Number 73 Also known as Aldingbourne Trust

Number 73 is a domiciliary care agency located in Bognor Regis, West Sussex. The agency provides personal care to people with a learning disability and/or physical disability and supports people to live independently in their own homes. The care ranges from a few hours of support a week up to 24 hour care for people in supported living services. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and receive their care and support from the domiciliary care agency. As the housing and care arrangements are separate, people can choose to change their care provider without losing their home. They provide support to adults of all ages At the time of the inspection visit the service was supporting two people with personal care.

People were supported to live a full and active life, offered choice and staff had safeguards in place to support people to experience holidays, outings and a range of activities to go ahead.

Comprehensive risk assessments were in place and support plans managed risks so people were safe. Risk assessments were regularly reviewed and also when people’s needs changed and the staff approach was flexible to allow for changes in circumstances. The staff ensured people were protected from the risk of harm.

The service had a robust recruitment process to help ensure people employed were suitable to work with vulnerable people.

Care and support plans included person centred daily observation records that identified the care and support interventions that had been provided and any issues around care and support for the person being supported.

There were enough staff to support people doing the things they wanted to do and to keep them safe. Staff were motivated and aware of their responsibilities. Staff told us they loved their jobs and felt they had all the support they needed to carry out their role. They told us, “We get a lot of support and always encouraged to share information or ask if we are not sure about anything” and “My induction and training really helped me to get into the role. It was a team effort.”

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

Systems were in place to safely manage people's medicines. Staff were trained in the safe administration of medicines and kept relevant and accurate records.

People's human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed.

People were supported to do things they enjoyed and keep in touch with those people who were important to them.

People had a good choice of diet and were supported to eat and drink when it suited them, as well as being offered choice which reflected their personal preferences.

People were supported to maintain their health and well-being and had regular access to health and social care professionals.

There were robust procedures in place to monitor, evaluate and improve the quality of care provided. The registered manager understood the requirements of CQC and sent in appropriate notifications. The registered manager made sure there was a focus on continuous development of the service.

This inspection was carried out by a team of two inspectors. We gathered evidence that helped us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with one person who used the service, two relatives, four care workers who supported them and from looking at a selection of records. They included care assessments and care records, records of medicines administered, safeguarding procedures and training records, care worker rotas and records related to the provider's quality assurance system.

Is the service safe?

Care workers had received training in identifying and reporting possible abuse. They also demonstrated they knew what was expected of them. This meant the provider had taken appropriate steps to guard against the risk of vulnerable people being abused.

The manager was unable to demonstrate how care workers had been allocated to ensure the personal needs of individual people had been met. This meant that people may be at risk of not receiving the personal care they required. A relative told us that their family member sometimes had to wait two or three days before a care worker was available to help with washing their hair and having a bath. We have set a compliance action in relation to this and the provider must tell us what they are going to do to address it.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in drawing up their care plans. This ensured care delivered had taken into account people's wishes and preferences.

People and their relatives told us, in the main, they were happy with the care provided. A relative told us, 'I have no concerns about the personal care provided.'

Is the service caring?

We observed care workers interacting with people in the office area. From our observations we saw people were treated with respect and dignity. People were supported by kind and attentive care workers. We also saw that care workers showed patience and gave encouragement when supporting people.

People and family members who completed satisfaction surveys reported they had no concerns about the care provided.

Is the service responsive?

Care workers supported people to talk about their views and experiences and to sort out any problems.

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

The manager showed us how the overall care worker hours to provide for the personal needs of people had been calculated. However, the manager was unable to demonstrate how these hours had been allocated to each person to ensure their identified personal care needs had been met. We have set a compliance action in relation to this and the provider must tell us what they are going to do to address it.

The provider had a system in place for gathering, recording and evaluating information about the quality and safety of the care and support the service provided Records that we looked at showed that identified shortfalls were addressed. As a result the quality of the service was continuously improving.

Care workers we spoke with were able to describe their roles and responsibilities and what they were expected to do.

They also confirmed they felt well supported by the manager and other senior staff.

We reviewed the supply process, supporting information and administration records. Medicines were obtained in a timely manner. The information to support care workers to administer medicines was complete, therefore we were assured that care workers less familiar with people who received a service would administer the medicines in a consistent manner. The administration records were complete and were compliant with the service's procedures.

We spoke to six members of staff who explained how medicines were obtained, stored, administered and recorded. We also spoke with one person who received a service. They told us they had not run out of medicines and if they had questions about their medicines the staff would help them find the answers.

The service undertook audits and the investigation of complaints and incidents. These were reviewed on a regular basis and changes were made to the service's procedures and or training as a result. Therefore we saw a process of continual learning and improvement.

Every one of the people spoken with told us that their care was personalised to their needs and that their privacy, dignity and independence was respected. For example, one person said, "They support me to do things for myself. They leave me to do things I can manage, which is good". Another person said, "They are very nice. We are on the same wave length. They are good at listening".

Everyone also felt that staff were well trained and understood their needs. For example, one person told us, "New staff come and shadow my workers so that they get to know me. It's like they are being taught by other staff and they involve me when they do this. I think they are great".

People told us that they felt safe and if they had concerns they would speak with a family member, friend or somebody from the office. Everyone that we spoke with told us that they were happy with the service they received and that care workers were reliable and friendly.

The evidence we gathered during our inspection supported the comments made by people.