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Inspection carried out on 3 July 2019

During a routine inspection

About the service

Advance Lincolnshire is a domiciliary care service providing care and support to older people and younger adults, as well as people who may be living with a learning disabilities or autistic spectrum disorder, dementia, mental health need, or a physical disability.

Not everyone using the service receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; 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 only one person was being supported with personal care.

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

People continued to receive a good service. They were safe from harm. Systems and appropriately recruited staff supported this. People’s risks were safely managed. Sufficient numbers of staff were employed to support them in taking risks. People were safely supported with handling medicines and keeping their homes clean.

Staff were trained, skilled and well supported by the provider. People had good relationships with the staff who protected their rights to lead a normal life. 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.

People told us staff were kind and caring. People were respected, staff championed their privacy and dignity and encouraged their independence in all aspects of life.

Staff were motivated to provide person-centred care based on people's choices and preferences. They were dedicated and praised for this by health and social care professionals. People were supported to do the things they wanted to. Any dissatisfaction in receiving the service was addressed and resolved.

People had the benefit of a service that was positive, inclusive and forward-looking. There was a registered manager and a management team who maintained checks on how well the service was provided. Documents held in the office were secure to ensure confidentiality of people's information.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service continued to meet the characteristics of good in all areas.

For more details, please see the full report which is on the CQC’s website at

Rating at last inspection

At the last inspection service was rated Good (report published 9 July 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Inspection carried out on 25 May 2016

During a routine inspection

Howards Court is a domiciliary care agency which is registered to provide personal care to people with learning disabilities, people with mental health needs and people living on the autistic spectrum. The service also operates a ‘floating support’ service to assist people with daily living skills such as budgeting and managing their housing tenancy although this aspect of the service is not registered with the Care Quality Commission (CQC). At the time of our inspection one person was using the registered personal care service.

We inspected the service on 25 May 2016 and spent time in the service office with the registered manager and other staff. We also met the person who used the service, having confirmed with them that they were happy for us to visit them in their home.

The service had a registered manager. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’), 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.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff had received training in this area and demonstrated their understanding of how to support people who lacked the capacity to make some decisions for themselves.

The provider maintained effective systems for assessing and managing any risks relating to the provision of care and support. Staff were aware of the assessed risks and preventive strategies that had been identified for the person who used the service and reflected this in their practice. Staff knew how to recognise signs of potential abuse and how to report any concerns. However, action was needed to ensure that the provider always notified CQC of any allegations relating to people's safety and welfare.

The provider organised staffing resources flexibly around the individual needs and preferences of the person who used the service which gave them a high degree of personal control over when they received their agreed support hours. The provider ensured staff received a wide range of core training and encouraged them to study for advanced qualifications. Safe recruitment practices were in place.

Staff worked closely with local health and social care services and helped the person who used the service to access this support when necessary. Staff were trained to assist people to take their medicines, should they need this level of support.

Staff worked together in a friendly and supportive way and provided warm, person-centred support. The person who used the service was treated with dignity and respect and was encouraged to exercise as much choice and control over their life as possible. The person was supported to prepare food and drink that reflected their individual preferences.

The person’s personal support plan was written in a person-centred way and was understood and implemented by staff. The person was closely involved in the preparation and review of their personal plan. Reflecting their personal wishes and preferences, staff supported the person to maintain an active lifestyle, inside and outside their home.

The provider encouraged people to provide feedback on the service they received and the person who used the service was clear how to make a formal complaint, should this ever be necessary. The provider maintained effective systems to monitor service quality.

Inspection carried out on 9 September 2014

During a routine inspection

A single inspector carried out this inspection. At the time of the inspection there were 60 people using the service. We talked with six people or their close relative. We talked with four staff and the manager and looked at the care records of six people using the service. We examined training records and the documentation relating to quality audits.

This helped us to answer the questions below:

Is the service safe?

Risk assessments were in place to identify the risks to the people using the service and identify action needed to reduce these risks.

People told us they had confidence in the staff looking after them and felt staff understood their needs.

We found that safeguarding policies and procedures were in place, staff understood their role in safeguarding the people they supported and knew how to take appropriate action if they had a concern.

Is the service effective?

Care plans were developed with the involvement of the people using the service and reflected their needs and preferences.

The service collaborated with other professionals and services to ensure people�s health needs were identified and met.

Staff were provided with training and development to ensure the provision of effective care.

Is the service caring?

People told us staff were friendly and caring. They said they felt well supported and one person said, �They do everything I ask them to. I am very happy with the care.� Another person said, �They do a wonderful job.�

People told us staff respected their privacy and confidentiality. They felt they could trust staff not to discuss private information with others.

Is the service responsive?

People were provided with information on how to make a complaint and told us they felt able to raise any issues with the staff or manager.

Staff listened to feedback from people using the service and responded to this wherever possible. We saw examples of changes made to the times and frequencies of visits to better meet the needs of the person using the service. The manager said, �We go to lengths to make sure they (people using the service) get what works for them.�

Is the service well led?

Policies and procedures were in place and accessible to provide staff with information and guidance on issues relevant safe and effective service provision.

The manager was available to staff and people using the service and staff felt well supported to carry out their roles.

Quality audits were carried out to assess and monitor the quality of care and introduce improvements.

Inspection carried out on 10 December 2013

During a routine inspection

On the day of our visit personal care was delivered to twelve people in their own homes. We spoke with people who used the service or their family members. A person who used the service said, �They are wonderful, I could not do without them.� A family member said, �The service is excellent, staff are on time, clean and take care of my relative.� Another family member said, �I am very pleased with them.�

We looked at three care records and saw that people or their representatives had signed a copy of the service user agreement to record their agreement to the care delivered.

We saw people�s needs were assessed and individual care plans developed. Individual risk assessments were undertaken and control measures were put in place to manage risk. A family member told us they had been involved in the development of the care plan.

Systems were in place for the management of medicines. The manager told us staff oversaw people take their medication. One family member said, �Staff only apply cream.�

Robust recruitment procedures were in place. Legal checks were made and staff underwent an induction and shadowed experienced staff. Staff told us they felt supported in their role.

We found systems were in place to assess and monitor the quality of service provision. A complaints procedure was in place and was made available to people who used the service. A family member said, �The manager comes to see if everything is going well.�

Inspection carried out on 19 December 2012

During a routine inspection

We spoke with three people who use the service by telephone. They told us staff were kind and respectful. One person said, �They�re polite and we have a chat. We have fun.� Another person told us, �They are quite pleasant and we always have time for a little chat.�

One person told us support staff always arrived on time and they were never rushed. They said, �They are better than anything we have ever had, they always arrive dead on time and never leave early.�

One person told us their support worker helped them with their on-line shopping. They told us, �We do my on line shopping every Tuesday, but it�s Christmas next Tuesday so I�ve had to do it early.�

People told us staff were competent and knew their roles. One person said, �I always have the same carers. They are very good.� Another person said, �They know what they are doing.�

We asked people if they knew how to complain. The people we spoke with told us they had a booklet in their file about how to make a complaint. One person told us, �It tells you everything you would ever need to know about complaining, but I don�t have to. If I had a problem I would speak to the manager.