This inspection took place on 4 and 7 July 2017. The first inspection day was announced. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the service's office who could assist us with the inspection.

The service is registered to provide the regulated activity personal care. Community Support Services specialises in providing two distinct services; a community support service that focuses on re-ablement from hospital discharges, chargeable services, intermediate care and palliative care, and a carer relief sitting service to support people who are caring for someone who is living with dementia which includes carer emergency cover to support carers in a crisis situation. People are supported with activities such as personal care, the provision of meals and the administration of medicines. On the day of the inspection people were receiving assistance from 98 community support workers, ten of whom were employed on a casual basis. In addition to this, there were 11 office staff and managers. The number of people using the re-ablement service changed constantly. Two hundred and fifty people had used the carer relief sitting service and 2,500 were registered with the carer’s emergency service. The office is situated in Driffield, in the East Riding of Yorkshire, and staff work over the whole of the East Riding of Yorkshire. There is parking available for people who wish to visit the office by car.

The provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). They were not currently managing the service and the provider had informed us of the interim and the planned future management arrangements. 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. Throughout this report we will refer to the registered manager as ‘the manager’.

Prior to this inspection we received information from the provider to inform us that they had suspended the whole service for a period of six weeks. This was as a result of a series of errors when community support workers were assisting people with their medicines. It had been recognised that these errors were due to staff not understanding or following the policies and procedures in place, as well as system concerns such as pharmacy error and inconsistencies, lack of information at the point of hospital discharge and complicated processes within the current medicines policy. Whilst the service was suspended, community support workers had refresher training on the administration of medicines and had competency checks carried out on their practice. The provider introduced robust governance systems and was able to demonstrate that they were transparent and applied learning in each instance. These are still in the process of being embedded within the on-going operation of the service.

We found that the service had followed their policies and procedures when recruiting new staff and this had resulted in people receiving support from staff who were considered suitable to work with people who might be vulnerable.

We saw there were sufficient numbers of community support workers employed to meet people's individual needs, and that people received the level of support they required to meet their agreed support package.

People were protected from the risk of harm or abuse because the provider had effective systems in place to manage any safeguarding issues. Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff und

The inspection of Community Support Services took place on 24 February and 3 March 2015 and was unannounced. At the previous inspection on 11 February 2013 the regulations we assessed were all being complied with.

Community Support Services provides two bespoke services to people under the East Riding of Yorkshire Council’s (ERYC) registration with the Care Quality Commission for the regulated activity of personal care. These bespoke services are Short Term Assessment and Re-ablement Service (STARS) and Carer Relief.  The majority of the carers are registered for Carers Emergency Cover Services which is provided when an emergency or carer crisis occurs.  It is available until alternative care arrangements can be made for a maximum of 72 hours.  Around 350 carers are registered with the Dementia Sitter Service which gives the carer the opportunity to go out or attend appointments and is available throughout the year,  However, there are limitations on the number of visits that can be allocated to each individual carer.  

STARS main focus is re-ablement, which is short term practical and emotional support to assist people to gain confidence in living skills, so they can remain at home or move back home with as much independence as possible. People are assessed regarding their re-ablement needs and a support plan with specific goals are agreed with them.

However due to the Local Authority’s duty of care, the STARS team also acts as the provider of ‘last resort.’ When independent providers have no capacity to provide the service requested, STARS have to look at the availability to take on these packages of care. This provision by STARS is usually short term and an interim measure until independent providers have capacity to take these services back.

Carer Relief comprises of ‘carer relief sitting service’ and ‘carer emergency cover’ as well as ‘flexible breaks’ for carers. This service is designed to offer relief to carers who provide support to someone who displays dementia due to underlying conditions or diseases. It offers care to people with dementia so that their carers can have relief from caring or when they may be unable to care for the person with dementia because of an emergency.

STARS has up to 100 people at any one time who may actively receive a service. This is a client group that changes regularly because of the success of the service. Carer relief has around 3000 people that are carers to a relative or someone they know and are registered with the service.  The majority of these carers are registered for Carers Emergency Cover Service which is provided when an emergency or carer crisis occurs. It is available until alterative care arrangements can be made for a maximum of 72hr. Around 350 carers are registered for a Dementia Sitter Service which gives the carer the opportunity to go out or attend appointments and is available throughout the year however there are limitations on the number of visits that can be allocated to each individual carer.

Community Support Services has a registered manager in post. 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.

We found that people that used the service were protected from the risks of harm or abuse because the provider had ensured staff were appropriately trained in safeguarding adults from abuse and the provider had systems in place to ensure safeguarding referrals were made to the appropriate department.

People were safe because whistle blowing was fully understood by staff and was appropriately addressed and investigated by the service where appropriate, or by another Local Authority department if not. Risks to people in their homes were reduced because the service had completed risk assessments on their environment and any activity they undertook.

The staff that worked for the service were in sufficient numbers to meet people’s needs and everyone we spoke with felt the level of support from staff was good and it was always on time. We found that staff recruitment followed safe policies and practices because the service followed procedures that took into consideration the requirements of our regulation on recruitment. We found that the management of medicines and infection control practices were safely carried out.

All of this meant people were protected from the risks of harm that they could be exposed to if staff had not been knowledgeable in safeguarding, were not employed in sufficient numbers, were unsuitable for their roles and if poor practices in medication and infection control were carried out.

People that used the service told us they were cared for and supported by skilled, knowledgeable staff who had undertaken induction and training for their roles. Staff had been appropriately supervised. They adhered to ‘best practice’ as adopted by ERYC and they communicated well to ensure the rights of people were upheld with regard to their mental capacity and any deprivation of their liberty. People were supported with nutrition and achieving optimum health.

This meant that people were well supported and had their needs met with regard to their personal care when needed. It meant they were supported with maintaining their living skills and were encouraged to live healthily. It meant those on the Carer Relief scheme were supported well or just had someone to guide them in the absence of their full time carer, when needed.

People told us they found the staff to be very pleasant, caring and knowledgeable. From the examples that staff related to us about how they had assisted people, we got a good sense of the attitudes and approaches to people that staff had in their caring roles. We found in people’s care files that there was suitably recorded information available to staff to know how best to support them.

Staff displayed empathy, compassion and understanding within their roles and were conscientious about striving to provide an excellent service.

This meant that people were treated with care and consideration, so that they felt the staff were like extended family. This meant they were valued and respected.

People had assessments of need, risk assessments and care plans in place to aid staff in providing the best possible care to them. Social activities were not facilitated by the service but staff did aid people to acquire new or regain old living skills abilities. Staff assisted people with returning to independence.

Everyone that used the Community Support Service had a system in place to follow in the event they wished to make a complaint.

This meant that people received support from staff that was responsive to their individual needs of care.

People received a service that was well managed. It was tailored to their individual needs and times and it was checked on a regular basis regarding the quality of service provision. There was an experienced registered manager in post who was deputised by an equally experienced deputy manager.

This meant that people had the benefit of a well-managed and run service of support. They either achieved the goals of their care plan and returned to independent living or they were signposted to appropriate independent domiciliary care services. Those whose main carer was listed on the Carer Relief register were given the level of service they required in the absence of those carers.