Creative Support (Bradford) provides a home care service to people living in Bradford. This includes older people and people with mental health needs. Between the dates of the inspection, 28 February to 7 March 2017, 21 people were using the service.

At the last inspection the service was rated as ‘Good.’

At this inspection we found the service remained ‘Good’ and had improved in the ‘effective’ section from ‘Requires improvement’ to ‘Good.’ The service had improved in the ‘caring’ section from ‘Good’ to ‘Outstanding.’

Why the service is rated Good.

People and relatives provided very positive feedback about the service. They said it was safe; staff were well skilled and very caring.

Staff were recruited safely and there were enough deployed to ensure people received a reliable and consistent service. Staff training provision had improved since the last inspection and people received a greater continuity of care workers due to the way rotas were now organised.

Medicines were safely managed and action was promptly to address any shortfalls. Risks to people’s health and safety were assessed and clear and person centred plans put in place. The service worked well with external agencies such as the police to help keep people safe. Safeguarding procedures were in place and were well understood by staff.

People were supported appropriately to eat and drink. People’s healthcare needs were assessed and the service worked with external health professionals to ensure these needs were met.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to ensure people’s rights were protected.

Staff demonstrated an outstanding commitment to providing person centred and dignified care for people. We saw numerous examples where staff had gone ‘the extra mile’ for people to ensure their comfort and wellbeing. Feedback about staff from people and relatives was extremely positive. The service worked exceptionally well at helping people maintain or gain independence and measured and evaluated its success in this area.

Care plans were very person centred and up to date. People’s likes, dislikes and preferences were recorded and care workers knew people well.

Incidents, accidents, complaints and safeguarding incidents were thoroughly investigated and used to drive further improvement of the service.

The service was well run and organised. People, staff and relatives all said communication was good and the management team acted on any concerns or queries they had. A range of audits and checks were undertaken to assess, monitor and improve the service. Electronic call monitoring had recently been introduced which alerted management if staff did not arrive at care visits, helping improve the safety of the service.

Creative Support (Bradford) provides a home care service to people living in Bradford. On the date of the inspection, 9 March 2015, 76 people were using the service. This was an announced inspection. The provider was given 48 hours notice because the location provides a domiciliary care service and management were not always office based. A registered manager was 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 and associated Regulations about how the service is run.

At the last inspection in July 2014, we found a breach of regulation 13 (management of medicines) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following the last inspection, we received an action plan from the provider detailing the improvements they planned to make. At this inspection we checked whether these improvements had been made.

We found improvements had been made to the medicine management system. A clear record was now in place for each service user, showing the level of support given, any associated risks and the medicines the person was supported with. This was underpinned by a new medication policy. Regular audits of the medicine management system were in place to help check people received their medication safely.

Risks to people’s health, safety and welfare were regularly assessed and risk assessment documentation provided staff with information on how to help keep people safe.

There were sufficient quantities of staff, this was a mixture of permanent staff, bank staff and agency staff. We found staff rota’s were appropriately planned and staff reported they were able to attend visits on time. Robust recruitment procedures were in place to help ensure people employed by the service were of suitable character.

People and their relatives spoke positively about the care provided by the service. However, people told us there was a lack of continuity of staff and as such they were often supported by unfamiliar faces who did not always know their individual preferences and/or needs.

Staff told us they had access to appropriate training and we found staff demonstrated a good knowledge of the topics we asked them about such as safeguarding. A comprehensive induction training package was covered which staff spoke positively about. However it was not clear how often training updates were provided and the training matrix showed a number of staff were overdue updates.

People told us that staff were kind and caring and treated them well. Various mechanisms were in place to check and promote dignity and respect amongst staff, including specific training and checks on staff attitude.

People’s healthcare needs were assessed by staff and plans of care were in place to help staff deliver appropriate care. Detailed daily records were in place which demonstrated people received care at the correct times and the required care and support was carried out.

A suitable complaints system was in place, we saw evidence that complaints were appropriately handled. Most people told us they had never had cause to complain which indicated a high level of satisfaction with the service.

Robust systems were in place to check the quality of the service and drive improvement where issues or shortfalls were found. This included learning from incidents, complaints and audits. People’s feedback was valued by the provider and was sought through review meetings, spot checks and quality questionnaires.

We considered all the evidence gathered from reviewing records and speaking with people. We used the information to answer the five key 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. The summary describes the records we looked at and what people who used the service and the staff told us.

Is the service safe?

At the time of our visit there were approximately 80 people who used the service. We spoke with four people who all told us they felt safe when staff visited them. We also spoke with three relatives who told us that overall they felt staff provided people with safe and effective support.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to manage these risks.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe, such as what action to take in the event of a medical emergency.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

We found evidence that people were not always protected against the risks associated with medicines because there were not appropriate arrangements in place to ensure that medicines were managed safely. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to the management of medicines

Is the service effective?

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

We found the service had made improvements to ensure people received support from staff when they needed it and at consistent times each day. Whilst the manager recognised these improvements were ongoing, most of the people we spoke with recognised there had been an improvement. One person told us “It’s much better now because I know when staff are coming and can be ready for them”.

Is the service caring?

Overall people said they were pleased with the standard of care provided. One person said “I would be lost without the help of these wonderful people”. Another person said “Most of the staff are very good and I have seen a big improvement in my mum’s wellbeing since staff have been helping her”.

Our discussions with people and the records we looked at told us that individual wishes for care and support were taken into account and respected.

Since our last inspection there had been a change to the management team at the service. During our discussions with them it was clear that they were committed to driving improvements in the standards of care people received.

Is the service responsive?

Care records were reviewed and any changes made either when people’s needs changed or as part of the annual review process. We saw evidence of this within the care records we reviewed. The staff we spoke with told us they would immediately alert the manager if they noticed a change in people’s needs.

We found people knew how to make a complaint if they were unhappy. We saw evidence that the service took complaints seriously and looked into them quickly.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

People we spoke with were generally happy with the care they received. For example one person told us “It is good so far” and another said “I am very satisfied with everything, we have a routine and it works well”. A relative told us “They are very responsive and do the best they can in the situation.” However three people we spoke, although happy with the overall standard of care, raised concerns with us that carers did not consistently arrive at the same time each day and that this disrupted people's daily schedules.

We found systems were in place to ensure valid consent was sought from people who used the service.

We found people’s needs had been assessed. However, we found that visit times to people were inconsistent and in some cases not in line with their care plans. This meant care was not delivered to people's individual requirements. We found there was no management system in place to ensure people received consistent visit times.

We found suitable processes were in place to safeguard people from abuse.

Arrangements were in place to monitor the quality of the service and ensure people’s views were regularly sought.

Documentation was in place in relation to people’s care needs and in relation to the running of the service such as staff training files.