Background to this inspection
Updated
5 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides nursing and personal care to people living in their own homes and specialises in end of life palliative care.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection site activity started on 15 July 2019 and ended on 29 July 2019. This included visiting the office location to speak with the registered manager, interview staff and review care records and policies and procedures.
What we did before the inspection
Before our inspection we completed our planning tool and reviewed the information we held on the service. This included notifications we had received from the provider, about incidents that affect the health, safety and welfare of people supported by the service and previous inspection reports. We also sought feedback from partner agencies and health and social care professionals.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with the registered manager, the clinical nurse manager, a registered nurse and a healthcare support worker. We looked at five people’s care records including their medicine records and daily notes. We looked at training compliance records for the staff team and we examined five staff members recruitment and supervision records and two volunteer files. We viewed documents relating to the management of the service, complaints and compliments, satisfaction surveys and quality audits.
After the inspection
We contacted two people, two relatives, two volunteers, the chairman of the Trustees for The Rosemary Foundation and eight healthcare professionals to obtain feedback on the service. We also requested further documents and information from the registered manager.
Updated
5 November 2019
About the service
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.