About the service:

ALS Support Limited t/a ALS Support is a domiciliary care agency. It provides personal care to people with learning disabilities living in their own homes. Not everyone using ALS Support Limited t/a ALS Support 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 the inspection the service was providing personal care to four people.

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 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 people with learning disabilities and/or autism to lead meaningful lives that include choice, control and independence. People receiving the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

None of the four people using the service were able to tell us their views about their care due to their complex needs. However, relatives were very satisfied with the service provided.

People received consistently high standards of person-centred care from regular support staff who knew them well and understood their communication needs. Staff understood how to manage any risks to people and knew the processes to follow to manage any allegations of abuse.

Care records provided detailed information about people’s needs and preferences. People’s health care and nutritional needs were well managed and they received their medicines when they needed them.

Staff were kind, compassionate and caring. They treated people with respect and maintained their privacy and dignity.

Staff were trained and competent in meeting the specialist needs of the people they supported. Recruitment processes ensured staff were suitable to work in the care service.

The service was well organised. Relatives told us staff arrived on time and had enough time to provide support without rushing. Staff told us they loved their jobs and were well supported.

Relatives and staff praised the management of the service. The registered manager was actively involved in delivering the service and worked alongside the staff supporting them and making sure the quality of care was maintained. Effective audits and checks helped them in this process.

Rating at last inspection: At the last inspection the service was rated Good (report published 25 October 2016)

Why we inspected: This was a planned inspection based on the rating awarded at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected ALS Support Limited on 28, 29, 30 September and 3 October 2016. We usually give the provider 48 hours' notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager can be available. However, we gave the provider seven days' notice due to the inspector’s planned leave.

The last inspection took place on 29 July 2013, when we found the service was meeting the legal requirements we inspected at that time.

ALS Support Limited provide outreach and domiciliary care services to people with learning and/or physical disabilities. The service has a range of vehicles available, including a minibus, which have been adapted for wheelchair users so care workers can support them to participate in their local community. At the time of our inspection the service was providing support to 30 people, however only six of these people were receiving personal care which is the part of the service the Care Quality Commission regulates.

There was a registered manager in post, who was also the nominated individual for the Company. 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 people who were receiving personal care had complex needs and were unable to verbally communicate with us about the service. We spoke with the relatives of three of the six people to gain their views. They were unanimous in their praise of the staff and the service provided to their relatives.

Relatives said staff were kind, compassionate and attentive and treated people with dignity and respect. They told us staff were knowledgeable and had the skills and competencies to meet people’s needs. This was confirmed in our discussions with staff and the training records we reviewed. We saw staff received mandatory and specialist training which was kept up to date. Staff told us they received regular supervisions and appraisasl and felt well supported by the registered manager.

Relatives told us they had regular care staff who arrived on time and stayed the full length of the call. They said communication was good and they were informed if staff were going to be late or if there was a problem. Staff confirmed they had sufficient time to carry out the care people required and told us they had regular people they visited which allowed them to develop good relationships with people and their families. We concluded there were sufficient staff to ensure people received a safe service. Staff were subject to the required checks on their characters and backgrounds to help ensure they were suitable to work with vulnerable people.

Relatives told us they felt their relatives were safe with staff from the agency. Staff understood the safeguarding procedures, knew how to identify abuse and were aware of the reporting systems.

Risks to people’s health and safety were assessed and clear, up-to-date plans of care were in place for staff to follow. Detailed care records showed people’s needs were assessed in a range of areas and provided comprehensive information showing the care and support people needed and how they wanted this to be delivered. Our discussions with relatives and staff showed this accurately reflected the care that was provided. Effective systems were in place to make sure people received their medicines safely and when they needed them.

Effective systems were in place which ensured people’s nutritional and health care needs were being met.

The registered manager understood their responsibilities under the Mental Capacity Act 2005.

Relatives and staff spoke positively about the leadership and management of the service. The registered manager led by example and wo

As part of our inspection we spoke with the parent of one person who uses the service and the wife of another person. These are some of the things they told us:

"There are no problems at all, we are really happy with the service"

"The service is really adaptable"

"It's wonderful, they turn up every time on time"

"We never expected to get that kindness and quality of care"

We also spoke with two members of staff both of whom told us they were very happy working for the service. One person said "I love it, I've never worked anywhere like it before, it's so nice to work for people who care about the staff"

We found that the standard of care planning and delivery of service was of a high standard.

This visit was made to focus on three outcome areas which had not been included in the last inspection of the service in April 2012. During that inspection we had found that the provider was compliant in the two outcome areas we looked at.

Due to the focussed nature of this inspection, we did not ask people who used the service for their opinions of the care they received. We did however see that people had expressed their satisfaction with the service through reviews and feedback forms.

We saw that people who used the service, or their representatives, had been fully involved in the development of support plans and had consented to the care and support being provided.

We spoke with a member of support staff who told us that they received the training and support they needed to do their job properly. We also saw that the service dealt appropriately with complaints.

Due to the nature of this visit, we did not, on this occasion, speak with people who use the service.

People told us that they are provided with a flexible service which meets their needs. The said that staff are kind and helpful.