Personal Assistant Services North

Personal Assistant Services North is a domiciliary care service that provides support to people with a learning disability in their own homes. The service’s main aim is to provide support to people to enable them to access and engage with their local community and build their independence. This meant that 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. At the time of our inspection 13 people were receiving a regulated activity.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Governance processes and quality monitoring procedures did not always support the delivery of high-quality, person-centred care. We have made a recommendation about governance systems and processes. Improvements required to the governance systems in place also included the way in which the service monitored support with medicines. We have made separate recommendations regarding the monitoring and auditing of medicines and the implementation of end of life care planning. Whilst quality assurance systems required some improvements the team managers in the service had a good oversight of the support provided. The staff team were supportive of each other. They worked effectively between themselves and with external stakeholders and professionals.

Recent changes within the staff team meant at times the service had to use agency staff to ensure people received their commissioned service. This was managed with little impact to people using the service although some staff felt at times this had placed an additional pressure on them. People were safe using the service, risks were identified and responded to. Staff felt a commitment to the people they supported and understood the importance of reporting any concerns to the appropriate professionals.

Staff worked proactively with health and social care professionals which helped ensure the support provided was in line with best practice. People were supported to be healthy, this included supporting people to manage their weight or accessing health care services. Staff spoke positively of the training provided and the additional support given by the provider to make sure they could meet people’s needs. 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.

Staff were kind caring and supportive. Many had worked for the service for a long time and staff demonstrated a commitment to ensuring people received a good service and were treated well. Staff understood the importance of supporting people to have a say in their day to day support and enabled people to make decisions about this.

People received personalised care that met their needs and preferences. The support provided and the associated care plans were continually reviewed and updated. People’s communication needs were assessed and staff utilised various communication aids to support people’s communication. The service’s main aim was to encourage and engage people in their community, activities, work, and promote their independence. People were supported to engage in various activities that were of interest to them. The service had received no recent complaints. Relatives of people using the service told us they felt able to raise concerns if necessary and team managers were quick to resolve minor issues.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 (report published 17 November 2016).

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.

This announced inspection took place on 26 September 2016. There were 21 people receiving care at that time.

The service had a registered manager in place. 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.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were well trained, and well supported, by their managers.

There were sufficient staff to meet people’s assessed needs. Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines safely. People’s health, care and nutritional needs were effectively met.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. The provider was aware of what they were required to do should any person lack capacity. They had made appropriate requests to commissioners to assess people’s capacity in regard to specific decisions. However, the provider had not yet completed their own assessment of people’s mental capacity and it was therefore unclear how people’s day-to-day care was being provided in their best interest. The provider had recently created a policy and procedure in relation to the MCA. The registered manager received this during our inspection and told us it would be implemented shortly and would assist them to bring about the necessary improvements.People received care and support from staff who were kind, compassionate and respectful to the people they were supporting. People and their relatives had opportunities to comment on the service provided and people were involved in every day decisions about their care.

People’s care records provided staff with detailed guidance to ensure consistent care was provided to each person. Changes to people’s care was kept under review to ensure the change was effective. People were supported to take part in social and recreational activities that promoted their well-being and reduced the risk of social isolation.

The registered manager was supported by a staff team that included team leaders and support workers. The service was well run and staff, including the registered manager, were approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. People had access to information on how to make a complaint and were confident their concerns would be acted on.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address the shortfalls. People and their relatives were asked for their views and staff were always looking for ways to improve the service.

The registered manager was not available during our inspection. We spoke with two people who used the service, two team leaders and three support workers. We reviewed four people's support plans and four staff files. We also reviewed a selection of other service records. These included the provider's policies and procedures and training materials.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. This included effective policies and procedures, mandatory safeguarding training and Disclosure and Barring Service (DBS) checks for all staff.

Staff had received training in relation to lone working and there were policies and procedures in place to help reduce the risks associated with lone working.

Staff were up to date with their mandatory training. This is training staff have to undertake, inclusive of refresher training, in order to provide safe delivery of care and support.

The people who used the service had effective risk assessments in place to reduce the risks associated with the different activities they participated in. These included gardening, going out in the car and going to the fun fair.

There were effective procedures in place investigate accidents and incidents, and we saw evidence that appropriate actions were taken to help reduce the risk of repeat occurrences.

The provider had arrangements in place to manage foreseeable emergencies. These included a shortage in staff numbers, adverse weather and fire.

Is the service effective?

One person who used the service said, 'I am very happy and do lots of nice things. I'm going to the sports centre today and to a concert next week.'

People's needs were assessed, and care and support was planned and delivered in order to meet their needs. Care plans were person-centred and undertaken with the person involved. People who used the service had various communication needs and it was evident that the support workers used effective techniques to communicate with people. The staff ensured that people consented to what was being proposed before care and support was delivered.

It was evident that their people's care and support enabled them to lead active lives in their own communities and maintain the level of independence that was right for them. Each person had different goals of what they wished to achieve. We noted that people's days were structured to facilitate this and saw evidence that people did achieve their goals.

Staff had received the appropriate training to effectively meet the needs of the people they were supporting. This was evident when we reviewed people's support plans as well as through direct observation of staff delivering people's care and support.

We noted that there was multi-disciplinary working and working with others. This included the involvement of people's speech and language therapists, their social workers and their general practitioners. Some of the people who used the service, lived in a care home or setting. We saw evidence of collaborative working between the team leaders at the service and the managers of care home.

Is the service caring?

People's care was person-centred and focused on what their preferences were and how they wished to spend their time. The care plans we reviewed focused on the importance of maintaining people's privacy and dignity and the promotion of their self-care.

We noted that the staff knew the needs of people well. This was particularly relevant in relation to people's communication needs. There was detailed documentation in people's support plans about how people received and understood information and the tools and techniques that should be used to ensure effective communication. During the time we spent observing staff interact with the people they supported we noted that staff were compassionate and respectful at all times. The staff displayed patience and did not hurry people. Instead, they allowed people the time they needed in order to express themselves.

It was evident that people's social and emotional needs were being met. The staff displayed detailed knowledge about how people felt by observing their actions and listening to the different sounds they were making. We noted that when a person became agitated or upset, the support worker remained calm and used the appropriate communication techniques to reduce the person's anxiety.

Is the service responsive?

Before people used the service the team leaders assessed whether both the service and the available staff could meet their needs. This included responding to people's request to have a female or male support worker, as well as people's requests for staff of a similar age with similar interests.

During our review of four people's support plans, we noted that these responded to and reflected people's physical and mental health needs as well as their social and emotional needs. We saw evidence that the care and support that was delivered responded to all of people's needs. This included activities to promote self-care, people's independence and to help achieve people's aspirations and goals.

The provider had a complaints policy and procedure. We noted that both verbal and written complaints were responded to in a timely manner and fully investigated. The results from complaints were fed back to the staff. This enabled learning to take place in order to improve the quality of the service provision.

Is the service well-led?

The staff we spoke with told us that they felt well supported. They told us that the team leaders shared information with them and we saw evidence of a positive culture within the service.

Staff were responsible for their own continuous professional development. They received constant support from the team leaders and this enabled them to undertake training and education and progress with their careers. The team leader told us that the support staff gave presentations and short teaching sessions to the other staff once they had completed a specialist course. This was done to enable them to share their learning with others.

The staff we spoke with understood their roles and responsibilities and knew when they needed to 'escalate' an issue or problem to the team leader.

The service had quality assurance systems in place to assess and monitor the quality of the service people received. At the time of this inspection the results from a current satisfaction survey were waiting to be audited.