About the service: Creative Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes and supports people to access the community and remain as independent as possible. The service specialises in supporting people with a learning disability. At the time of the inspection the service supported 13 people, two of whom received the regulated activity of personal care.

People’s experience of using this service:

Since the last inspector the provider had introduced a system to ensure care plans were regularly reviewed. When reviewing care delivery staff actively engaged people and their relatives in the process to ensure it was meeting their needs.

Staff were very kind and caring. People enjoyed spending time with staff and meaningful relationships had developed between staff, people and their relatives.

Staff empowered people to remain as independent as possible and were passionate about enabling people to have maximum choice and control over all aspects of their lives.

Staff understood how to recognise and protect people from abuse. Systems were in place to ensure people received their medication safely. Risks to people’s everyday lives had been assessed. Care plans provided information for staff about how to support people in accordance with their preferences and wishes. Staff understood their responsibilities to prevent the spread of infection whilst working in and between people's homes.

The registered manager supported staff to complete a variety of training sessions. This ensured they had the necessary skills to meet the needs of people. Staff supported people in line with the legislation of the Mental Capacity Act (MCA) and we saw no unnecessarily restrictive practices in place.

Incidents and accidents were monitored to inform practice and make improvements to the service. Concerns and complaints were effectively responded to and where appropriate action was taken to resolve the situation.

People were supported to access healthcare services when they needed to. Staff described positive working relationships with healthcare professionals.

Staff respected people's life histories, diversity and personal preferences when delivering care. People and their relatives had confidence in the staff and were pleased with the care they received. The provider actively sought feedback from people using the service and their relatives. This information was used to develop and improve service delivery.

Staff were supported by a well-established management team who had a clear vision for the service, placing the needs of people using the service at its core. This ethos was firmly embedded into the culture of the service and was emulated by staff, who took pride in their work and endorsed the values of the service.

Rating at last inspection: Good (published 24/06/2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At the last inspection the service was given an overall rating of good but the domain of well-led was rated as requires improvement. This was because the quality assurance systems in place were not effective. During this inspection we looked to see whether the provider had made the required improvements to this area and found effective systems were now in place.

Follow up: We will continue to monitor the service through the information we receive.

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

The unannounced inspection took place on the 25, 26 and 27 May 2016.

Creative Care Services predominantly provides community support for 20 people who have mental health and/or learning difficulties of varying degrees. Personal care is also provided if required.

The service is required to and did have a registered manager. 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 service needed to improve their quality assurance systems. Systems were in the process of being developed and a Quality Assurance Manager had been recruited to achieve robust quality monitoring of the service. Although systems were in place to make sure that people’s views were gathered, analysis and action plans were not in place to make effective use of people’s views.

Staff delivered support effectively. People’s safety was ensured and care was provided in a way that intended to promote people’s independence and wellbeing. A robust recruitment process was in place and staff were employed upon completion of appropriate checks. Qualified staff supported people satisfactorily with the administration of their medications and prompted people to maintain their own health.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA). The registered manager knew how to apply such measures appropriately.

Staff supported people to attend healthcare services when required. Staff also worked with a range of external services, such as social workers, and GPs, to implement care and support plans.

People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. Staff were respectful and caring towards people ensuring privacy and dignity was valued. People were supported to carry out their own interests and aspirations independently or achieve them with the support of staff, if requested.

Creative care services provide personal care to five people with a learning disability in their own homes and the community.

Our inspection team was made up of one inspector. We spoke with one person who used the service, the manager, two staff and a relative of a person who used the service. Where one person was unable to verbally communicate with us we observed them and their care r worker when they visited the office on the day of the inspection.

We looked at three people’s care records. Other records viewed included training records, health and safety checks, medication records, quality assurance audits and satisfaction questionnaires completed by the people who used the service, relatives, staff and health professionals who were involved with the people who used the service.

We considered our inspection findings to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We saw that records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. Any training needed for staff to support people safely was identified and provided prior to the commencement of the service and were updated annually. This ensured that the staff had the relevant skills and knowledge to meet people’s individual needs.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We saw that all staff had completed refresher training in the last year for Safeguarding of Vulnerable Adults, Mental Capacity Act 2005 and Deprivation of Liberties Safeguards.

Is the service effective?

One person told us that they were happy with the care they received and felt their needs had been met. We saw and staff told us they understood people’s care and support needs and that they knew the people well.

People’s health and care needs were assessed with them. We saw people were involved in writing their plans of care and support. For example, we saw specialist dietary needs had been identified in care plans where required.

The training that staff had received equipped them to meet the needs of the people who used the service.

Is the service caring?

A person who used the service and their care worker visited the office on the day of the inspection. We saw that the care worker interacted with the person who used the service in a caring, respectful manner, showed patience and gave encouragement to the person they were supporting. One person commented, “The staff were very good and kind.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw people had an opportunity to provide feedback on the service they received and to review their progress against their individual goals and aspirations. People reviewed their goals and aspirations with their key members of staff.

We saw health and social care professionals and the staff were encouraged to provide feedback about the quality of the service provided.

Is the service well led?

Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the aims and objectives of the service. This helped to ensure that people received a good quality service at all times.

The service had a quality assurance system in place and records seen by us showed that regular audits had taken place in areas such as medication, reviewing care plans and risk assessments and training and supervision. Where any issues or concerns were identified then the manager had taken immediate action to address them.