The inspection took place between 17 and 24 February 2017 and was announced. The provider was given a short amount of notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office. At the time of the inspection 37 people were using the service. We checked whether improvements had been made to the service following the previous inspection in December 2015 where we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations and rated the service as ‘Requires Improvement.’

The Support and Independence Team (Lower valley) is a domiciliary care agency and helps people regain their independence following periods of illness or time in hospital. The service provides short term personal care and support to people in their own homes in the Brighouse, Rastrick, Halifax and Elland areas. The service's office base is situated in Brighouse Health Centre. Referrals to the service are usually from the community, Gateway to Care or following hospital discharge.

A registered manager was not in place with the previous manager deregistering with the commission in September 2016. 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. A new manager had been appointed and was in the process of completing their application with the Care Quality Commission to become the registered manager

We found improvements had been made to the service following our previous inspection in December 2015. Documentation demonstrating people’s care needs had been assessed were clearer and more detailed. Improvements had also been made to the way medicines were managed.

People and relatives all spoke positively about the service. They said their care needs were met by kind, friendly and knowledgeable staff.

People told us they felt safe in the company of staff. Safeguarding procedures were in place which were well understood by staff. We saw appropriate liaison had taken place with the safeguarding unit where concerns had been identified.

Risk screening took place and where significant risks to people’s health and safety had been identified, detailed risk assessments had been put in place to keep people safe. People and relatives reported staff worked in a safe way.

There were enough staff deployed to ensure people received a safe and reliable service. Service delivery was carefully planned and care referrals were not accepted unless there was staff capacity to provide the service.

People received care and support from staff with the right skills and knowledge to care for them effectively. Staff turnover was very low which meant the staff team were highly experienced and familiar with the requirements of the role.

Where required people received appropriate support to eat and drink.

The service worked in partnership with other healthcare professionals to deliver effective care and meet people’s healthcare needs.

People told us staff were kind and caring and treated people with dignity and respect.

The service was effective in promoting and encouraging people’s independence.

People’s care needs were assessed and relevant care plans put in place to provide staff with information on how to care and support people. People’s care needs were subject to regular review.

People received a reliable and consistent service that met their individual needs. People told us staff usually arrived on time with some minor variation.

A system was in place to log, investigate and respond to complaints. No complaints had been received since our last inspection and people told us they were very satisfied with the service.

People and relatives told us the service was well led. They said th

The inspection took place between 16 and 22 December 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The Support and Independence Team (Lower valley) is a domiciliary care agency and helps people regain their independence following periods of illness or time in hospital. The service provides short term personal care and support to people in their own homes in the Brighouse, Rastrick, Halifax and Elland areas. The service's office base is situated in Brighouse Health Centre. Referrals to the service are usually from the community, Gateway to Care or following hospital discharge.

A registered manager was not in place with the previous manager deregistering with the commission in February 2015. 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. A manager had put in an application to become the registered manager in January 2015 however this application had been returned due to being incorrectly completed. Since then, satisfactory steps had not been taken to ensure a registered manager was in place.

At the last inspection in June 2014 we found one breach of the Health and Social Care Act (Regulated Activities) Regulations relating to the way the service assessed and monitored the quality of its service provision. At this inspection we found the provider had made improvements in addressing the concerns we previously raised.

People we spoke with told us they were happy with the care and support provided by the service. They said they felt safe in the company of staff and didn’t raise any concerns over their conduct. People said the service was effective in helping them to do more for themselves and achieve independence. People said staff were always kind and caring and treated them with dignity and respect.

Medicines were not consistently managed safely, as there was a lack of information recorded about the medicines staff were supporting people with.

People told us staff supported them safely with equipment and aids. However risk assessment documentation was not sufficiently thorough to demonstrate risks to people’s health and safety had been fully assessed and appropriate control measures put in place.

There were sufficient staff employed to ensure people’s needs were met. Robust recruitment procedures were in place to help ensure staff were of suitable character to care for vulnerable people.

Safeguarding procedures were in place and we saw examples of where they had been followed. Staff we spoke with had a good understanding of how to act on any concerns to help keep safe.

The service was acting within the legal framework of the Mental Capacity Act (MCA). People told us they were supported to make choices about their care and support.

People told us staff had the right skills to care for them. Staff received a range of appropriate training on induction to the service and at regular intervals. Good links were in place with other health professionals to help ensure staff received bespoke training to help support people who use equipment and aids.

The service had a strong focus on developing people’s independence. People we spoke with told us the service was effective in allowing them to do more for themselves.

People told us that their needs were met by staff delivering care and support. However care plan documentation was not sufficiently detailed to provided staff with clear instructions on the care and support tasks required. This meant there was a risk of inconsistent or inappropriate care. There was a lack of information recorded on people’s likes, dislikes and preferences.

Systems we

The inspection visit was carried out by one inspector who visited the agency’s office where they looked at records and spoke with the registered manager, the reablement team leader and the Calderdale Council ‘CQC registered manager,’ who also had responsibility for five other services. After the visit we spoke with five care workers, four people who used the service and two relatives by telephone. At the time of our inspection 29 people were being supported by the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

When we last visited the Support and Independence Team - Lower Valley in March 2014 we found records were not well-maintained and could not be located promptly. We asked the provider to make improvements. We went back on this visit to check whether improvements had been made.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff employed at the service to support people who used the service. However, staff and people who used the service told us staff were often rushed. One relative said, “Sometimes they’re in a bit of a rush but they do all they need to do,” one person who used the service said, “If I’ve asked them to do something extra for me they’ve always done it,” another person said, “They’re always in a rush bless them, they do everything we need though.”

