Bridges Family Support is a service which provides domiciliary support to children and young people up to the age of 19 years, with a range of disabilities. At the time of the inspection there were 38 people using the service.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People we spoke with told us they felt safe. The service adhered to the local authority safeguarding children and adults policies. Staff had received appropriate training and updates.

The service continued to have robust recruitment systems in place. The staff team remained at appropriate levels to enable them to meet the needs of the young people who currently used the service.

General and individual risk assessments were in place and the service remained committed to their ‘can do’ philosophy. Risks were thoroughly assessed and minimised, but the service continued to support people to achieve their full potential and reach their personal goals.

There was an appropriate medicines policy and procedure in place. Medication systems remained robust. Care files included a good range of health and personal information.

The induction programme was robust and training was on-going. The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA).

Staff interactions were warm and friendly and demonstrated respect for all the young people and their families. The service was flexible and person-centred. Support plans and risk assessments were regularly reviewed.

Records were stored securely and staff were aware of all aspects of confidentiality within their work. The service took concerns seriously and listened to families to try to resolve any issues promptly. We saw a number of compliments from both young people and their families.

The registered manager was accessible to staff and families. Appropriate referrals were made to other agencies and excellent partnership working was evidenced. Families felt the connections had a huge impact on enabling them to make contact with those services

Since the last inspection the service had won the local council’s ‘Best Customer Care’ award. The service had an appropriate statement of purpose.

Quality assurance was a high priority and we saw a number of audits, service reviews and competency checks which helped ensure the service continued to operate at a very high standard.

Further information is in the detailed findings below.

The inspection took place on 30 June 2015. The provider was given 24 hours’ notice as the location provides a domiciliary care service and we needed to be sure that a member of the management team would available on the day. The service was registered to support children and young people up to the age of 19 years, with a range of disabilities. At the time of the inspection there were 39 people using the service.

There was a registered manager in place. 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 we spoke with felt the service was excellent and the staff and manager provided above average care and support. One young person who used the service told us, “Staff are funny, they keep me entertained and they are kind to me”. One person whose relative used the service said, “We receive fantastic support, the team enable me to spend some time with my other children which is really important”. Another person told us, “Staff are really reliable, always keep in touch by phone or text if anything changes like appointment times.”

The service took safeguarding concerns seriously and followed the local authority policy and guidance when dealing with safeguarding children and adults (age 18+) and the staff we spoke with demonstrated a good understanding of safeguarding issues. Where appropriate the service had attended and contributed to safeguarding discussions and meetings. We spoke with a professional social care worker who told us that the service had contributed to some complex safeguarding cases and their help had been invaluable in helping to reach a satisfactory outcome for all parties.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with young and/or vulnerable people .Young people who used the service were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and participation within the service.

Staffing levels were sufficient to provide the level of care required. Arrangements were in place to cover any sickness or absences. Flexible working was encouraged and supported and this helped provide a good work/life balance for staff. It also helped the service to meet the needs of every individual young person who used the service.

Risk assessments were in place and were regularly reviewed and updated. The service endeavoured to balance risks with the young people’s rights, wishes and goals to ensure positive outcomes for the young people who used the service. A further demonstration of the service’s commitment to the client group they supported.

Staff were trained to administer medicines safely and had undertaken further training to ensure they could deal with a number of health issues. Regular checks were undertaken to help ensure on-going competence in this area.

There was a robust induction programme, which included mandatory training, shadowing and buddying with an experienced worker. Staff demonstrated a good understanding of their roles and responsibilities.

The service demonstrated a commitment to staff training, which was on-going and regular refreshers were undertaken. Staff were given positive encouragement to undertake further, more specialised training appropriate to the work, including working towards Qualifications and Credit Framework (QCF), which is a nationally recognised diploma in health and social care.

Supervisions were undertaken regularly and considered important in offering an opportunity for discussion between staff and management about on-going work issues. Professional Development Reviews (PDR) were held annually to ensure learning was reviewed and training needs were met.

Care files were clear and comprehensive and contained relevant health and personal information. They were person-centred and included individuals’ goals, wishes and achievements. The service was flexible and responsive to changing needs, desires and circumstances. Positive outcomes were personal to each individual and were celebrated within care files.

Young people who used the service and family members we spoke with said staff were caring and respectful. Some recent feedback we saw included the comment, “I like the way my child has been treated, with respect and consideration.”

Confidentiality was respected and independence was promoted. Young people who used the service were encouraged and facilitated to participate in discussions about their care and support. Some of the information was produced in easy read format to enable more of the young people to participate and alternative methods of communication were explored for those people who were non-verbal.

Information was given to young people and families at the start of the service to ensure they had an understanding of the support they could expect. Communication with families was on-going throughout the duration of their relative’s involvement in the service. Young people who used the service were encouraged to pursue their interests and positive outcomes were celebrated. Staff ensured that they treated each person as an individual and tailored activities and support to them.

Comments were encouraged formally and informally and there was a complaints policy in place. Literature given out to families gave the information and opportunity for people to raise concerns or make suggestions.

The management were described as approachable by staff, families and other agencies and health care professionals. One professional said, “I have absolutely no negative comments to make, people thoroughly appreciate the service, the team are excellent and highly professional”.

Best practice guidelines were followed and the service was innovative and creative in its approach to support. The management and staff were not afraid to challenge decisions and advocate fully on behalf of the people they supported, often with excellent results.

Feedback was regularly sought from families and users of the service. The service listened and took action to address any concerns and suggestions put forward by people who used the service and their families.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples. The meetings were used as a forum to share current best practice guidance and keep staff up to date with new methods and innovation.

A number of audits were undertaken, results analysed and lessons learned from these to drive continual improvement in service delivery.

We found that Bridges Family Support provides support to disabled children, young people and families who need help to maintain their independence and lead as full a life as possible within the confines of their specialist needs.

We spoke with three members of staff and three parents of people currently supported by the service, all comments we received were positive in nature.

Support was offered in the home, hospital and community settings.

We found Bridges Family Support had up to date policies and procedures in place to support the safe running of the service.

The service securely maintained both electronic and paper based records.

Bridges Family Support had a robust complaints policy and process however they had had no complaints for us to track.

Bridges Family Support had an intense recruitment process for people wishing to become support workers, with all required checks being evidenced before the worker began with the service.

Parents told us; “We could not have got through without X she has been great, always there when we needed her. Our X loves her she is part of the family”. “They are never late, we have a rota in advance so know when they will be here and can plan a little personal time or to spend time with our other children whilst they support X. Sometimes I just need my hair cut and know I can go without worry as X is in safe and caring hands”.

Staff told us they felt supported and valued in their roles.

Bridges family support provides support to children and young people who need help to maintain their independence and lead as full a life as possible, within the confines of their specialist needs. This was met by flexibly supporting the service user and their family with a carer for their needs. This can be both short and long term in duration and for a variety of hours. Support was offered with practical issues for example getting ready for school, supporting complex health needs, personal care and after school and social activities. As far as possible these are carried out within the home.

Parents told us: "This is a great service". "I have confidence in the staff that visit us and my X gets on really well with them". "Great service I cant say anything else". "We consistently get the same carer coming which is really good as we know them and my X is comfortable with them".