We undertook an announced inspection of the service on 7 February 2018.

Southwark Disablement Association is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection, 64 people were using the service.

At the last inspection, the service was rated Good.

At this inspection, we found the service remained Good but improved its rating of the key question of Responsive to ‘Outstanding’.

A registered manager was 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 were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People received care that was exceptionally responsive to their individual needs. People using the service and their relatives commented the registered manager and staff went over and beyond to place people at the centre of the service. Health and social care professionals highly commended staff for meeting people’s needs. The registered manager and provider continually looked for ways of developing the service to enhance people’s lives. This was in line with the provider’s vision to ensure people living with a physical disability enjoyed and lived their lives to the fullest and as equal citizens.

A high person centred approach greatly minimised the risk of social isolation and loneliness prevalent to people with a physical disability. The provider, registered manager and staff were abundantly flexible in supporting people to pursue their hobbies, develop new interests and skills. People received support to undertake activities at home and in the community regardless of whether this formed part of their care package or not. The provider developed plans which enabled people living with a disability access activities, events and opportunities available to those without a disability.

People had their health and well-being needs assessed. Staff delivered care and support to people as planned and in line with their choices and preferences. People knew how to make a complaint and were confident issues would be resolved.

Staff delivered people’s care with kindness and compassion. People had their dignity and privacy maintained. People had access to information and advocacy services they required.

People received care in a manner which protected them from the risk of harm. Appropriate arrangements remained in place for staff to identify and report safeguarding concerns and abuse. Risk assessments and management plans were detailed and ensured people continued to receive safe care and support. There were enough numbers of suitably recruited staff deployed to provide care. Staff administered and managed people’s medicines in a safe way. Staff knew how to prevent and control the risk of infection. Staff learnt from incidents.

People underwent an ongoing assessment and review of their needs. Staff delivered care in line legislation and best practice guidance. Staff received support to undertake their roles, attended training and had supervision. People received the support they required to eat healthily and meet their dietary needs. People had access to healthcare services.

People enjoyed good standards of care because of the regular checks and audits carried out on the support they received. People benefitted from an open culture at the service that focussed on their individual needs. The provider valued people’s feedback and made the necessary improvements to develop the service.

People using the service and staff commended the management team and the manner in which they managed the serv

People using the service were involved in discussions about the care and support they received and had opportunities to modify the service they received at regular reviews and at other times as required. People were treated with dignity and respect and were encouraged and to set goals and objectives to promote independence.

Service user plans were personalised to reflect individual needs and preferences and were updated to reflect changes in the care package.

The provider had procedures to ensure continuity of care and the safety and welfare of people using the service, and staff had the necessary training and contacts to manage risks and emergencies.

The provider cooperated with a variety of different services and health care professionals to help ensure that all people's needs were met.

Nutritional and dietary needs were incorporated into the care delivered and tailored to people’s circumstances, health and wishes.

Staff had appropriate training and support and had regular supervision and appraisals.

The provider had a variety of systems to monitor the quality of service provided. Customer surveys and feedback showed a high level of satisfaction with the service and people were contacted regularly to obtain feedback on their care.

One person using the service told us, “They are the best carers I’ve ever had”, while another said, “I’m very pleased with the service, she’s so good - she can’t do enough for me.”

There were about 60 people using the service at the time of our inspection. We saw from the provider’s survey of service users, the regular monitoring checks that people were satisfied with the service. The person we spoke with also praised the service

People using the service were involved in discussions about their care and support and asked for their consent. The person we talked to said the care coordinator regularly discussed their needs with them.

People using the service and their relatives found the service reliable and commented on the benefit of the continuity of care provided. The person we spoke with told us how much their care worker cared. Someone else commented about their care worker: “Always on time and very reliable … the quality of her work is excellent.”

People said they were contacted regularly to check if everything was running smoothly. One person said “I know whenever I raise something either with the office or the carer it always gets sorted very promptly”. There were two written complaints in 2012, which were investigated appropriately.

There were detailed instructions on how the care worker should administer medicines, if this was included in the care plan. There were regular checks on the the recording of medicines administered.

There were effective staff recruitment and selection processes in place.

This inspection took place on 29 October and 5 November 2015 and was announced. We gave the registered manager 48 hours’ notice as we needed to be sure they would be available for the inspection.

When we last visited the service on 12 November 2013, the service was meeting the regulations we looked at.

Southwark Disablement Association support including personal care for people in their own homes. At the time of the inspection 55 people were using the service.

The service had a registered 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.

Medicines were handled and administered safely. Staff understood the organisation’s medicines policy and followed it to ensure people received their medicines safely.

Risk assessments were in place and detailed actions to manage identified risks and to keep people safe.

Recruitment procedures were robust and safe. Staff understood how to recognise signs of abuse and how to protect people from the risk of abuse.

Staff understood their responsibilities within the Mental Capacity Act 2005. Staff were supported through effective induction, supervision, appraisal and training to provide effective service to people.

The service worked with social care and health care professionals. People were supported to arrange appointments to ensure their health needs were met. Relevant professionals were involved to ensure people received appropriate support and care that met their needs.

People were supported to eat and drink appropriately and to meet their dietary and nutritional requirements.

People told us staff treated them with kindness, compassion and respect. Staff provided support to people the way they wanted to be cared for. People and their representatives were involved in their care planning and these were reviewed and updated regularly to reflect people’s changing needs.

People, their relatives and staff were encouraged to provide feedback and to raise concerns. The registered manager investigated and responded to complaints and concerns appropriately to improve the service.

The service had various and effective systems to monitor the quality of service delivered. They worked in partnership with other agencies to deliver effective service to people.