People’s home environments were assessed before they started to use the service to check they were safe and secure. People we spoke with told us they felt safe when care workers visited them in their homes. One person said, “They’re all very nice; every one of them.” A relative said, “In our hour of need they were a godsend.”

This showed us the service people received was safe.

Is the service effective?

All of the people we spoke with told us they were very happy with the care provided by the service and their care and support needs were being met. One person said, “When they started coming I had my shower with them, but I was soon able to do it by myself” and a relative told us, “My husband and I have used this service three times, overall its very, very good.”

We found staff were suitably qualified and had the skills, knowledge and experience needed to meet peoples’ needs.

From our observations and from speaking with staff, people who used the service and relatives we found staff were aware of peoples care and support needs. Weekly review meetings were held to review people’s progress towards achieving independence. One person told us, “I’m managing to get washed and dressed myself now.”

This showed us the care treatment and support people received from the service achieved good outcomes.

Is the service caring?

People who used the service and their relatives told us they were supported by kind and caring staff; they all said they would recommend the service to others.

Care workers we spoke with told us they felt people who used the service received good care and they were happy with the support they received.

People told us, “I’m quite satisfied with them;” “They’re all very nice, every one of them;” “I thought they were all great, very nice people” and “I shall be sorry when they don’t come – I’m on my own all the time.”

This showed us staff who worked at the service were caring and well-thought of.

Is the service responsive?

We saw the team leader and deputy team leader carried out assessments of peoples’ needs - before they started to use the service. This was reviewed on a weekly basis.

Care records showed people’s preferences, interests and diverse needs were taken into consideration and care and support was provided in accordance with peoples’ wishes.

People’s social and emotional needs were also considered and the agency worked closely with other agencies to ensure people were supported to maintain relationships, including their social life and interests.

One care worker told us they had flagged to the managers that a person’s manual handling was not as good as it should be. They said, “The team leader came out with an occupational therapist to look at the issues

This meant the service was organised so that it met peoples’ needs.

Is the service well-led?

We found there was a lack of evidence to show the service had good leadership and governance in place. For example the provider did not have effective systems to assess and monitor the quality of service people received. There was no evidence of continuous improvement in the quality of the service people received.

This meant people who used the service may not be protected against the risks of inappropriate or unsafe care. We have asked the provider to make improvements.

The service had a team manager, who was on leave on the day of our visit. The reablement team leader explained the service to us; they told us the deputy team leader was responsible for producing staff rotas. They said they organised staff supervisions and appraisals, spot checks on staff and staff meetings.

We were shown some records of quality assurance interviews with users of the service. Consultation with users and their relatives about the service provided was not sufficient. We did not see any evidence of quality checks on staff or involvement and communication with people who used the service and their relatives.

When we asked people whether they had any complaints or concerns about the service they all said they had “no complaints.” When we asked people whether they had been asked to give feedback about the services they all said they had not been asked to do this.

Staff we spoke with told us they were clear about their responsibilities and generally felt supported by the team managers. However, they said the service was “In limbo” since changes that had taken place in November 2012. One care worker said, “It would be nice to have something definite in place, it’s worrying not knowing about your job stability. “Another care worker said, “We are all left to our own devices at the weekend. The team leader is alright but we just don’t see enough of them. They are not involved in the day to day running of the service.”

This demonstrated to us that the service quality was suffering due to the lack of a permanent management structure and direction for the staff employed at the service.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at the location at the time of inspection. Their name appears because they were still a registered manager on our register at the time. The Support & Independence Team – Lower Valley is registered to provide support to adults in their own homes so they are able to gain independence after an accident, illness or injury or to help manage long term health conditions.

When we inspected Support & Independence Team – Lower Valley in December 2013, we found the service was not compliant with the regulations relating to requirements relating to workers (outcome 12). We told the service they needed to make improvements.

On this inspection we found the service had made significant improvements, but we found some outstanding issues in this area. We also identified issues with regard to supporting workers (outcome 14) and records (outcome 21).

When we carried out this inspection, we were unable to gain access to all the information we required due to the manager not having access to required electronic systems. We asked the manager to take the necessary steps to gain access to the systems and send the required information to us electronically on the same day. The manager did this.

We found staff personnel files were not always maintained and contained some areas where training had been identified but a record had not been made to show this had been undertaken.

There were effective recruitment procedures in place.

At the time of our inspection, there were 43 people receiving personal care from the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The Support and Independence Team – Lower Valley is registered to provide support to adults in their own homes so that they are able to regain independence after an accident, illness or injury or to help manage long term health conditions..

We spoke with three people and three relatives of people who used the service, all of whom told us that they were happy with the care and support they, or their relative received. One person we spoke with told us "I'm happy, I feel safe and I know what to do if that ever changes."

We also found that people were protected from abuse by policies and procedures that were in place. One member of staff we spoke with told us; “If I had any issues or concerns about safeguarding, I would go straight to my team leader or the manager.” One person we spoke with who used the service told us "I've been given plenty of information and I would know what to do if there was any abuse going on. They're all very good."

We found that people were involved in their own care and support planning, along with their relatives and other relevant agencies. One support worker we spoke with told us "We definitely have input into people's care planning. We are like assessor's ourselves because things change all the time and we need to know what we can do to support that ".

At the time of our visit, there were 23 people receiving personal care from the service.