South Tees Home Support Service

South Tees Home Support Service is a domiciliary care agency providing support to children and young people living in their family homes. At the time of inspection the service was supporting eight children and young people under the age of 18.

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 children and young 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 children and young people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. Children and young 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

Staff were consistently kind and caring. One relative said, “The service is brilliant.” Professionals working closely with the service gave very positive feedback. One professional told us, “My experience of using their service was excellent. They clearly know the children well that they support and they are very supportive and proactive in helping families avoiding a crisis.”

Risks to children and young people were assessed and measures had been identified to reduce those risks identified. Robust recruitment procedures reduced the risk of unsuitable staff being appointed.

Care plans were comprehensive and reviewed regularly. Children and young people had their care and support needs met by sufficient numbers of suitably trained staff. Staff were supported through regular supervision and team meetings.

Children and young 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. The staff team ensured children and young people’s rights were respected.

A range of play, social and recreational activities were provided within the community, the service base and family homes. Staff worked closely with other services to support young people on their transition into adulthood. Relatives knew how to complain if required but told us they had not needed to do so.

Quality assurance systems had been used to identify which aspects of the service worked well and where improvements may be needed.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that children and young 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 the children and young people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

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 requires improvement (published 14 February 2019). There was a breach related to the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

The service was last inspected in July 2016 and was rated good. When we returned for this inspection we identified issues with staff training and the provider’s quality assurance processes. The rating of the service deteriorated to requires improvement. This is the first time the service has been rated required improvement.

This service is a domiciliary care agency. It provides personal care to people under the age of 18 who live with a physical or learning disability.

Not everyone using South Tees Home Support Service receives regulated activity. 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 take into account any wider social care provided. At the time of our inspection eight people were receiving personal care from the service.

The service operated in line with the Registering the Right Support guidance. These values include choice, promotion of independence and inclusion. People using the service could live as ordinary a life as any citizen. Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this and used other best practice to support them.

There was 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. The registered manager was registered in 2011. The registered manager had been absent on planned leave and had returned to work the day before our inspection began. During that time the service had been managed by an interim manager, who also assisted with this inspection.

Training was taking place but the provider’s governance systems were ineffective at monitoring and recording this. The provider did not have systems in place to assess, monitor and improve the quality and safety of the service.

Risks to people were assessed and steps taken to reduce them. The provider had effective infection control policies and procedures in place. People were safeguarded from abuse. Plans were in place to support people in emergency situations. The provider monitored staffing levels to ensure people were supported safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. Policies and procedures were in place to provide support with medicines if needed.

Staff were supported with regular supervision and appraisal. A detailed assessment was carried out before people started using the service to ensure the appropriate support was available. The service worked closely with other healthcare professionals to ensure people received effective support. 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 were supported with food and nutrition.

Relatives we spoke with told us staff were caring and kind. External professionals also spoke positively about the support provided by staff. People were treated with dignity and respect. Staff were passionate about their roles and committed to supporting people to live full and happy lives. Staff were knowledgeable about issues surrounding equality and diversity and were clearly committed to treating people as individuals. Policies and procedures were in place to support people to access advocacy services if needed.

People received person-centred supported based on their assessed needs and preferences. Staff were knowledgeable about people’s communication support needs and were able to interact with people effectively. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. The service did not provide end of life care.

Staff spoke positively about the leadership provided by the registered manager and the culture and values of the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Feedback was sought from relatives and staff. The service had a number of links with other professionals and community agencies to help improve people’s health and wellbeing.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to good governance. You can see what action we took at the back of the full version of this report.

South Tees home support provided care and support to people under the age of 18 who lived with a physical and / learning difficulty. People had very limited communication difficulties; this meant we were unable to speak with people during inspection. Staff assisted people's parents to make sure people received the care and support needed. This included helping people get ready for school, assistance with personal care and mealtimes, providing activities and taking people out into the community. At the time of inspection, they were 21 people using the service. All staff provided care and support to people in their homes; however the service did have an office located in a residential area of Middlesbrough.

