The Rosemary Foundation (Office)

The Rosemary Foundation is a domiciliary care agency specialising in providing end of life palliative nursing and personal care to people in their own homes. At the time of inspection there were 32 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

The Rosemary Foundation offered bespoke care and support for people at end stage of life (EOL) and to their families. People, relatives and professionals were, without exception, very positive about their EOL care and support.

People and their relatives said they felt safe with their carers and liked and trusted them. People, relatives and professionals told us the registered manager and staff were extremely kind and caring and very good at their jobs. They praised the standard of care provided and described the service as exceptional.

The service was passionate about supporting people with their end of life care in the way that they wanted. They had created a team of enthusiastic and dedicated staff and volunteers. Staff turnover was low, and people and relatives told us they were supported by staff who knew and consistently met their needs. Staff had the skills, knowledge and experience required to support people with their end of life care. The service used practical and creative ways to teach staff care skills and put this into practice to provide high quality care.

People, relatives and professionals were overwhelmingly positive about the person-centred support people received. The feedback emphasised how varied and person specific the support is. People's care and support was planned proactively and in partnership with them.

People and relatives said staff were respectful, friendly and extremely conscientious. Staff had a strong emphasis on encouraging and empowering people to be supported with the end of life care they wanted. We saw evidence of the care the service took to ensure people’s beliefs were respected and supported.

Staff worked in excellent partnership with other organisations, groups and healthcare professionals to make sure they followed good practice and people received high quality end of life care. The management team used a variety of methods to check the quality of the service and develop good practice. They were extremely proactive in encouraging people to discuss how their support could be improved or raise concerns.

Staff were aware of people's individual preferences and had the skills, knowledge and ability to meet their dietary requirements. Medicines were managed safely, and people received them at the times they needed them. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. The service was exceptionally flexible and fluid in providing care at very short notice.

The service had a strong bereavement support programme which was offered to anyone who had been affected by the loss of a person.

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 provided excellent leadership and showed empathy and a real desire to promote the best outcomes for people. All staff had a clear vision of what was required of them and focused strongly on doing so.

There was a clear and supportive staffing structure and lines of responsibility and accountability. Staff were highly competent and experienced. The service was involved in joint operational meetings with colleagues from the local hospice, community nursing services and social care.

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

Rating at last inspection

The last rating for this service was Good (published 03 February 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 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 the management and running of the service. People felt listened to and a complaints procedure was in place.

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.