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Inspection carried out on 9 April 2019

During a routine inspection

About the service:

Primary Access Limited provides care and support to younger people with learning disabilities, autistic spectrum disorder and or physical disabilities living in 'supported living' settings. This is so that they can live in their own home as independently as possible. At the time of our inspection the service was providing support to nine people.

People’s experience of using this service:

• People were protected from abuse, neglect and discrimination. Staff ensured people’s safety and acted when necessary to prevent any harm.

• Individual risks to people were assessed and managed to keep people safe.

• People received their medicines as prescribed.

• The service was person centred and assessed people’s needs and individual preferences.

• Staff told us that the training they attended was good and gave them the skills and knowledge they needed to support people. However not all self-employed staff had undertaken refresher training.

• Health care professionals such as district nurses, the GP, and the community mental health team had been involved in people’s care.

• 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 to express their views and staff were knowledgeable about people’s preferred communication methods.

• People were supported to pursue their own hobbies and interests.

• Relatives and staff were very positive about the management of the service.

• The service had links with the local community to enhance the lives of people using the service.

Rating at last inspection:

• At the last inspection in October 2016 the service was rated Good. At this inspection the service remained good.

Why we inspected:

• We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.

Follow up:

• We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

Inspection carried out on 3 October 2016

During a routine inspection

Primary Access Ltd is a domiciliary care service providing care and support to 16 people living in their own home and to two people who live in supported housing.

The service has a registered manager. 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.

People were safe because staff understood their role and responsibilities to keep them safe from harm.

Staff had a good knowledge of the provider's whistleblowing policy and procedures which meant they were able to raise concerns to protect people from unsafe care.

Recruitment processes were robust to make sure people were cared for by suitable staff. There were sufficient numbers of staff deployed to meet people's needs.

People were supported by staff who received regular training, support and supervision to help them provide effective care.

Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to ensure that people who were unable to make their own decisions about their care and support were protected.

People had good relationships with the staff and were treated with dignity and respect.

There were systems in place to monitor the care provided and people's views and opinions were sought regularly.

There was an effective complaints system in place. People and relatives told us they were confident to raise any issues about their care and that they would be listened to and their concerns addressed.

People, relatives and staff told us the service was well-led and managed by an effective and organised management team.

People had confidence in the provider and staff were clear about their roles and responsibilities.

Inspection carried out on 22 April 2014

During a routine inspection

We previously inspected Primary Access Ltd on 15 January 2014, and judged the provider did not take all reasonable steps to ensure the safety and welfare of people that used the service. They sent us a action plan and told us how they were going to make the required improvements. At this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

When we inspected Primary Access Ltd on 15 January 2014, we found that people were not always being supported in line with their individual care plan, and that risk assessments were not regularly reviewed. At this inspection, we found the provider did make the necessary improvements and saw suitable arrangements were in place in order to regularly assess the risks associated with people's care needs. This meant that people were provided with safe care.

Our previous inspection on 15 January 2014 also found care workers had not received training in safeguarding of vulnerable adults, and the providers safeguarding policy did not contain contact information for the Care Quality Commission (CQC) or the local authority safeguarding team. This meant that people and care workers were not supplied with suitable information to raise concerns about possible abuse. At this inspection, we found the provider updated the safeguarding policy and included contact details of CQC and the local authority safeguarding team. We also found that care workers had recieved safeguarding of vulnerable adults training. This meant that care workers were able to recognise signs of possible abuse and were knowledgeable about how to report it.

Is the service effective?

Care workers we spoke with had a good understanding of people�s needs and interacted positively with them. We saw they communicated effectively with people. For example, we observed one care worker interacting with someone who had limited verbal commination skills. The care worker followed the person's communication support plan, and provided reassurance and clear communication.

Is the service caring?

People�s life style choices, preferences, interests, and different needs had been written in their plans and care and support had been provided to make sure these were upheld.

Care reviews demonstrated that where people had been identified as requiring additional support, arrangements had been put in place in order help people to achieve their desired outcome. For example, accessing the community and attending medical appointments.

Is the service responsive?

People�s needs had been assessed before they received care from Primary Access Ltd. We saw that people�s health needs were monitored and they were referred to health professionals appropriately. For example, we saw two records that demonstrated two people had been referred to a particular support group for help with communication. We also found that any concerns about people's health were followed up and appropriate action was taken.

Is the service well-led?

There were clear lines of accountability within the service. We saw that regular audits of the quality and safety of the service took place and were recorded. For example, there were audits of care plans and health and safety checks. Records we looked at confirmed this.

Care workers told us they felt part of a team and that the manager's were approachable. They told us the managers visited people regularly to check the care was delivered effectively. Records showed team meetings had been held every three months, and care worker's told us they had confidence in the management to deal with any concerns raised by people or relatives.

Inspection carried out on 15 January 2014

During a routine inspection

People told us that they had been involved in the assessment and care planning process carried out by the agency to ensure that it could meet their individual needs. One person said "I was involved and was able to tell them what I wanted".

People had an initial assessment in place, however we found that care plans and risk assessments did not support delivery of the care that met people's needs.

People we spoke with told us that they felt safe, however, care staff had not received safeguarding of vulnerable adult training and the provider's safeguarding policy did not provide sufficient detail about how to report possible abuse.

There were effective recruitment and selection processes in place. All candidates were required to complete an application form and attend an interview with the manager.

Records were kept securely and could be located promptly when needed. Staff told us that people's care records were located safely in the office and told us that they could access the records when necessary. But the information in people's care records was not accurate as assessments and plans were not regularly updated.