North Star Foundation Limited is a domiciliary care service. It is registered to provide personal care to people with learning disabilities living in their own homes. There were 22 people using the service on the day of our inspection.

At the last inspection, on 20 and 21 April 2015, the service was rated Good. At this inspection we found the service remained Good overall with a rating of Outstanding in the ‘Caring’ key question.

People received support from experienced, committed and compassionate staff. There was a strong ethos which was held by the provider and management team of keeping people at the heart of their care. This ethos was adopted by staff and interweaved in their supporting roles. Staff were always looking for ways to improve people's lives and frequently went over and above to assist people in achieving their dreams. This approach frequently resulted in compelling accounts of improvements where people had been supported to reach certain individual milestones in their lives.

Staff respected people's privacy and dignity when they supported them and promoted their independence which assisted people in making choices which people appreciated. With the sheer determination of staff and management working alongside people their life opportunities, welfare and quality of life were respected and enhanced.

People who used the service and relatives provided overwhelmingly positive feedback about the service and individual staff. Throughout people’s feedback they expressed accounts of how they felt truly involved in their care and part of the overall management of the service. Staff liaised with health and social care professionals and community services to support people in planning and meeting their individual goals.

People continued to receive care which protected them from avoidable harm and abuse. Risks to people’s safety were identified and measures were in place to help reduce these risks. When people required support to take their medicines there was assurance staff only supported people when they had received the training to do so. Regular checks on staff practices were undertaken to support people’s safety.

Staff were available to respond to and meet people's needs safely without people feeling rushed and/or care calls being missed. Checks were completed on potential new staff to make sure they were suitable to support people in their own homes.

People were provided with care which continued to be effective in meeting their particular needs. Staff received training to provide them the skills and knowledge they needed to support staff in providing the right care and support people required. Additional specialist training was sought to raise staffs skills to support their confidence and competence in providing the care to meet people’s complex needs.

Staff asked people's permission before they assisted them with any care or support. People's right to make their own decisions about their own care and how they received this were supported by staff. When needed, arrangements were in place to support people in remaining in good health and have enough to eat and drink.

People were provided with care and support which was individual to them. Their care and support needs were kept under review and staff responded when there were changes in these needs. There continued to be a flexible approach to providing people with the care they required at times when people needed this the most which reflected a responsive approach when people wanted to remain living in their own homes.

People were encouraged to raise concerns and make complaints and were happy these would be responded to. The management team used feedback to assist them in focusing upon areas of improvements for the benefit of people.

Staff were happy in their work and were clear about their roles and responsibilities. There was an ethos of keeping people at the heart of their care amongst the staff team which was fully promoted by all the managem

When we visited North Star Foundation care agency, we spoke with the registered manager, the care coordinator, the quality assurance manager and four members of staff who provided care. We met and spoke with four people who used the service and spoke with four relatives on the telephone following our visit. We looked at four people's care records and six care staff records.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "The staff are really good, we do something different every day."

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs. We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that systems were in place to effectively deal with complaints. The provider monitored the quality of the service and had made improvements where needed. One relative told us, "They are particular about who they employ. The standard of knowledge and skills of the staff is very good."

We carried out a themed inspection looking at domiciliary care services.

We reviewed all the information we held about this service and carried out an unannounced visit to their office on 21 May 2012. We looked at the records of people who were using the service, staff records and talked with senior staff and care workers, people who use the service and their relatives.

We visited four people in their own homes, spoke with three senior staff and one care worker at the time of our visit and a further three care workers by telephone. An expert by experience (a person who has used a domiciliary care agency) carried out telephone interviews with six people using the service.

People told us that they were happy with their care and the support they received and that it met their needs and preferences. They confirmed that senior staff had carried out an assessment of their needs before the service had commenced and that their care plans were being reviewed periodically or when their needs had changed. Comments provided included;

“They treat me very well and respond to my individual needs as far as they can.”

“The service is very accommodating and very reliable.”

“I speak to staff about what I want.”

The people we spoke with gave us positive comments about staff:

“The staff are very nice, just a friendly bunch.”

“They are very fine staff.”

“They respond to our views and any issues very well.”

People felt that they were involved in making decisions about how the care and support was provided. Everyone we spoke with reported that staff treated them with respect and promoted their dignity.

The people we spoke with told us they were confident that they could raise any concerns about the quality of the service provision. We saw evidence that the service carried out annual quality assurance audits and where actions were required, they were carried out.

We undertook an announced inspection on 20 and 21 April 2015. We gave the registered manager 48 hour’s notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes and or the family home we needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care and support for people with learning disabilities who live in their own homes. At the time of our inspection 55 people received care and support services.

There was 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 who used the service were safe as the provider, registered manager and care staff had a clear understanding of the risk associated with people’s needs as well as activities people chose to do. There were sufficient numbers of suitably qualified staff, who had a good understanding of protecting people from the risk of abuse and harm and their responsibilities to report suspected abuse. Medicines were administered by care staff that had received training to do this. The provider had procedures in place to check that people received their medicines as prescribed to effectively and safely meet their health needs.

Care staff had been recruited following appropriate checks on their suitability to support people in their homes and keep them safe. The provider had arrangements in place to make sure that there were sufficient care staff to provide support to people in their own homes and when going out in the community. People told us they received reliable care from a regular team of staff who understood their likes, dislikes and preferences for care and support.

People told us they were supported by staff to make their own choices and decision’s about their care and support. We saw people were actively involved in how their care was planned and their needs met. Staff understood they could only care for and support people who consented to being cared for and knew when people were unable to consent best interest meetings were held so that decisions were made by those who knew people well and had the authority to do this.

People told us that they were happy with the way in which care staff supported them with cooking their meals, learning about different foods to keep them healthy and in accessing health and social care services when they needed them.

People who used the service, their relatives and a social work professional described the care people received as meeting people’s needs in a positive way. Staff were caring and showed a genuine warmth and commitment to the people they supported. People felt they mattered to staff and were involved in every aspect of their lives. Where communication and people being supported to lead independent lives could have been a barrier for people the provider and the registered manager led by example to find ways to ensure people could lead fulfilled lives and communicate in a way that suited them.

People’s needs were assessed and staff understood these needs and responded appropriately when people’s needs changed. People’s interests and preferences were documented and they were encouraged to pursue social events and areas of interests. Social inclusion was an important priority for people and the staff who supported them.

People were encouraged to share their opinions about the quality of the service through telephone conversations, visits with the management team and regular satisfaction questionnaires.

The provider and the registered manager had a clear vision for the service that was shared by the staff team. This vision was about complete inclusion and involvement of people and care staff in shaping their lives and the service. This vision was being embedded within staff practices and evidenced through the conversations we had with people and their family members.

Leadership of the service at all levels was open and transparent and supported a positive culture committed to supporting and enabling people with learning disabilities.