Northumberland Mid & North Domiciliary Care Agency

The inspection took place on 26 October and 9, 14 and 28 November 2018. The inspection was announced. We gave the provider notice because the service provided support to people in their own homes. We wanted to make sure someone would be available at the office to arrange visits for us to meet people.

At our last inspection we rated the service good. At this inspection we found that the service had improved to outstanding overall.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in post. A registered manager is a person who has registered with the 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 provider's vision and values were person-centred to make sure people were at the heart of the service. This vision was driven by the exceptional leadership of the registered manager and management team.

People and relatives were extremely positive about the caring nature of staff. Staff used inclusive ways of communicating with people so they were supported to take ownership of their care and support.

Staff encouraged, recognised and celebrated people's successes. The service held celebration and reflection events at people’s homes to recognise people's achievements and progress towards the outcomes they wanted. The promotion of privacy, dignity and independence was at the heart of the service's culture and values. It was embedded in everything that the service and its staff did.

People and relatives described the responsiveness of staff as outstanding. The service was exceedingly flexible and responsive to people's individual needs and preferences. Staff found inclusive ways to meet people's needs and enable them to live as full a life as possible. A creative activities programme was in place to help meet people's social needs.

People were actively encouraged to give their views and raise concerns or complaints. There was a complaints procedure in place and people knew how to complain. Various inclusive feedback systems were in place to obtain people's views.

Staff were highly skilled and knowledgeable. Comprehensive training was in place to guide and inform staff in the most effective approaches to ensure the best possible outcomes for people. People were offered and attended the same training as staff. They also undertook bespoke and additional training which met their particular needs.

People were supported to take part in the recruitment of staff to ensure prospective staff had the values and skills which met their needs and preferences.

There was a strong emphasis placed upon the importance of eating and drinking to maintain health and promote well-being. Staff ensured that people experienced the best possible healthcare outcomes. The provider’s “Getting it Right Charter” listed statements to help ensure that people with a learning disability had an equal right to healthcare.

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. The service had a very flexible approach to any restrictions it imposed on people and kept them under constant review.

There was a strong emphasis on continually striving to improve. Audits were carried out by staff and people on all aspects of the service. The service and provider sought to ensure that people experienced the best possible outcomes through research, following best practice guidelines and consultation.

Northumberland Mid & North Domiciliary Care Agency provides personal care and support to people in their own homes and help to access the community. At the time of our inspection the provider delivered care and support to 29 people and employed 60-70 members of staff. The service supports people with mental health issues, physical disabilities, sensory impairments, learning disabilities or autistic spectrum disorders, older persons and people living with dementia. The care and support provided ranged from 24 hour care packages to short visits, which for example, supported people to access the community, and provided companionship.

A registered manager was in post at the time of our inspection. 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 spoke highly of staff whom they said supported them safely and in line with their needs. Systems were in place to protect people from abuse and there were channels available through which staff could raise concerns. Records showed that safeguarding matters had been handled appropriately and referred on to either people’s social workers or the relevant local authority safeguarding team for investigation. The provider worked collaboratively with these organisations.

People’s needs and risks that they were exposed to in their daily lives were assessed, documented and regularly reviewed. Medicines were managed and administered safely and staff supported people to manage health and safety risks within their own homes and refer matters on to third parties, if necessary. Recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled and physically and mentally fit. Staffing levels were determined by people’s needs and the number of people using the service.

Staff training was up to date and staff received the support they needed to ensure they had the skills relevant to their roles and the varying care needs of the people using the service. Supervisions and appraisals were carried out regularly, as were staff meetings. Staff told us they felt very supported by the registered manager and the provider organisation overall. The provider had support schemes in place for staff to access wherever necessary and recognition schemes to reward good practice.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. There was evidence to show the service understood their legal responsibility under this act and that they assessed people’s capacity when their care commenced and on an on-going basis, if necessary. Decisions that needed to be made in people’s best interests had been appropriately referred to their social workers.

People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and we observed this when we visited people within their own homes.

Care records were person centred and demonstrated that the provider was responsive to people’s needs. People were supported to access the services of external healthcare professionals if they needed help in this area.

Communication was good within the organisation at both provider level and service level. Regular meetings took place and newsletters were distributed which kept staff informed of key issues and changes within the organisation.

People knew how to complain and records showed that complaints were handled appropriately and records kept of each complaint received. People’s views and those of their relatives were gathered through surveys.

We received positive feedback from both people and staff about the registered manager and the provider organisation. They promoted an open culture and staff told us they found both the manager and provider organisation very approachable. The provider had clear visions and values which were embedded into the organisation in order to develop the business positively. Auditing and quality monitoring of the service delivered was thorough and were carried out regularly. Records showed that any issues which were identified, were promptly addressed.

We spoke with six people, seven relatives and six support workers about the care and support provided by the service. One person told us, "It's nice living here and the staff are very good.I know I can talk to the staff about anything." A relative commented, "The care and support he gets is excellent, it's made a big difference to him and he has come on a lot. The staff have a great rapport with him."

We were unable to speak to some of the people using the service because of the nature of nature of their condition.

People and their relatives told us they were happy with the service they received.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

Staff we spoke with had a working knowledge of safeguarding matters and we found that safeguarding policies, procedures and information were available at the service. One person told us, "I feel very safe here. There is nothing that worries me, or anything I do not like. The staff are very caring."

The provider had detailed policies in relation to infection control, the use of personal protective equipment and effective hand washing. Records confirmed that all staff received regular training in infection control and food hygiene. One relative commented, 'The rooms are kept lovely and spotless, I would be happy to take anyone in there and show them how clean it is.'

We found staff recruitment procedures were in place. Records showed that these were followed when new staff were appointed and appropriate checks were undertaken before staff began work. One relative commented, 'All the staff are very good, lovely and caring. I am very happy with the service and the staff.'

The service had a complaints procedure that detailed the process to be followed in the event of a compliant. One person told us, "I have never complained, but I would tell the staff or the manager if something was wrong. I have been given a form telling me how to make a complaint."