About the service: The service provides support to people in their own homes including children and adults with learning disabilities or autistic spectrum disorder. At the time of our inspection, 22 people were receiving a regulated activity.

People’s experience of using this service: The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible to maintain people’s safety. Systems were in place to recruit staff safely. Staff felt supported and were equipped with the skills required to provide effective care and support.

Staff supported people to manage their medicines, access healthcare and maintain a nutritious diet. 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 by a small group of regular staff which provided continuity. Staff had developed relationships with people and knew them well; people received person-centred care as a result. Staff promoted people’s independence and treated them with dignity and respect.

People were involved in making decisions about their care. They were involved in reviews to ensure their care plans met their needs and supported them to achieve good outcomes. Staff supported people to access the community and chosen leisure activities.

There was an open and supportive culture shared by managers and staff. The service had undergone a period of change; throughout this uncertain time for staff the team worked together to support one another. The commitment to providing high quality care and support for people was evident. Systems were in place to monitor the quality and safety of care delivered.

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

Rating at last inspection: Good (report published 14 June 2016).

Why we inspected: This was a planned inspection based on the previous rating.

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.

This inspection took place on 28 and 29 April 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care and support to people living in their own homes and we wanted to make sure staff would be available. At our last inspection in April 2014, the provider was meeting the requirements of the regulations inspected.

Birmingham Multicare is registered to provide personal care and support for adults and children with learning and physical disabilities and complex care needs in their own homes. The service provides support to family carers, enabling them to take a break from their caring responsibilities. Birmingham Multicare also supports the adult or child to participate in activities within the community. The service currently provides care and support to 105 adults and children, ranging in age, gender, ethnicity and disability.

There was a registered manager in post at the time of the 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 were kept safe. Relatives believed their family members were kept safe. Staff had received training and understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm. Staff was provided with sufficient guidance on how to support people with specific medical conditions. The provider had processes and systems in place that kept people safe and protected them from the risk of harm.

People were supported by staff that had been safely recruited. People were supported with their medication by staff that had received appropriate training.

People and relatives felt staff had the skills and knowledge to care and support them in their homes. Staff were trained and supported so that they had the knowledge and skills to enable them to care for adults and children, in a way that met their individual needs and preferences. Where appropriate, adults and children were supported by staff to access health and social care professionals.

People were supported to make choices and were involved in the care and support they received. The provider was taking the appropriate action to protect people’s legal rights.

Staff was caring and treated people with dignity and respect. People’s choices and independence was respected and promoted and staff responded to people’s support needs. People were supported with their healthcare needs because the provider involved family members if concerns were identified.

People and relatives felt they could speak with the provider about their worries or concerns and felt they would be listened to and have their concerns addressed.

The provider had quality assurance and audit systems in place to monitor the care and support people received to ensure the service remained consistent and effective.

When we visited Birmingham Multicare the service was providing respite care and support to people within their own homes or within the community. We spoke with the relatives of four people who used the service because most people were unable to speak with us because of their care needs. We also spoke with the manager, one of the provider’s directors and three staff members.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

All of the relatives we spoke with told us that the provider’s staff cared for people in a safe and effective way.

Effective systems were in place to make sure that managers and staff learn from events such as accidents and incidents. This meant that the service could identify the risks to people and had an adequate system of service improvement.

A process for staff supervision was in place and staff were supported to undertake training relative to the needs of the people they cared for.

Staff had undertaken training relating to the Mental Capacity Act 2005 and mental capacity issues had been discussed during some staff supervision sessions. This meant that staff had received training and support to help them understand mental capacity issues.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. This meant that staff understood what to do in an emergency.

Is the service effective?

People’s initial care needs were assessed when they started to receive care, and plans of care were developed. These plans of care were updated to reflect people’s changing care requirements so that staff had up to date information to help them meet people’s needs.

All the relatives of people who used the service told us that they were very happy with the standard of care that people received. They told us that the provider was responsive and that care was designed and delivered to meet people’s individual needs. They told us that people were treated with respect and their dignity was maintained.

Is the service caring?

We spoke with the relatives of four people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; “I am very, very happy with the standard of care provided.” Another relative told us, “I am very impressed with the standard of care service.” “The staff help my relative to gain independence and to take part in social activities.”

When speaking with staff it was clear that they cared for the people they supported.

