This inspection took place on 20, 21 and 28 December 2018 and was announced.

Outreach Sefton is a domiciliary care agency, providing care and support to people in their own homes. The service operates in Southport and surrounding areas, as well as in Bradford in West Yorkshire. At the time of our inspection, there were approximately 90 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People and their relatives told us they felt safe using the service. Staff were clear about their responsibility to keep people safe and had confidence in managers to address any concerns. People's risks had been assessed to help keep them safe and safeguarding concerns had been investigated appropriately. People and relatives told us that at times staff could be slightly early or late, but that generally they were punctual and did not miss any calls. Staff had been recruited using appropriate checks. The service generally supported people to manage their medicines safely.

The service worked in partnership with people, relatives and other professionals to achieve good outcomes. Staff received ongoing support through induction supervision and training, although some training needed to be refreshed. Staff supported people's needs around drinking and eating well. The service followed the principles of the Mental Capacity Act 2005 to protect people's rights to make decisions and maintain their best interests.

People and their relatives told us staff treated them with kindness, dignity and respect. Many staff had worked for the service for a long time and knew people well. People and relatives were involved in the planning of care.

People and relatives felt that at times the service needed to be better at meeting individual needs. Our review of care plans confirmed that information at times needed to be clearer and more detailed. People and relatives knew how to make a complaint and told us they were listened to, although at times this needed a few attempts. The service had worked in partnership with people, relatives and professionals to provide dignified and respectful care at the end of the person's life.

People and relatives told us that overall the service was managed well. Senior staff visited people and relatives generally on an at least six-monthly basis to ask them about their views of the service. There had been no recent team meetings. Staff received appraisals at which they were invited to share their views and suggestions. We heard and saw compliments and positive feedback for the service given by people, relatives and local authority commissioners.

Further information is in the detailed findings below.

Outreach Sefton Limited is a domiciliary care agency that operates in the Bradford and Southport area. The agency provides support for personal care, social care and domestic services to adults and children. The agency is owned by Outreach [Sefton] Ltd.

This was an announced inspection which took place over three days between 20 and 23 June 2016. The inspection was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

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.

Medicines were administered safely. Medication administration records [MARs] were completed in line with the services policies and good practice guidance.

People we spoke with said they felt safe with the staff from the agency and the support they received. We were told that if any issues arose they were addressed by the managers.

We saw that any risks to care provision had been assessed and there were fully developed plans in place to help ensure they were kept safe. Staff were arranged to support this depending on each person’s needs. There were sufficient staff available to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We looked at three staff files and found that appropriate applications, references and security [police] checks had been carried out.

The staff we spoke with clearly described how they recognised abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report through any concerns they had. We reviewed a number of safeguarding investigations during the inspection and the agency had followed procedures and liaised well with safeguarding authorities. Agreed protocols had been followed in terms of investigating and ensuring any lessons had been learnt and effective action had been taken. This rigour helped ensure people were kept safe and their rights upheld.

Arrangements were in place for checking the care environments to ensure they were safe.

We saw that peoples consent to care was recorded. The service worked in accordance with the Mental Capacity Act 2005.

Feedback from people and their relatives told us that staff seemed well trained and competent. Communication between relatives, people being supported, staff and senior management was effective.

Staff were supported by on-going training, supervision, appraisal and staff meetings. Formal qualifications in care were offered to staff as part of their development.

Local health care professionals, such as the person’s GP, were involved with people and staff from Outreach Sefton Limited liaised when needed to support people. This helped ensure people received good health care support.

Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw that staff respected people’s right to privacy and to be treated with dignity.

All family members and people spoken with felt confident to express concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised.

All of the managers we spoke with were able to talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual rather than the person having to fit into a set model within the service.

People

At the last inspection of the service in November 2013 we found people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to record and manage medicines safely. Previously, the administration records had not specified the individual tablets which staff prompted or assisted people to take. This had meant that staff did not know the individual tablets they were giving to people and the records were not completely accurate.

On this inspection we checked to see if the new arrangements were in place. We found improvements had been made.

People who were supported by the agency were visited and asked their views. Feedback was positive about the agency and people expressed a high level of satisfaction with the level of care.

They said staff were friendly and always on hand to talk to. One person said. ''Staff are lovely and very caring. There are no complaints at all.’’ Another said ‘’Staff are excellent. They always tell us what’s going on and communicate well.’’

People spoken with expressed the view they were treated with respect and dignity. They said their wishes were listened to. One relative told us about the care staff delivered and said they were always professional and took time to explain things. They carried out care at a good pace and were not rushed. Staff were confident and capable when using equipment, such as the hoist. This helped people to feel safe.

People reported that staff understood the care needs and had built up a positive relationship. The care was consistent. Another person told us that they also received care from the district nursing team and the agency liaised well with the nurses to complement the care. This showed the agency was responsive to people's care needs.

People, when asked, said that they felt ‘safe’ with the care delivered and they were confident any concerns would be listened to and addressed. People we spoke with knew who to contact if they had any concerns.

We received positive comments about the staff which helped evidence their competency and approach to care. One person commented, ‘’Staff are very good. They always make sure they spend time with [my relative] and are very patient.’’

People reported that staff were consistent and they were always positive in their approach to care and there was a good morale. People said that staff supported each other and worked well together.

People were able to give there views as to the running of the agency when they received regular reviews of their care.

We undertook this inspection in two stages, over two days. We visited the head office, where we met with the Operations Manager. We spent time with three people who received support and their relatives and invited them to share with us their views and experiences. The service provides support to people living in their own homes in the Sefton and Bradford area.

We spoke with 12 people who received support and five relatives on the telephone, from both geographical areas. Some of their comments included; “My staff are very experienced and know their job”, “I recently had some new equipment to help me transfer and they (staff) all had training to make sure everything was ok and I was safe”, "The agency tells us straightaway if they feel my family member’s needs have changed or if they’re unwell”, “If I need the time of my call changed for a hospital appointment then I give them 24 hours’ notice and it’s sorted”, “Obviously it changes sometimes if people are off but basically I have a team of 15 staff. I know them all and they know me” and “I have the same workers all the time as they (provider) know I am not very confident.”

We reviewed four people’s care records and found they contained the information staff required to provide care in a way which met people’s individual needs.

We looked at the medication procedures, in order to assess if medicines were correctly and safely administered. We found medication was not recorded to identify the name of the medication.

We looked to see if the provider had experienced staff and provided the training and support staff needed to support them in their work. We saw the programme of training in place for all staff.

We looked at the complaints system Outreach Sefton Ltd had in place. We found complaints were responded to according to their complaints policy.