About the service:

Stars Social Support is a domiciliary care agency providing personal care to people in their own homes. At the time of this inspection it was providing services to 81 people.

People’s experience of using this service:

• People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent. Staff asked people for consent before providing care, however improvements were required in how the service recorded when people consented to their care or when they lacked the mental capacity to make the decision themselves;

• People felt safe in the presence of care staff. However, some staff recruitment records did not contain all the information required by regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; fit and proper persons employed. New staff received an induction to the service, which included time shadowing an experienced staff member. We fedback to the provider to start recording staff inductions so they can clearly evidence when key learning objectives were met;

•The service supported access to other community health professionals as required. Staff supported people safely with their medicines, though some minor improvements were required with the quality assurance systems which promoted safer medicine administration;

• Staff received a range of training and people thought staff had the right skills and experience to care for them effectively. Most staff were supported in their role through regular supervision meetings with their line manager. The provider had recently introduced an electronic system which monitored staff training and supervision commitments and flagged when these became overdue. This system was relatively new so its efficacy needed to be tested over time. We have made a recommendation about recording staff meetings;

• People were informally asked for feedback about the service and they told us they were confident they could raise any concerns with staff or the manager. We have made a recommendation about expanding the provider’s stakeholder feedback processes. Some people and their relatives said the office communication was poor at times, in particular when communicating changes to people’s rota schedules;

• The provider had recently started to overhaul people’s care plans to improve the quality of information it included about a person’s care and support needs, thereby increasing the likelihood of them receiving person-centred care. We looked at a sample of the new format care plans and they were much improved over the previous version. However, as the service was less than 10% through this project we need to see this improvement implemented service wide. People and their relatives told us they were consulted about their care, though the service was not always recording these discussions during care reviews.

• At the last inspection the service was in breach of Regulation 17. At this inspection the service had not made enough improvements to meet the requirements of this regulation and therefore was in continued breach of Regulation 17.

• The service met the characteristics of good in the key question of caring. The registered manager had plans in place to improve other areas of the service. The provider had not ensured adequate steps were taken to address all issues previously raised at the last inspection;

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 1 February 2017). The service was rated requires improvement in the well-led domain with one breach of Regulation 17.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any re

This was an announced inspection which took place on the 31 October 2016. The service was last inspected in August 2013 and was compliant with the regulations in force at that time.

Stars Domiciliary care agency provides support to children and adults with disabilities who live in their own homes. The service was supporting 59 people at time of inspection.

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.

We found that people’s care was delivered safely and in a manner of their or their representatives, choosing. People were supported in a way that reflected their wishes and assisted them to remain as independent as possible. Staff were aware of signs of potential safeguarding issues and knew how to raise them both internally and externally.

Staff were well trained and encouraged to look for new ways to improve their work. Staff felt valued by the registered manager and this was reflected in the way they talked about the service, the registered manager and other staff. Staff were not receiving regular formal supervision but the registered manager had put in place steps to address this with staff. Staff had access to informal and ad hoc supervision and told us they felt supported.

People who used the service were initially assessed and then matched up with suitably trained staff to support their needs, and if people requested changes to how support was delivered these were facilitated quickly. People and relatives were complimentary of the service, and felt included and involved by the staff and registered manager. Where people had specific needs, staff attended training before starting work with them to ensure they had the correct skills and competencies in place. We saw that staff had access to very comprehensive induction training.

The service had not always formally sought and confirmed people, or their representatives, consent when assessing and devising their care. People and relatives we spoke with told us that staff sought their consent verbally before delivering any care. From talking to staff and checking other care records we could see that the best interests’ decision making process had been followed, but that the provider’s records did not support the clear recording of the process and final agreement.

There were high levels of contact between the office and senior staff and people with those staff seeking feedback and offering support as people’s needs changed. People and their relatives were able to raise any questions or concerns with the service and were confident these would be acted upon. No one we spoke with had any issues or complaints about the service they received.

Staff worked to keep people involved in their local community and in activities that mattered to them where possible. Relatives thought that staff were caring and supportive and sought their advice and support with the permission of the person.

The service had not always identified and acted promptly upon issues such as the failure to regularly supervise staff, to ensure that consent was correctly recorded and record keeping of the use of best interest’s decision making was in place.

The registered manager was seen as an experienced leader by staff, people using the service and peoples relatives. The registered manager was trusted and had created a strong sense of commitment to meeting people’s diverse needs, supporting their staff and developing a better service. The registered manager had recently taken steps to increase management support and to develop and IT solution to help reduce paperwork and improve their ability to collate and analyse quality data.

We found a breach of regulation in relation to go

At the time of our inspection, Stars Social Support provided care and support to 46 people. We spoke with three people who used the service that came into the office on the day of our inspection. We spoke with a further person who used the service and five relatives of people who used the service via telephone. We spoke with the manager and six members of staff.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People’s comments included, “I tell them [staff] where I want to go” and “They ask me what I want to do”

People experienced care, treatment and support that met their needs and protected their rights. People said about the service, “They’re brilliant, happy with everything”, “They really are good” and “Very pleased with them."

Where people were assisted and/ or prompted with their medication, people we spoke with did not have any concerns. Staff were appropriately trained in handling medication and risk assessments were in place where applicable.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had appropriate and effective recruitment procedures in place.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with two people on the telephone on the 31 October 2012 and we found that they were happy with the support they had received and they said that they looked forward to seeing their support worker. They told us that they were involved in decisions and that they had choice.

We spoke with six relatives on the telephone on the 31 October 2012 and they were happy with the quality of care that their relative had received. Their comments included: “Very good, the same carer and very reliable.” “Its going really well I have got no complaints.”

We saw that where people were able they signed their support plans. Relatives we spoke with told us that they had signed the support plan documentation on behalf of their relative. They told us they were involved in their relatives supporting planning.

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People told us that they felt "safe". They all said that if they had any concerns or worries they would speak to their relative or staff.

We saw evidence that staffing levels were appropriate and that staff had received training and were supervised.

We found that most relatives who had raised issues in the past were satisfied with the outcome. Two relatives we spoke with told us that they had not been fully satisfied with the outcome of their complaint but had decided not to pursue the complaint further.

People told us that they were satisfied with the care and support provided. Their comments included:

“I am very happy with them (the agency).”

“(The agency) are really good.”

“Brilliant.”

“I am quite happy. We have had our ups and downs but (the manager) sorted them out.”

“I can contact them at any time, they are always available. Sometimes they (the office staff) are slow to pass messages on.”

“My carers are second to none.”