the lives they wanted. People's progress was monitored and celebrated.

The service was viewed as an organisation that went ‘the extra mile’, providing a level of dedication and commitment to the people it supported that often exceeded expectations. People were encouraged to express their hopes and dreams and the service looked for ways to make their aspirations a reality. .

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."

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.