About the service: North East (DCC Homecare Service) is a domiciliary care service providing personal care to people living in their own homes. At the time of the inspection there were 198 people using the service.

People’s experience of using this service:

The service continued to meet the characteristics of good in all areas.

People continued to receive care that was safe. The provider’s arrangements for people’s care helped to protect people from the risk of harm or abuse. Staff were safely recruited and deployed to provide people’s care. Risks to people’s health, associated with their care and related safety needs, were effectively monitored and managed. Staff supported people to take their medicines safely when required.

People continued to received care that was effective. People’s care needs were effectively accounted for and regularly reviewed, as agreed with them or their representative. Staff supported people to maintain or improve their health in the least restrictive way possible and to maximise people’s choice and control in their care. Staff were trained, informed and supported to provide people’s care. They worked closely with relevant agencies to ensure people received consistent, informed care as agreed with them.

People continued to receive care from kind, caring staff; who treated them with respect and ensured their dignity, choice, independence and rights. Staff took time to know people well and to understand what was important to them for their care. People were informed and involved to understand, agree and make ongoing decisions about their care; or to access relevant advocacy to speak up on their behalf, if needed.

People continued to receive care that was timely and responsive to their individual needs and wishes. People were confident and knew how, to raise a concern or make a complaint if they needed to. People’s views, feedback and any complaints received were monitored by the provider and used to help inform any service improvements needed. Staff were trained and supported to follow nationally recognised best practice standards, concerned with people’s care at the end of life.

The provider operated effective governance systems for the quality and safety of people’s care and to ensure sustained or timely service improvement when needed. Staff understood their role and responsibilities for people’s care. Provider oversight and operational management arrangements at the service, helped to ensure effective communication and record keeping. The provider worked in partnership with people, their representatives and relevant health or social care agencies when needed, to inform and optimise people’s care experience.

More information is in the full report.

Rating at last inspection: Good. Report published 18 May 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection was carried out between the 1 and 2 February 2016 and the 8 and 9 February 2016. The inspection was announced, and we gave the provider 48 hours’ notice to ensure there was a manager available to assist with the inspection process.

North East (DCC Homecare Service) provides personal care for adults in their own homes. This includes people living with dementia, people with physical disabilities and people with learning disabilities. North East (DCC Homecare Service) also provides extra care and re-ablement for people. Extra care services are where people have flexible home care in purpose-built developments. Re-ablement services provide short term support for people after hospital discharge. At the time of the inspection there were 296 people using the service.

There was a registered manager at 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.

At the last inspection on 17 February 2014 we asked the provider to take action to make improvements to medicines management and availability of people’s records and this action has been completed.

People felt safe using the service and staff understood how to protect people from potential abuse. There were systems and processes in place to check the suitability of staff to work with people who used the service.

People were supported by staff who treated them with dignity and respect. People felt cared for by staff who understood their care needs. The registered manager understood the key principles of the Mental Capacity Act (MCA). The registered manager and the staff respected people’s rights to make their own decisions and gained people’s agreement before they provided any personal care.

The registered manager and the management team strived to provide people with a stable and consistent team of staff. Staff completed a period of induction and shadowing to support them to meet people’s needs effectively. The provider had arrangements for staff training needs to be met.

Care plans and risk assessments contained relevant information for staff to help them to provide personalised care to people. Information was available to people about making complaints and people knew how, and who, to complaint to. Staff said they knew how to raise any concerns or issues with the registered manager and the management team, and knew they would be listened to and their concerns would be acted on.

People were supplied with a rota in advance so they knew which staff to expect to provide support and care. People received their care calls when they felt they should, and were contacted if or when staff were running late.

Staff were aware of people’s personal care and associated health needs. People’s planned care was regularly reviewed and evaluated to ensure people received the service they needed.

People were promoted to remain as independent as possible. When people needed help and support with their nutritional needs, it was provided by staff.

Staff were aware of people’s needs and wishes and supported them in a personalised manner. Staff understood the values of the provider and ensured people were involved in their care.

The service was managed by a team who understood their roles and responsibilities in providing a good service to people. There were clear arrangements for the day to day running of the service.

There were processes in place to monitor the quality of the service people received and this helped to drive service improvements.

People had care records and understood the care and support choices available to them. The information about how people needed to be supported was included in the care records. This ensured people using the service received safe and consistent care. One person told us, “They’re marvellous. They all know what they are doing and they always ask me what I want.”

People were able to choose how they wanted to be supported. We saw records which confirmed their consent to the care.

The staff received training that was appropriate for their individual needs and provided them with the information they needed to care for people living in their own home. One person told us, “I can’t fault any of them. They’ve helped me to stay in my own home and I can’t thank them enough.”

We found safe systems were not in place to ensure people received their medicines as prescribed.

We saw that the provider had implemented quality monitoring systems to ensure they monitored the service delivery. People were consulted about the quality of the service and were able to influence service development.

Some people lived in their own homes in a communal living environment, known as extra care. All records relating to this part of the service were not available for us to inspect as required.

People we spoke with were generally very satisfied with the direct care they received from North East (DCC Homecare Service). One person said, "The care is first class."

Some people said that they needed to be made aware of any changes in the planning and delivery of their care, for example if there were staff changes or their visit would be later than planned and that this did not always happen.

We saw that the provider made suitable arrangements for the recruitment of staff.

We saw that although consent was sometimes obtained for people's care that this was inconsistent and procedures were not in place for obtaining consent where people were unable to make decisions for themselves, for example due to dementia.

We found that although assessments and support plans were completed that care planning systems did not fully describe people's personalised care and support needs. We saw that risks that could affect people were not always adequately assessed and managed. We also found that arrangements for supporting people with medication were not always ensuring that they were protected from risk and were receiving safe, appropriate care.

We saw that written complaints were investigated thoroughly and responded to appropriately by the provider. We found that not all complaints and comments were recorded using the system, however, and that this meant that complaint records were not accurately recording people's concerns and how they were dealt with.

As part of this inspection we spoke by telephone to 9 people who were supported by the Homecare Service and saw groups of staff at every locality office. We also spoke with organisation’s operational managers and Domiciliary Service Organisers (DSO) at the locality offices and senior officers at the Adult Social Care Department’s headquarters; they all gave us a perspective about their work.

All of the people we spoke to expressed very positive relations with the staff who provided support and care, and good relations with the agency’s office based coordinator and management staff. They told us that staff worked sensitively and carefully, that ‘they are always friendly and caring in what they do’ and that ‘they all work to a very high standard’.

Patterns of care delivery worked well for the people being supported. A very small number commented on the high numbers of staff supporting them but not that this was a particular problem. A small number also expressed their concerns with the timekeeping aspects of the service.

People told us in general terms about their confidence in the agency’s staff to work safely and the staff that we spoke to all told us that they had received proper training about abuse of vulnerable people and they demonstrated an understanding about their responsibilities to report any concerns.