About the service:

Free Spirit Support Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, including people living with dementia, people with sensory needs, physical disabilities, learning disabilities and mental health needs. Not everyone using the service received the regulated activity of personal care. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection six people were receiving personal care as part of their care package.

People’s experience of using this service:

The registered manager had not kept up to date with their audits and checks that monitored quality and safety. Whilst they told us they were aware of some improvements which were required, they had not identified all the shortfalls in the fundamental care standards that our inspection found. At the time of our inspection, the registered manager did not have an improvement plan, but following our inspection they forwarded one to us that detailed the action they planned to make.

Staff had not received training and competency assessments in the safe administration of medicines. Records completed by staff to confirm they had supported people with their medicines, did not reflect nationally best practice guidance. There were no systems in place to review these records, to monitor if people had received the support they required with their prescribed medicines.

Risks associated with people’s care needs had not been fully assessed and planned for. People’s care plans did not contain detailed guidance for staff or reflected people’s current needs. However, staff were found to be knowledgeable about people’s needs and routines. The Accessible Information Standard was not fully complied with, because people’s sensory and communication needs had not consistently been assessed and planned for.

Staff had not consistently received training, with three staff not having received any training other than an induction and shadowing opportunities with experienced staff. Staff had not received formal opportunities to review their work and development needs. However, staff had received informal support and had regular contact with the registered manager and care coordinator, who were described as supportive.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. However, the principles of the Mental Capacity Act 2005 were not fully understood. The registered manager was not aware of the action required should a person be restricted of their freedom and liberty. We made a recommendation about the application process to the court of protection.

People were cared for by staff who had completed safe recruitment checks on their suitability to work with people.

The registered manager had not sent quality assurance surveys to people, to seek feedback about the service. However, people told us they were confident to report any concerns and that they were happy with the service they received.

People who used the service and their relatives were positive about the service provided by Free Spirit Support Services. They told us they received care from regular care staff who they had developed positive relationships with and who knew how to care for them. Staff in the main were reported to arrive on time and if they were running late, people were informed. Staff also stayed for the duration of the call and were unrushed, kind and compassionate in their approach.

People told us they had not received formal opportunities to meet with the registered manager to review the care they received. However, they had regular contact with the registered manager who responded t

This announced inspection was carried out on 28 January 2016. Free Spirit Support Service is a small domiciliary care service which provides support and personal care to adults living in towns and villages in north Nottinghamshire. On the day of the inspection there were 10 people using the service who received personal care.

The service had a registered manager in place at the time of our 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.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent with as little restriction as possible.

People knew the staff who supported them and they worked well together as a team. People received a flexible service that suited their individual circumstances. People who were supported to take their medicines received support to do so when this was needed.

People were provided with the care and support they wanted by staff who were trained and supported to do so. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed.

People were supported by care workers who understood their health conditions and ensured they had sufficient to eat and drink to maintain their wellbeing.

People were treated with respect by staff who demonstrated compassion and understanding. People were involved in determining their care and support and were treated in the way they wished to be.

People were able to influence the way their care and support was delivered and they could rely on this being provided as they wished. People felt they would be able to express any issues of concerns and that these would be acted upon.

People who used the service and staff were able to express their views about the service. There was a motivated staff team who felt supported by the management of the service.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with two people who used the service and a relative and asked them for their views. We also spoke with two support workers, known as personal assistants, and the registered manager. We also looked at some of the records held in the service including the care files for three people.

A person who used the service told us, “I am very happy with the service, they do anything I ask them to.” In a survey questionnaire completed by six people who used the service they all said they felt staff respected their right to make choices and to make decisions about their life.

A relative told us, “The care plans are kept up to date. I have discussed them with the main carer.” A person who used the service said, “They always arrive on time and stay the whole time. If they have finished they ask if there is anything else I want them to do.”

A person who used the service told us, “I feel very safe when they visit me. They always ask if I want the door locking. They leave everywhere secure.” They also said, “They seem to do everything as it should be done. That must be down to the training they have.”

A person who used the service told us, “I feel it (the agency) is very well run and very professional. The time keeping is generally very good. They deal with anything I ask of them to the best of their ability. ”

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with two people who used the service and a relative and asked them for their views. We also spoke with two carers, a team leader, and the registered manager. We looked at some of the records held in the service including the care files for three people.

A person who used the service told us, "They (the care workers) are all good at something.“ A relative told us, "We are getting a first class service.” Another person said, “Communication is very good. The staff seem to be well trained as they always know what they’re doing.”

Staff we spoke with told us that everyone had a care plan and they were always up to date.