Hedley’s Community Outreach Service (known locally as Able 2) is a domiciliary care agency which provides personal care and social support to people living in their own homes and whilst accessing day services. Services were provided to younger adults with a wide range of health and social care needs. At the time of our inspection there were nine people receiving a service.

The service is based within the ‘Able 2’ day centre which is also run by the Percy Hedley Foundation. Everyone who used this service accessed the day service too. However, not everyone using Hedley’s Community Outreach Service received regulated activity; 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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. We found further developments and improvements in the responsive domain and have rated that area outstanding. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a new registered manager in post since our last inspection.

People received extremely person-centred care, designed to meet their needs and enable them to live full and active lives People’s needs were thoroughly assessed, planned and reviewed to ensure they received exceptional support which met their healthcare needs.

Staff encouraged and promoted activities which inspired people to participate in pastimes that were meaningful and important to them. People were empowered to get involved with social activities matched to their interests and goals. Staff ensured people were given the best support to pursue education and work experience. People had achieved very positive outcomes and fulfilled ambitions. Staff made sure people maintained links with their local community and supported opportunities for social interaction with family and friends outside of the day services they attended.

Without exception, people and relatives told us all staff were caring, kind and respectful. People said staff upheld their dignity and privacy. Support workers knew people extremely well.

The registered manager shared multiple examples of people who had achieved a positive outcome following successful support from staff.

Staff understood their responsibilities with regards to safeguarding people from harm. People told us they felt safe with support from staff and relatives confirmed this.

Staff supported people to maintain their health and safety in their own home. Fully completed risk assessments of the known risks people faced were in place for staff to follow. Accidents and incidents were recorded and investigated to resolve issues and reduce the likelihood of a repeat occurrence.

Medicines were well managed and staff protected people from the risks of infection

and cross contamination.

Staff recruitment was safe. We considered there were enough staff employed to safely and effectively meet people’s needs. People told us their support workers were consistent and arrived as expected.

Staff were qualified and experienced. They received a company induction and had regular training updates. Staff attended regular supervision sessions as part of their personal development. Support workers told us they felt supported by the management team.

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 supported this practice.

People’s nutrition and hydration needs were met. The service worked well with external health and social care professionals who were involved with people’s care to ensure their ongoing welfare.

No-one we spoke with raised any complaints about the service. Our pre-inspection questionnaire

Able 2 is operated by The Percy Hedley Foundation. The office is located within a day centre on a large site in Forest Hall, North Tyneside. The service provided care and support to eight adults in their own home who had physical and/or learning disabilities.

This inspection took place on the 12 April 2016 and was unannounced. We last inspected this service in May 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The service had 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.

People told us they felt safe in their own home being supported by the staff from Able 2. Staff had a thorough understanding of safeguarding procedures. No concerns of a safeguarding nature had occurred, however the registered manager was fully aware of her responsibilities with regards to protecting people from harm or improper treatment. Other policies, procedures and systems were in place to ensure the service was operated well.

There were enough staff by the service to ensure it was run safely and effectively. Staff supported people on a one to one basis and regular cover was available from a bank of staff from across the Percy Hedley Foundation. We saw staff rotas were planned in advance and people received a consistent service.

Care plans were very person-centred. Care needs and risks were regularly reviewed and updated. Control measures and positive strategies were in place to direct staff in the event of an incident.

There had been no accidents or incidents since the last inspection. However the registered manager had a system in place to record, investigate and monitor these should an event occur. The registered manager was aware of her responsibility to report all incidents to external bodies as necessary.

Care records contained personal emergency evacuation plans. The staff we spoke with told us they were confident and trained to deal with emergencies.

Medicines were well managed and staff followed safe working practices. People were encouraged and supported by staff to self-medicate wherever possible. Medicine was administered safely and accurately recorded.

Annual surveys were used to gather the views and opinions of people, their supporters and staff about the service they received. Advocates were involved as necessary to ensure all people were able to engage with the service.

The registered manager and staff had an understanding of the Mental Capacity Act (MCA) and their own responsibilities. Staff were trained in MCA principals and care records demonstrated the service worked within these principals.

