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Inspection carried out on 25 October 2016

During a routine inspection

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 carried out on 24 January and 3 February 2014

During a routine inspection

We spoke with 26 people, of which five were family carers over the telephone and visited five people in their own homes. We asked people for their feedback about the staff provided by the service. Comments included, “The carers are first class, they are really nice people and very helpful”. “I love them all to bits, they're lovely people”. "They ask me what I want them to do, and what I would like to eat, they definitely respect me and don't rush me". “They respect me and my house, I feel completely safe”. “I wouldn't change them for the world, they're very good”. “I have one person and they are wonderful, courteous and nothing is too much trouble”. “The agency have a lovely team looking after my relative, they are caring and compassionate”.

Overall people spoken with gave positive feedback about the service they received. However we received mixed feedback about the timing of visits and the consistency of staff. The majority of people told us that their visits were fairly prompt, however one person commented, “The timing we requested can be out by an hour”. Another person stated that, “We have to wait up to an hour with some care workers, but not others”. Other comments included, “They can come about ten to fifteen minutes late, but that's not a problem”. “I have carers four times a day, on time, and it's very rare they're late”. “If the rotas change, it can shift things a little but they do try and keep to times”.

People told us that most of the time the same staff visited. However one person commented, “We don't get the same carers every day, and occasionally get new ones”. One person told us that they were, “Not quite sure who's coming”. One person said, “I've got to know the regular person who I have most of the time, however somebody else comes on a Monday, and there's no real telling who I have on a Monday, unless my regular carer tells me on a Sunday”. One person commented, “I usually do know whose coming as you get a rota”.

People told us that they felt safe and relaxed with staff. We saw that people who used the service were well cared for by responsive and well led staff. We found that people received care and support according to their assessed needs. Where people did not have capacity to consent to their care we saw evidence that best interest meetings had been held, in accordance with the legal requirements of Mental Capacity Act (MCA) 2005.

We found that there were enough skilled and experienced staff to meet people's needs. Staff told us that they had received appropriate training and spoke knowledgably about the people they provided care and support to. Systems were in place to assess and monitor the quality of the service that people received.

Inspection carried out on 18, 23 January 2013

During a routine inspection

We spoke with five people who used the service to ask them what they thought about the care they were receiving. They all provided positive feedback about the care staff they regularly saw. One person told us, "I have always found my carers excellent and we cannot fault them.

We found that the service was meeting the personal, emotional and healthcare needs of people who used the service. Care plans had been reviewed and updated within the past six months and risk assessments were in place where a specific risk had been identified.

Families we spoke with told us that they felt that that their relative's privacy and dignity were respected by staff. They told us that staff knew how to communicate with individuals to ensure that they understood their wishes. All five people who used the service told us that they felt able to raise any concerns they had with staff and that they would respond appropriately.

Relatives we spoke with also told us that they knew how to complain. One person told us that, "Staff were very friendly, kind and caring and they knew how to care for me."

We saw that staff had been provided with the appropriate training and support to carry out their role effectively and safely. Staff told us that they found the manager to be supportive and approachable.

The service is regularly monitored and reviewed by the manager. There are systems in place that have ensured people who used the service have been consulted about the care received.