Is the service responsive?

The relatives we spoke with knew how to make a complaint if they were unhappy. We reviewed the records of complaints and found that they had been investigated and responded to in a timely manner.However the provider’s complaints policy did not contain a timescale in which people could expect to receive a response.

People’s relatives had completed satisfaction surveys. These survey results had been collated and where shortfalls or concerns were raised these were taken on board and dealt with.

The service had recorded the details of accidents and incidents that had occurred. These had been investigated and the cause of the issues identified. Service improvement actions plans had been put in place.

Is the service well-led?

A registered manager was in place.

We found that regular staff meetings had taken place and the records showed that the issues discussed related to how the service was run and how care had been delivered. This meant that improvements could be made to the way the service operated

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The service had an effective quality assurance system. Records showed that incidents identified had been investigated and that actions had been taken to change things for the better. This meant that the service had reviewed the standard of care delivered and had taken steps to prevent incidents re occurring.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

On the day of our inspection we were told that Birmingham Multi-Care was providing support to 86 people, with some people receiving support on a daily basis to meet their needs and others a few hours a month. During our visit, we looked at five care records and spoke with the manager and the managing director. We spoke with nine care staff and four people that used the service and / or their relative.

Care plans were detailed about people's identified needs and risk assessments were in place so that staff had the information they needed about the people they supported. One member of staff told us, "All the information needed is in the care plan."

Arrangements were in place to ensure that people were safeguarded against the risk of harm or abuse.

Effective recruitment procedures were in place to ensure that suitable staff were employed.

We saw plans in place to support staff and all staff felt supported in their role. One staff member told us, "I really enjoy my job, helping people to get involved in activities and do things in the community."

We saw systems of audit were in place so that the quality of the service provided was monitored. One relative told us, "I have no concerns, I am happy with the service."

On the day of our inspection we were told that Birmingham Multi-Care was providing support to 114 people, with some people receiving support on a twenty-four hour basis to meet their needs and others a few hours a month. During our visit, we looked at ten care records and spoke with the manager and deputy manager. We later spoke with six care staff and eight people that used the service or their relative.

People were involved in their care and were encouraged to do things for themselves as far as possible. One person using the service told us, “I feel involved in my care.”

Care plans were personalised and risk assessments were in place so that staff had the information they needed to meet people's identified needs.

Arrangements were in place to ensure that people were safeguarded against the risk of harm.

Staff felt supported in their role. We saw some evidence of staff supervision. However, we saw gaps in training needed for staff to gain the skills and knowledge for their roles.

We saw some systems, including easy-read surveys, were in place so that people could give feedback on the quality of the service they recived. However, we saw some areas that were not audited which meant provider was not monitoring the quality of the service provided.

We saw that concerns or complaints that had been raised had been acted upon appropriately so that the quality of the service was improved. One person using the service told us, "I get an excellent service.”

We visited the registered office of the service on 15 and 16 February 2012. The registered manager told us that the service was currently providing for approximately fifty people. The majority were young people and children living with their families. People lived in different parts of the city. We followed the care of three people who received personal care from the service.

We saw that each person had a set of clear, well organised and up to date records. Each person had a completed form of assessment of their needs when they applied for the service. They had a care plan that was individual to them and signed as agreed to by the person or their relative. Risks posed to the person by their conditions were assessed and agreed plans to manage those risks were detailed and written in a 'person centred' way. Care plans were not just a list of tasks for workers to carry out. They involved the person in their care.

We looked at the training records for three workers each of who regularly cared for the people whose care we followed. We saw that each had the necessary skills and knowledge to meet the person's care needs and contribute to safeguarding them from the risk of abuse. We talked to the workers. They knew the people well that they cared for and supported. They knew and understood their care plans and the agreed way to manage risks. They spoke about people who used the service with respect and warmth.

We spoke to a relative of a person who used the service. They told us that their care worker had been given the necessary training quickly by the provider organisation and had learned about their child very quickly. They said " I know I can trust her to keep [my child] safe."

The service had written policies and procedures in place including a complaint procedure and workers were able to tell us about them. Some monitoring of the quality of the service does take place. Important ongoing records about the care and welfare of people were not consistently completed by care and support workers. There was no system for monitoring or safely storing for future reference if needed, those that were completed. We have asked the provider organisation to improve this.