Staff told us they received a thorough induction into the service and shadowed more experience workers. We saw evidence which showed on-going training took place. Formal supervision and appraisal had also taken place as well as informal supervisory discussions. The registered manager was in regular contact with the staff.

As staff mainly supported people to access the community, sometimes meals were eaten in café’s or restaurants. One staff member told us they supported a person to cook and bake at home as this was their preference.

The staff we spoke with displayed genuine, kind and caring attitudes. They spoke about people as individuals and knew them very well. In the feedback we read from people who used the service, people said staff offered them choices and encouraged them to make decisions. People who responded to our survey said they were respected by staff and their privacy and dignity was maintained. The daily notes we reviewed reflected these values and behaviours.

People chose to take part in a range of activities that were personal and meaningful to them.

At the time of the inspection there were six people who used the service. Due to their health conditions and complex needs not all people were able to share their views about the service they received. During our visit we spoke with one person who used the service and their one to one support worker, two relatives of people who used the service and observed people's experiences. We spoke with the operations manager who assisted us with the inspection and two members of staff.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five 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 have found.

Is the service safe?

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who received care and support at the service. We saw people were safe and protected from abuse.

Is the service effective?

People were asked for their consent before any care or support was provided. We saw their wishes were respected. People who used the service and their representative were given information they needed to make an informed decision about their care.

People were cared for by suitably qualified and experienced staff. The representatives of people who used the service were asked about the support they received and if they understood their rights. One person said, “Staff communicate very well with us and they always explain what they are doing”.

Is the service caring?

People's preferences, interests and needs were recorded and staff were able to give

examples of these when we spoke to them.

People's health and care needs were assessed. Care was planned together with people who used the service and their representative. People told us they were involved in the care planning process.

People we spoke with were positive about the care they received from the service.

Comments included, "The level of care X receives is 50 times better than when they were at school. The care is focussed on him as an individual. He is definitely a happier person”.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. Regular care reviews were held and any changes in the persons needs were recorded in the care plans. The information was then provided to care staff.

Is the service well led?

We saw a manager was in place and has applied for registration with the Care Quality Commission. The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service which were used to obtain feedback about the service.

Only one person was using this service at the time of our inspection. We spoke with a relative of this individual to find out their opinion of the care and support provided by this service.

We obtained information from staff and viewed care records, which demonstrated that the service respected the person’s diversity, values and human rights.

We looked at the person’s care plan and found it contained relevant information to enable staff to care for the person properly. The relative described the care and support for this one person as “excellent.”

Staff with whom we spoke had a working knowledge of safeguarding vulnerable adults and we found that safeguarding policies, procedures and information were available at the service. The relative told us, “I trust the staff that look after X. If X wasn’t happy, I would know.”

We found that there were enough qualified, skilled and experienced staff to meet the person’s needs. The relative said, “There is one to one care and X knows all the people and I have confidence in the staff that they know X well enough to keep X safe.”

The relative with whom we spoke told us that staff were approachable and there were no complaints about the service. We found that there was a complaints procedure in place and this was provided in a format that the person could understand.

The name of the registered manager at the service does not appear in this report, as the manager in post was awaiting CQC registration.

We were unable to speak to some of the people who used the service because of the nature of their condition.

Four people were using this service at the time of our inspection. We spoke with two people, three relatives and six support workers about the care and support provided by the service.

People and relatives told us they were happy with the service they received. One relative told us, “The flexible support service is working very well at the moment, it’s fine. It took a little while to get into the groove with the staffing to know exactly what they were doing; but they’ve got it nailed now.” Another relative said, “It’s an excellent service and we’ve no problems whatsoever. Our biggest point is that she’s really happy and she really enjoys her time with Able 2 – she loves it.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

The provider had detailed policies in relation to infection control and the use and storage of personal protective equipment. Records confirmed that staff received regular infection control and food hygiene training.

We found staff recruitment procedures were in place and records showed that these were followed when new staff were appointed and appropriate checks were undertaken before staff began work.

We noted that not all staff had received an appraisal, or had regular supervision and staff training needs were not always being met.

People’s care records and staff personal records were maintained and updated regularly. Records were kept securely and could be located promptly when needed.