North STSS (Short Term Support Service) Alnwick

North Short Term Support Service (STSS) – Alnwick is a domiciliary care agency, with a focus on reablement care, providing personal care to people in their own homes. At the time of our inspection there were 25 people using the service.

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

People were at the forefront of their care. Care was exceptionally personalised with people being supported to achieve their goals. Staff were passionate about providing the best care possible to people.

The provider was championing projects to help people’s reablement and alleviate pressure on the local healthcare systems. People were being supported whilst in hospital to help maintain their independence and skills, so they required less support on returning to the community.

The management team were constantly working to improve the service. Staff at all levels collaborated well to achieve excellent outcomes for people. Health and social care professionals praised the service’s management. Quality assurance checks were carried out to ensure people received good quality care. Lessons had been learnt from incidents.

The provider was committed to continuous improvements to the service. Often through effective partnership working with local healthcare, social and voluntary groups. Even the smallest pieces of feedback from staff and people was acted on.

People experienced good quality, consistent and safe care from reablement staff. Comments from people and their relatives were overwhelmingly positive. For example, on person said “When you’re feeling so dreadful it just gives you the boost you need to have such kind lovely people helping, they were simply amazing.”

People were safe from the risk of abuse. Risks were assessed and regularly reviewed when people's needs changed. People were supported in positive risk taking as part of their reablement.

Medicines were managed safely. The provider employed sufficient staff, who were trained appropriately and recruited safely. The provider championed staff training over and above the care certificate standard, with staff undertaking enhanced training in falls prevention.

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 outstanding (published 1 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for North STSS on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

North STSS (Short Term Support Service) Alnwick is provided by Northumberland County Council in partnership with Northumbria Healthcare NHS Foundation Trust. It provides three distinct services; re-ablement, crisis intervention and a ‘bridging’ service. Re-ablement concentrated on supporting predominantly older people following a recent illness, hospital admission or an exacerbation of a longer term condition, with the aim of getting them back to an optimal level of independence. The crisis intervention service supported those who required immediate support due to a sudden change in their circumstances such as an accident or acute illness. The bridging service supported people until a long term provider was assigned.

At the time of the inspection, the service was providing personal care and support to 31 people in their own homes.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

North STSS (Short Term Support Service) Alnwick was last inspected by CQC in November 2015 and was rated Good. At this inspection we found the service had improved to Outstanding.

The service was very flexible and extremely responsive to people’s needs. We saw and heard how staff went above and beyond their role.

The service used a number of research based assessment tools to ensure the best possible outcomes for people, and employed occupational therapists and physiotherapists to work alongside care staff.

People’s care and support was planned proactively with them in a person centred way. People’s preferences and choices were clearly documented in their care records and people told us they were involved in the care they received. The service had used case studies to review the support people had received and identify good practice or lessons learned.

There were consistently high levels of constructive engagement with staff and people who used the service. Staff felt supported by the registered manager and said there was an “open door policy” at the service. Policies and procedures were in place to keep staff safe, and management and office staff provided outstanding support to care staff.

People who used the service and health and social care professionals were extremely positive about the service. The service worked collaboratively with other organisations and local charities.

Governance was well embedded into the running of the service. Service quality and improvement was high on the organisational agenda and was measured through a variety of audits, satisfaction questionnaires and performance dashboards.

There was a strong emphasis on continually striving to improve. The service had an electronic monitoring system in place. The registered manager told us it helped them “effectively manage resources” and achieve “value for money”.

People who used the service and family members were extremely complimentary about the standard of care at North STSS (Short Term Support Service) Alnwick.

Staff respected people’s privacy and dignity. People spoke positively about how staff respected their privacy and dignity while carrying out personal care, and the support they received to help them regain their independence.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff, and described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place to ensure the safe administration of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. Staff were suitably trained and received regular supervisions and appraisals.

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.

' 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 '

Is the service caring?

