We inspected the service on 18 and 19 October 2018. The inspection was announced so we could ensure someone would be available at the office to support the inspection.

At the last inspection we found the service in breach of two regulations of the Health and Social Care Act. Concerns were noted around the risk management systems in place and the management of medicines. We also had concerns around governance arrangements which would help the manager and provider to identify concerns and continuously drive improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. We found some action had been taken but further action was still planned to further improve standards and meet the requirements of the regulations.

Norwich First Support domiciliary service is a short-term service providing personal care to people in their own homes. The service was provided normally for no longer than six weeks. People’s need for the service was assessed at each visit. If it was assessed the service would be needed for longer than the anticipated six weeks, people were referred to different longer-term services for ongoing support.

The domiciliary care service was part of Norfolk First Response which included three other services. One service in partnership with Norfolk Community Health & Care (NCH&C), met more complex and clinical needs, another met urgently required support including support following falls or other accidents and the third provided residential based reablement. Each service was registered in isolation but were managed by the same senior leadership team and the registered managers worked closely together to ensure people’s shorter-term needs were met.

The newly developed service had been added to the Norfolk first support domiciliary care which included intensive seven-day support provided to people with more complex needs including support with pressure areas, urinary tract infections and falls. People could require more intensive observations and some funding was provided from Norfolk Community Health & Care (NCH&C) who recruited the clinical staff to support people's needs as required. Each partner agency worked to support people under their own registrations.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults.

The Norwich and Northern first support team was managed by two registered managers. At the time of this inspection one of the previous registered managers was acting up into a county manager role and an acting manager was managing the Norwich side of the service. 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.

Since the last inspection improvements have been made across the board in relation to how the service is run and how it fits into the provider group. However, there is still some work to do. The management of medicines has improved with more focus on training and audit of records. This has allowed for inconsistencies to be recognised and addressed with the provider addressing issues in staff supervision and if required with additional training. This has meant the service is no longer in breach of this element of the regulation. However, the service was still in breach of the safe care and treatment regulation in respect of how they managed and mitigated risk. We continued to find inconsistencies in this area and some risks which were not suitably addressed or managed.

Good governance procedures and systems were also found to be in breach of the associated regulations du

This inspection took place on 14 September 2017 and was announced.

NCC First Support - Northern and Norwich is a service that provides intensive support to people in their own homes to help them re-gain as much independence as possible. At the time of our inspection, there were approximately 200 people using this service.

The service had two registered managers. One to manage the Northern team and the other the Norwich team. 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. The registered managers managed a team of re-ablement practitioners across their designated areas of the county. These re-ablement practitioners then in turn, managed a team of support workers.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks to people’s safety had not always been sufficiently assessed. Records in relation to people’s medicines did not support they had always been managed safely. Furthermore, some systems in place to assess and monitor the quality of care provided had not been effective at identifying and improving these areas of practice.

You can see what action we told the provider to take at the back of the full version of the report.

There were enough staff to meet people’s needs and the provider had ensured staff were safe to work within this type of service before they had been employed. Systems were in place to protect people from the risk of abuse.

Staff had received training in a number of different subjects. They were competent to support people in a number of areas. However some staff needed further training in risk and medicine management which the registered mangers agreed to implement.

The staff obtained consent from people in line with the relevant legislation before providing them with support. Where required, people received support to eat and drink enough to meet their individual needs and with their healthcare.

The staff were kind, caring and polite. They treated people with dignity and respect and people valued their relationships with the staff. People’s needs and preferences had been assessed and were kept under review to ensure they were being met.

People were able to make decisions about their own care. They were listened to and empowered by staff to do this. Any concerns they raised were investigated and resolved.

There was an open culture within the service. People and staff felt able to raise concerns without fear and the service learnt from any complaints that people made.

Staff received good leadership. They understood their roles and responsibilities. Systems had been put in place to ensure staff felt valued and appreciated and they were supported in their roles.

The registered managers worked with other services to share best practice and improve the quality of care people received.