The registered manager had been registered with the Commission since 2011. 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 supervision was carried out, however this was not in line with the registered provider’s policy for supervision. There were some gaps in supervision and appraisal records.

All staff participated in training. We identified a number of gaps in training; however the registered manager had started to take action to address this.

All staff were supported through an induction programme which included training, shadowing more experienced staff and developing relationships with the people and their families whom they would be working with.

People were supported with their nutritional and hydration intake. Staff worked closely with people’s families and followed any recommendations put in place by health professionals.

The service took action to keep people’s care records up to date about each person’s health. Records showed the health and social care professionals involved in each person’s care and staff supported people to attend health appointments if needed.

All staff followed and understood the guidelines set out in the Children’s Act 2004. The service sought consent from parents who held parental responsibility for each person. Staff told us they did observe for non-verbal cues to make sure people were happy with the care and support they were providing.

The service worked closely with social workers and child protection teams to keep people safe. Care and support and care plans were updated when required to reflect any new or increased risks. All staff told us they felt confident in raising any concerns which they had about the people they cared for.

Detailed risk assessments were in place and where needed were followed up by a care plan. Robust procedures were in place to keep people safe. Risk assessments also included information about people’s understanding of risk and any further measures which staff needed to take into consideration.

People’s parents were responsible for their prescribed medicines and staff did not have responsibility for this. Staff were trained to dispense emergency epilepsy medication. Protocols and emergency health care plans were in place for this.

People’s parents spoke positively about the care and support their children received from the service. From speaking with staff we could see they enjoyed caring for these people.

Privacy and dignity was maintained at all times. People's parents told us they felt involved in people's care and felt able to make decisions on their behalf which staff respected.

Person-centred care plans were in place which reflected people’s individual needs, wishes and preferences. Care plans included detailed information about individual routines, risk and triggers for behaviours which may challenge. These were regularly reviewed.

People participated in individual and group activities which reflected their choices and preferences. Group activities helped people to maintain social contact with one another and develop friendships.

People’s parents told us they felt able to raise any concerns with staff without feeling it necessary to raise a complaint. However all told us they were aware of how to make a complaint it they needed to. The service had received a number of compliments which showed people and their families were happy with the service.

All staff spoken to told us they enjoyed working at the service and felt supported by the registered manager. All staff told us they could speak with the registered manager whenever they needed to.

A registered manager was in post and had submitted notifications to the Commission when required to do so.

Quality assurance procedures were in place and feedback sought to improve and maintain the quality of the service. All accidents and incidents had been investigated and action taken to reduce any further risk of harm.

The service had good links with health professionals and health and social care agencies aimed at improving the lives of children and keeping them safe from harm and abuse. The service regularly attended meetings and forums.

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Parents told us that they were well supported. We were told that the agency provided a reliable service. One person said, 'It took me a long time to trust anyone to look after him / her but they do a great job.' Another person said, 'He / she has a small team that work with him / her. I'm given the rota in advance. They never send bank staff. Someone always steps in to cover sick leave."

Children, young people and parents were supported by, suitably qualified, skilled and experienced staff. We found that the provider had effective recruitment procedures and that relevant checks were carried out on staff to ensure that they were suitable to work with children and young people.

We saw that there was sufficient staff with the right knowledge and experience to support people.

We found that appropriate systems were in place to deal with comments and complaints.

We found that records were stored securely.

We looked at the care plans for three people who used the service. These showed that the service had carried out sufficient assessment of the needs of each person, and as an ongoing review, to enable appropriate care and support to be given.

We spoke with three of the agencies' care staff, the manager, and a social worker for one person who used the service. Staff told us that they 'loved their jobs,' enjoyed working for the agency, were well trained and supported by management, and thought that the agency provided a good service.