We visited two people in their homes and spoke with a further three people on the telephone. People told us they were very happy with the service. They told us that staff knew what to do and always turned up when expected. Comments from people included, 'I've been very fortunate with carers; they have been exceptional'; 'They are all good but these three (providing care for the current period) have that extra something'; 'I think it is an excellent service, they all do a good job'; 'They are all good in their own way; every one is different' and 'They are very caring. They make sure all the bits are dry, even between your toes.'

We spoke with four members of staff. Care workers told us they would be given details of the care to be delivered and any other important information before they visited. They also told us they checked the care plan kept in people's homes. Staff told us there were always a supervisor and manager on call, who they could contact if any issues arose. This meant there were arrangements in place to deal with foreseeable emergencies.

Is the service responsive?

We looked at ten care plans and found that they were reviewed, as appropriate, within the six week period that people were supported by the service. A supervisor told us that reviews were undertaken at a minimum two weeks, but probably more often because people's needs changed so quickly. People we spoke with confirmed that staff from the service visited to review their progress and ongoing needs.

We noted that the service had received 18 formal letters of compliment. One comment from a written compliment state, 'Very caring and willing at all times; which I much appreciated.'

Is the service safe?

The provider had in place a safeguarding policy. Information about action to be taken in the event of a safeguarding incident and contact details of agencies to be kept informed was maintained in a dedicated file. The manager told us, and records confirmed that there had been no recent safeguarding incidents.

Staff we spoke with told us that they had undertaken safeguarding training and certificates in staff personal files confirmed this.

People we spoke with told us that they felt safe when care staff visited them. One person told us, 'Yes I feel safe. They are not just young bits of stuff; they are sensible and mature.' Other people said, 'I feel safe with all of them; they are all capable staff' and 'I feel safe with all of them; exceptionally safe.'

Staff told us, and records confirmed that the provider had in place a lone worker system. Staff stated that they could contact a supervisor or manager at any time.

Is the service effective?

A supervisor showed us how the new electronic system helped in scheduling support visits and allocating staff. We saw there was a checking system to ensure that all required visits had been appropriately allocated. They told us that staff were also required to scan in and out of visits. This meant the system could log that calls had been made and alert the office to missed or late calls.

People told us that they found the service helpful. One person who used the service told us, "I think it is a wonderful service. They are very wise in caring and know stuff that helps you." Staff understood about people's needs and the role of the service in supporting people. One member of staff stated, "We involve them in their care and encourage them.'

Is the service well led?

In this report the name of a registered manager appears who, due to retirement, was not in post at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The provider is currently undertaking a recruitment process to appoint a new manager.

The deputy manager, a supervisor and staff confirmed that supervisors carried out spot check observations on care delivery.

Staff told us they felt supported by the supervisors and the managers. One staff member told us, 'I have the out of hours number but also my supervisor's number. I can ring her at any time.'

A team supervisor told us, and staff confirmed that there were twice weekly team meetings when any issues could be discussed in relation to people's care or any associated problems. The deputy manager told us, and staff and records confirmed that there were monthly operational meetings.

The deputy manager told us that there had been one formal complaint within the last 12 months. We saw letters and documents from the investigation of this complaint and saw that processes had been followed appropriately.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us, "They are absolute wonders; it's the little things that mean so much. I am very impressed." Another person commented, "I am happy, one hundred percent. They are very thorough."

The provider had detailed policies in relation to infection control and hand hygiene. People who used the service told us that staff always wore gloves and aprons when they delivered care.

People's care records contained a detailed summary of their current medication and an assessment of need in relation to the support they required with medicines. Staff had undertaken training in the safe handling of medicines and we saw copies of up to date certificates that confirmed the training had taken place.

People who used the service told us that generally they got support from a small group of staff. We concluded all shifts were covered by the service and there were enough staff to meet people's needs.

The service had a written complaints procedure that detailed the process to be followed in the event of a complaint. This indicated complaints should be documented, investigated and responded to within a set timescale. One person said, "The service is very good. I would recommend it to other people."