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Inspection Summary


Overall summary & rating

Good

Updated 14 April 2017

The inspection took place on 25 and 27 October 2016 and was announced. This was an announced inspection so that the service had time to arrange for us to visit and talk with people using the service in their own homes. We also inspected office based records and spoke with staff during this time. From November 9 to 24 we contacted other people using the service by telephone to understand their views of the service. At our last inspection of February 2014, using our methodology at that time the service was viewed as compliant.

The service is registered to provide personal care and is a domiciliary service. There were one hundred and fifty-seven people receiving support at the time of the inspection.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

The service was outstandingly well-led which was demonstrated by how the staff were supported and how well the service was organised to ensure people received high standards of care according to their assessed needs.

The care plans were person-centred written to clearly identify the support required alongside what the person could do for themselves.

All staff had attended training as part of their induction to the service designed to help them recognise abuse and know what actions to take to protect people as far as reasonably possible from actual or potential harm. Staff had a clear understanding of their roles and responsibilities, whether this was staff involved with providing direct support or those working to organise and support. People using the service were supported by a sufficient number of suitably experienced and knowledgeable staff to meet their needs. The manager carried out appropriate recruitment checks before staff began work with the service. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred. As part of the assessment process to determine if the service could meet the individual’s needs, people were asked about their preferences and choices and the support plans were written in a person-centred style.

The service had a medicines policy, staff had received training and systems were in place to manage medicines and people were supported to take their prescribed medicines safely. The service carried out an audit to determine that medicines were being managed safely.

People using the service experienced a service based upon their assessed support needs which was person-centred. The staff were knowledgeable about the people they supported. Individual goals were identified as the service employed occupational therapist alongside experienced care staff and sought the advice of other professionals to organise and deliver the care support.

Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 including best interest meetings. A best interests meeting may be needed where an adult (16+) lacks mental capacity to make significant decisions for themselves and needs others to make those decisions on their behalf.

Positive and caring relationships had been developed between the people using the service and staff supporting them. Staff responded to people’s needs in an empathic manner. People’s choices were respected as was their privacy and dignity. The care plans were written to take account of people’s needs and to promote and maintain independence. People were involved in the planning and reviewing of their care and support, as were family members with their permission. The service was focused upon a solution based approach and to achieve this aim.

The service had a clear set of values, positive culture and ethos which were understood by the staff as these were shared across the organisation in meetings and company literature. People and relatives we spoke with were positive about the service. Saying the important things of coming on time and staff clearly knowing what to do to support them were carried out without fuss and people could enjoy a laugh and a joke with the staff.

Staff were supported and supervised in their roles and had an annual appraisal to discuss their performance and career development. Part of the supervision process was for the service to carry out spot checks of the care delivery. The service also supported senior staff with mentors for their career development.

Staff supported people with their health care needs including where required monitoring of people’s food and fluid intake. The service reviewed people’s care to ensure the service continued to meet their needs and they worked with other professionals to that end.

The staff told us there was an open culture as the manager was approachable and enabled people who used the service to express their views. People were supported to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service. The service had systems in place to check the quality of the support provided which included surveys to analyse people’s views who used the service.

We consider the service was outstandingly well-led. This was because the manager was an effective role model actively seeking the views of people using the service and other stakeholders as well as supporting the staff. A positive culture had been created where people felt confident to challenge and raise concerns. Also the service had worked with other services to welcome apprentices and also supported staff that were working for the service while embarking upon nurse training.

Staff management systems were in place to provide sufficient staff at the correct times to support people with the care and support they required. The service was provided over a large geographical area to some remote parts of the county and there was management support in place to support the staff delivering the direct support. People using the service were consulted about having the staff of the gender they wished to support them.

People using the service were confident any concerns they raised would be listened to and resolved professionally. This was because there were policies and procedures in place as well as management systems focussed upon delivering and developing quality services. Staff reported to the registered manager who in turn reported to the provider of the service. Senior managers were supported by mentors to help them to develop their skills and resolve management problems as they occurred.

The management systems in place we saw included audits of people’s view that used the service the views of staff and also checking upon the standards of service delivery such as spot checking that staff attended to people on time. The organisation is one of a learning culture where information gained is shared across the organisation for the benefit of the staff and people using the service.

Inspection areas

Safe

Good

Updated 14 April 2017

The service was safe.

People were protected as far as reasonably possible by staff who had received training to recognise abuse and how to report any issues.

There were sufficient numbers of staff to meet people’s needs and people were supported by staff that knew them.

There were appropriate systems in place for handling and administering medicines.

There were robust recruitment practices in place designed so that only suitable staff were employed.

Effective

Good

Updated 14 April 2017

The service was effective.

People were supported by motivated staff. The induction for new staff was robust and all staff received regular and effective supervision and support, including spot checks of direct support staff.

People’s rights were protected. Staff and management had a clear understanding of the Mental Capacity Act 2005 and best Interest meetings.

People were supported to maintain good health and an appropriate diet for their needs.

The service worked with other professionals as required to support people to meet their needs and involved other professionals as needs were identified.

Caring

Good

Updated 14 April 2017

The service was caring.

The service provided support to people using person-centred and regularly reviewed care plans.

People were treated with respect by staff who were kind and compassionate.

People were treated with privacy and respect

Responsive

Good

Updated 14 April 2017

The service was responsive.

There was an assessment process in place designed to determine the personalised support people.

Staff knew people well because they were organised to work with a small number of people using the service.

Any issues, complaints or ideas for improvement were listened to and addressed promptly.

Well-led

Outstanding

Updated 14 April 2017

The service was outstandingly well led.

The manager set the example of how the service was to perform and was approachable to people using the service and staff.

People using the service had access to on-going assessments from occupational therapists employed by the service.

The service had clear values which were put into practice by organised and caring staff.

There were effective systems in place to assess and monitor the quality of the service.

The service communicated clearly with people using the service by newsletters and customer calls.