About the service: Disabled Children's Support Services is a domiciliary care service which provides personal care and support to children and young people in their own home and in the community. At the time of the inspection, 66 children or young people were receiving some element of support with personal care.

People’s experience of using this service:

• Risks to children’s safety had been assessed and acted on. Regular reviews were carried out to ensure any changes in care needs were addressed. Parents felt staff supported their children safely. Staff understood how to report any concerns that could lead to people experiencing avoidable harm.

• There were enough staff to meet the needs of each child or young person. Small teams of staff were in place for each child, which helped to provide consistent care. Most children’s medicines were managed by their parents. Safe medicine practices were followed where support was provided. Staff understood how to reduce the risk of the spread of infection. The registered manager had processes in place to learn from mistakes and to reduce the risk of children and young people experiencing avoidable harm.

• Children and young people received care and support in line with their assessed needs. Staff were well trained and felt supported to carry out their role effectively. Where staff supported children and young people with their meals this was done in accordance with their assessed needs. The provider worked alongside other health and social care agencies to provide consistent care and support. Parents and their children’s views were considered when decisions were made about care. This was done in accordance with appropriate legislation.

• Staff were kind, caring and dedicated to their role. They treated children with dignity and respect and involved them wherever possible with choosing how they would like to be cared for and supported. Effective processes were in place to store records safely and in line with data protection legislation. This protected children’s and young people’s privacy.

• Children received person centred care and support that considered their and their parents’ personal choices and preferences. Parents welcomed the consistency of staff who understood their and their children’s needs. Efforts had been made to provide information in a format children and young people could understand. Complaints were handled appropriately and in line with the provider’s complaints policy. Effective end of life plans were in place where needed.

• Parents, staff and where applicable, children and young people, were encouraged to give their views about how the service could be improved. This feedback was used by the registered manager and the provider to develop the service. Staff enjoyed working at the service and felt respected and valued. Robust quality assurance processes were in place to help inform the provider of the quality of the service provided.

Rating at last inspection:

At the last inspection the service was rated as Good (Published June 2016).

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

The Disabled Children’s Support Services is a domiciliary care service which provides personal care and support to children and young people in their own home. At the time of our inspection the Service was supporting 27 children living in Nottinghamshire. There were three types of services offered that the commission regulates. Overnight short breaks at home where staff supported a child in their own home, homecare service which involved working with parents to support their child in their home and the short-term assessment team which supported children and parents for a period of six to eight weeks.

This inspection took place on 14 April 2016.

There was a registered manager in place and they were available during 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.

Relatives told us they were satisfied with most aspects of the service provided and spoke highly of the staff that were supporting their child/children. Parents and guardians told us their child was treated with compassion and kindness and that their privacy and dignity were respected.

Parents and guardians told us they felt staff provided safe and effective care. Staff we spoke to had a good understanding of the various types of harm people could suffer from and their roles and responsibilities in reporting any safeguarding concerns. Staff had also received safeguarding children’s training.

Children’s care plans reflected their individual needs and personal wishes, but did not contain enough information to make it child friendly. Relatives told us they were involved in the development of their care plans and were enabled to express their views on an on going basis.

Staff at the service were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure only people with the required skills and of suitable character were employed.

Relatives told us the children received their medicines as prescribed and we saw records that confirmed this. Staff received regular supervisions and annual appraisals and were able to reflect on the care and support they delivered and identified further training requirements. The service encouraged feedback from all people involved with the service.

Children received care and support from kind, caring and compassionate staff, who respected their privacy and dignity at all times.

Relatives were positive about the leadership of the service. Staff were clear about the vision and values of the service. There were audits in place but these were not always carried out consistently. The registered manager agreed to improve the systems to monitor quality and safety during our inspection.

When we visited the offices, we spoke with managers and we looked at some of the records held in the service including the care assessments and planning for seven children.

Due to the complex needs of the children using the service we used different methods to help us understand their experiences when we undertook our inspection. Following our visit to the offices, we spoke with family members by telephone and this represented 20 per cent of those using the service. We also spoke with some of the care and support workers.

Care was planned and family members confirmed that the children and young people were happy to have the care and support. One parent told us, "If he could tell you himself, he'd say 'It's absolutely brilliant!'"

There were enough skilled and experienced staff and the staff we spoke with confirmed they were well supported by managers. The families told us, "The way they talk to him is amazing." and "They are all very experienced and know what to do."

Since our last inspection in January 2013, we found action had been taken to develop systems to regularly monitor the quality of the service through regular checks on individual care files and staffing records. There was evidence that improvements had been made in the way the service was being led. There was an effective complaints system available. Families we spoke with told us they did not feel the need to make any complaint about the service and would find out the procedure if they needed it.

Following the inspection visit we spoke by telephone with five families that used the service. Parents told us they had been included in meetings to discuss what support was needed. We saw copies of summaries of sitting/befriending sessions and these included feedback from the child/young person.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Standard risk assessments were used and recorded to determine how the care should be given as safely as possible. Parents told us the service was extremely helpful. One parent who used the sitting service said, "We wouldn't want to lose it. It helps us to relax." Another parent told us, "My son is happy with they way they care for him. They follow the care plan and keep him safe."

Parents told us they felt staff gave care safely and they had no concerns when their children were with the care workers. We saw various written evidence that showed staff had the opportunity to discuss with senior workers and managers all aspects of keeping people safe.

Parents told us that all the staff were very helpful and knowledgeable about helping people with disabilities.

We saw records that showed how staff were supervised and the training they received.

All the parents we spoke with found the service highly valuable, but some felt it had not seemed so well organised in recent months. We found the provider did not fully monitor the quality of the service.