HF Trust – Cheshire DCA provided domiciliary care services including personal care and supported living to adults with learning disabilities. At this inspection they were supporting 65 people in their own homes.

There are three registered managers in post, but owing to pre-arranged annual leave one of the managers was unavailable at this inspection. We were supported throughout by the regional 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.

At the last inspection the service was rated good. At this inspection we found the service remained good.

People continued to remain safe as staff knew how to recognise and respond to concerns of ill-treatment and abuse. There were enough staff to support people to meet their needs. The provider followed safe recruitment procedures when employing new staff members.

People continued to receive care that was effective and personalised to their individual needs and desires. They were assisted by a staff team who were well supported and had the skills and training to effectively support people. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Staff were aware of current guidance which informed their practice and people’s rights were maintained by the staff who supported them.

The support people received continued to be caring. People were supported by a kind and considerate staff team. People’s privacy and dignity was respected by those providing assistance. People were supported at times of upset and distress.

People continued to be involved in developing their own care and support plans. Regular reviews took place and accounted for any changes in people’s needs. People’s individual preferences were known by staff members who supported them as they wished. People and relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

HF Trust – Cheshire DCA continued to be well-led. People were involved in decisions about their care and support and their suggestions were valued by the provider. Staff members believed their opinions and ideas were listened to by the provider and, if appropriate, implemented. The provider had systems in place to monitor the quality of service they provided and where necessary made changes to drive improvements.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We visited this service on 12 August 2014 and the inspection was announced.

The last scheduled inspection was carried out in November 2013 and we found that the service met the required regulations.

HF Trust Cheshire is a Domiciliary Care Agency which supports people with learning difficulties across the Cheshire, Wirral and Liverpool areas. The main office is situated in Ellesmere Port and there is limited car parking at the office.

At the time of our visit the agency was supporting 61 people within the local community.

The registered manager was experienced and had worked at the service for many years. She had been the registered manager for eight years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us that they were happy with the support provided and they felt the staff understood their care needs. People commented “The staff are kind”, “I like it here” and “I feel safe here.”

We found that people, where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team were knowledgeable of people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We looked at the care records of nine people who used the service. We found there was detailed information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were complete and up to date.

We found the agency had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw that policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005, safeguarding and staff recruitment. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who used the service.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people who used the agency could be confident that they were protected from staff who were known to be unsuitable.

We saw that the agency had a range of quality assurance systems in place to monitor the service.

The acting director of service told us that all these audits gave her the opportunity to look at the service as a whole and use information gathered to maintain and improve standards at the agency.

We looked at six support plans and other care records and they all had an assessment of people's health and social needs completed. The documentation was up to date and reviewed on a monthly basis.

We spoke with four people who used the service, five staff and professionals involved in the service. People who used the service said: “I like it here” and “The staff are kind.”

Staff commented: “The training is good”, “We have regular team meetings”, “The staff team are good” and “We have a good staff mix who advocate well for the people they support.” All the staff said they got good support from the management team and that they had no concerns about the welfare of the people they supported.

The professionals said: There has been some turnover of staff and this has made it more difficult to know who to speak to”, “The manager is supportive and keeps me informed of changes” and “They take on board advice and suggestions made.” They said they had no issues or concerns with the home.

We looked at staff recruitment and found that robust recruitment procedures were in place.

Some of the people who used the service had limited or no verbal communication. We observed interactions between the people who used the service and staff during the day and found there was a relaxed and friendly atmosphere between them. Staff interpreted non-verbal communication well during our observations and were able to describe what an individual needed or how they felt.

People we spoke with told us they were given choices as to what they needed care staff to do for them. They said that they were involved in making decisions about their care and support package. Comments included “Staff are kind and helpful”, “The staff are my friends.”

People told us that their support worker was involved in discussion and decisions about future care and support needs. They said they felt as if their wishes had been listened to and acted upon. They said their individual needs were catered for.

People said that information had been recorded in a care file and this was used to produce a plan of care and risk assessment to ensure the care and support provided was appropriate to need.

Comments from people included "I was asked to tell them exactly what I wanted "; "I felt I was listened to"; "Staff are good, they help me and make my life good.”;” Staff live here and support us”;” The staff have lots of training and provide good care and support”. ”Staff are friendly and kind and seem to like supporting us.”

One person said they felt safe and secure in the company of the support workers.

One person told us they were “always asked what they thought of the service.”

We spoke with a group of people who use the service who were enjoying a music session. They were happy with the service that was provided and enjoyed getting out and about in the community. Sometimes this is on a one to one basis with a member of staff or in small groups. Some people who use the service go out and about alone in the community and also enjoy this. There was overall agreement that the staff were kind, friendly, helpful and supportive towards the people who use the service.

They said that they enjoyed the music sessions and often also had a dance whilst they were there. There was also the opportunity to sing and play along with the music. It was a very lively session and people were enjoying it.

We also spoke to some people individually and they said:

The staff are a good team, and the people I live with are my best friends”

“I have daily jobs around the house and help with the shopping and cooking”

“I am happy with the support staff give me”

“Staff explain what they are writing about me”

“Staff are very kind and considerate” and “the staff are always caring.”

We spoke with relatives of the people who use the service and they commented:

“I speak with the manager on the phone on a regular basis. She is always willing to listen to me. I am very happy with the service provided. Staff are interested and helpful.”

“The staff are great. I am very happy with the service provided. There have been issues in the past but they were resolved. I know my relative would like to go rock climbing as this appears to have stopped at the moment. Also it would be good if key workers would remain with the person for a while as my relative has had several different people and this caused upset for a while and lack of continuity of care.”

“On the whole the service is very good. I have had some issues recently which have been resolved following a meeting with the person in charge. My relative has improved since being supported by this agency.”

We spoke with staff and they commented:

“The staff team is good and we work well together. I get good team support.” This staff member also showed their knowledge and understanding of adult abuse and what they would do if they suspected abuse of a resident. They described the support that different people needed and that each person is an individual with needs that are specific to themselves.

“The manager is fair and easy to talk to. She is a good manager. The staff team are good and we work well together. I like the people we support and it’s good to get out and about in the community.”

“I love coming to work, and helping the people we support. The training is very good and I have been on a wide range of training including NVQ level 3. We complete mandatory training every two years.”

“I enjoy my job and I like getting out and about in the community. The staff team are good and the management are very approachable.”

“I have only been working here a short time. I have received a lot of support from my colleagues and from senior management. The induction was good and for the first couple of weeks I visited the service users, homes and staff. The manager has an open door policy and is always willing to listen. I really enjoy my job. I have attended a range of training and completed some E-learning training too. The staff team are good and work well together.”