We completed an announced inspection at Special People North on 23 February 2017 and 24 February 2017. At the last inspection on the 21 January 2016, we identified multiple breaches in Regulations. We found that the service was not consistently safe, effective, responsive or well-led. After the last inspection the provider completed an action plan which showed the actions in place to make the required improvements to the way people received their care. At this inspection we found that the service was meeting the required Regulations.

Special People North is a small domiciliary care service who provide support to people and children who have a physical and/or a learning disability. At the time our inspection Special People North were providing personal care to 10 people/children.

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.

Staff and the registered manager understood their responsibilities to keep people safe where abuse may be suspected.

People's risks were assessed. Staff knew people's needs and carried out support in a safe way whilst they ensured that people's independence was promoted.

There were enough suitably qualified staff available to meet people's assessed needs. The provider had an effective system in place to monitor the staffing levels against the needs of people who used the service.

Staff received training which was updated regularly to ensure they had the knowledge and skills required to meet people's needs effectively.

People consented to their care and where they were unable to consent mental capacity assessments had been carried out in line with the Mental Capacity Act 2005 (MCA). Staff showed they understood and applied the requirements of the MCA. This ensured that when people had the ability to make decisions for themselves, their decisions were respected. It also ensured decisions were made in people's best interests if they were unable to do this for themselves.

People were supported to eat and drink sufficient amounts and staff understood people's nutritional needs and preferences when they supported people with their diet.

People were supported to access health professionals and referrals for advice were sought by the registered manager, which ensured people's health and wellbeing was maintained.

People received care that was caring and compassionate and they were enabled to make choices about their care. People's dignity was maintained when they received support from staff.

People were involved in the planning and review of their care, which was planned and carried out in a way that met their preferences.

People told us they knew how to complain and the provider had an effective system in place to investigate and respond to complaints.

People and staff were able to approach the registered manager. Staff felt supported to carry out their role.

Feedback was sought from people and staff, which was acted on by the registered manager to make improvements to the quality of care people received.

Effective systems were in place to assess, monitor and manage the service to make improvements to the way people received their care.

This inspection was announced and took place on the 21 January 2016.

The service was previously inspected in January 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The office for Special People North is located in Alderley Edge. Special People North mainly support people who are receiving direct payments to recruit personal assistants, they also support people to manage their care needs and deal with any problems that may arise. The agency is registered to provide personal care to adults and children. At the time our inspection Special People North were providing personal care to 9 people.

At the time of the inspection there was a registered manager at Special People North. 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.

During this inspection we found breaches of the Care Quality Commission (Registration) Regulations 2009 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.

We found that people’s care needs were not appropriately assessed and planned for therefore individual risk factors had not been fully considered, placing people at risk of avoidable harm. Care records kept at people’s homes were incomplete and had not been regularly reviewed.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of service users not in place and auditing systems were not robust.

The provider had a complaints policy and procedure in place but we saw complaints were not fully investigated and not recorded in the complaints log. The Commission had also not been notified of a safeguarding concern.

The provider did not have an effective recruitment and selection procedure in place and did not carry out relevant checks when they employed staff.

We looked at records relating to personal care the service was providing and found that information kept at the registered location was disorganised and not well managed.

Staff did not receive an effective induction, although staff had recently been enrolled to undertake the care certificate we found many gaps in training and a lack of supervision. Staff and registered manager had not received training on the Mental Capacity Act 2005 and lacked awareness of this protective legislation.

We found insufficient evidence of staff training in medicines administration. The registered manager informed us they did not support anyone with administration of medicines. However, upon speaking to one member of staff they informed us that on occasions they had ‘provided when needed’ (PRN) medication. This member of staff confirmed they had not received medication training and did not record this on a PRN chart.

People told us they felt safe when the personal assistants were in their homes and that they were treated with kindness and compassion.

Staff we spoke to were able to tell us about ways in which they protected people’s privacy and dignity whilst undertaking personal care tasks. We spoke with people who used the service and their relatives about their experience and they confirmed that care workers were respectful of this.

We spoke with people’s relatives and one person about their experience of the care and support they recieved, all were extremely positive. One person receiving care told us: “The staff are brilliant, there are three core staff and they are all good, I get on well with them, decent people, they are good for me.”

Relatives told us: “Staff are tremendous, they have made an enormous difference to us – as good as you get,” and “Can’t speak highly enough of the support worker, they work very well with X, they go above and beyond and are keen to give input on what they have learnt, like, things which triggers X’s behaviour and share with everyone to update care plans. They take an active interest in X’s needs.”

People expressed their views and were involved in making decisions about their care and treatment.

We looked at four peoples care records, all included assessments of need, care plans and risk assessments, providing staff with the outcomes people wished to achieve from their care.

There were enough qualified, skilled and experienced staff to meet people’s needs.

We reviewed four staff files; these included a record of training, and a record of supervision and appraisal. We saw staff had received supervision as and when required and annual appraisals had taken place.

We saw people were consulted for their views. Results were positive from the most recent evaluation forms returned, with the service overall receiving good to excellent results.

We spoke with three people who used the service. They told us that the service worked closely with them to ensure their needs and wishes were met. All three people we spoke with said staff respected their rights, their privacy and their dignity. Comments included: "they respect what I say” and “it’s a sterling service”. People told us that had copies of their care records and they were regularly consulted.

We also spoke with two family members whose relatives used the service. Both relatives said that they considered the care to be good. Comments included:” they are very professional, I have no concerns at all” and “it’s absolutely brilliant.”

During our visit we looked at the care and support plans for four people who used the service. These were examined in the office of Special People North. We saw that the assessment of need documentation contained information about the persons care needs and how staff were to support them.

We found that systems were in place to ensure people were protected from the risk of harm and abuse and we saw evidence to show that people were regularly consulted about all aspects of the care and service provided to them with timely feedback provided.

People we spoke with told us they were asked for their views about the service they received. They told us they were ‘very satisfied’ that their views and wishes were always listened to when planning their care. They told us that staff were ‘very respectful’ and ensured the dignity of the people they support was maintained. One person told us how the support they received was ‘a great help’, particularly as they were ‘very keen’ to be as independent as possible.

People told us that staff supported them in a way that meets their needs and keeps them safe. We were told by the people who use the service that staff treat them with respect and they have no concerns about their safety or well being.

The relatives we spoke with told us they had no concerns about the safety and welfare of the people who use the service. They told us the manager and staff were ‘excellent’.