Voyage DCA (East 2) is registered to provide care and support to people living in their own homes. On the day of our inspection the service was supporting 150 people with learning difficulties across Norfolk.

There was 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.

People’s feedback about the safety of the service showed that staff had a high level of understanding of this whilst understanding the importance of people remaining independent and able to challenge themselves. People were supported by staff who understood safeguarding procedures and were able to recognise the signs of potential abuse.

Risks to people had been thoroughly assessed and innovative plans put in place to manage these risks while enabling people to live their lives without unnecessary restriction and in the manner they wished.

Robust recruitment procedures had been followed to reduce the risks of employing staff unsuitable for their role. There were sufficient numbers of staff deployed to meet people’s needs. Staff received comprehensive training to enable them to meet people’s care and support requirements.

People were given support to take their medicines as prescribed and medicines were stored and managed safely.

People’s nutritional needs were met and they were supported to access healthcare services if they needed them. People’s health needs were closely monitored and any changes to their needs were immediately reflected in their care plans and the care that they received. The service worked in collaboration with the people who used the service and healthcare professionals in order to ensure people’s wellbeing and quality of life was not only promoted but improved.

The manager and staff had a solid understanding of the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance. People were fully involved in the decision making process and, where required, best interests decisions were made with appropriate others.

People were supported by staff who showed respect and cared for them as individuals whilst maintaining their dignity. People were encouraged to make their own decisions where possible and their consent was sought appropriately. Staff understood the importance of people being in control of their own lives and realising their ambitions and wishes.

People and those important to them were involved in planning their care and agreeing how it was delivered. People’s independence was promoted and their care was delivered in the way they wished by staff who were knowledgeable about their needs, wishes and preferences. Care and support was delivered in a respectful and highly personalised way.

People who used the service and staff who supported them were able to express their views on the service and actively encouraged to think creatively in order to improve the service. People were supported to make complaints and were confident that these would be heard and acted upon. The service maintained good communication with people who used the service and their families.

People were supported to pursue a wide range of leisure activities of their choosing and to maintain contact with their families and other people important to them where they chose to. With the assistance of staff, plans were put in place and actioned to help people meet their wishes and aspirations.

The manager had an excellent overview of the service and regular in depth audits were carried out to monitor the quality of the service. Their approach was one of innovation, commitment and dedication. People described the manager as exceptional.

The service promoted a clear and delivered ethos of promoting the independe

During our inspection, we spoke with two people who used the service, eight relatives, five staff members and the registered manager. The majority of people and relatives told us that they were happy with the service. One person told us, “I am very happy with my care.” Another person said, “I am happy where I live.” A relative told us, “X gets wonderful support.” Another relative said, “It’s been brilliant.” A further relative said, “I can always ask for extra hours for X, it’s no problem with some notice.”

The service carried out an assessment of people’s needs before they used the service. Risk assessments were in place to ensure that people’s day to day living was safe.

Recruitment checks on staff members had been carried out before they commenced employment with the service. We found that staff had been trained to deliver safe and effective care.

There was an effective system in place to monitor the quality of the service provided.

People told us that the service was responsive to their feedback and any complaints they had made. An effective system was in place to monitor complaints. Records were available for inspection when required. These were in the main, accurate and up to date.

We spoke with four people who used the service and six relatives. People who used the service said they were happy with the care and support provided by the service. Comments included, "They (care workers) are kind to me and help me to go night clubbing and shopping" and "I am happy with the service, they (care workers) are helping me to be more independent."

A relative told us, "We did have a problem with staff not turning up on time but after speaking with the manager this got sorted out and now we don't have a problem."

We observed that staff were caring and understood the needs of the people they were supporting. This meant that the needs could be met.

During this inspection we found shortfalls in the management monitoring the quality of the service. The service did not have robust mechanisms in place to ensure that important decisions in relation to the provision of care and treatment for people who used the service were taken at the appropriate level. This meant that people using the service could not be assured that there was someone in overall control of the service who could identify risk and make decisions that protect the health, welfare and safety of people.

We spoke with four care staff. Two staff recently employed by the service told us they had received induction training which included mandatory training in safeguarding people from abuse, equality and diversity and first aid.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with eleven people who used the services, four relatives of people who used the services and eight staff members. In addition we looked at four people's care and support plans.

Is the service safe?

Risk assessments were in place to ensure that as far as possible people were safe in their homes and that staff were safe in their working environments. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with ongoing support and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs.

Is the service caring?

People we spoke with said that staff treated them with respect and consideration. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing the care.

We observed that staff were kind and caring in their interactions with people.

Is the service responsive?

The provider had a system of dealing with complaints. We found that people’s complaints had been dealt with in a timely manner. There were two outstanding complaints which were going through internal investigation at the time of the inspection.

People told us that the provider responded to their changing needs in a timely manner.

People who used the services and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

At the time of the inspection the provider was in the process of moving from a semi paper based quality assurance system to a fully computerised one. This meant that all of the provider’s sites would have access to the same system for information gathering and sharing.

All of the people using the services that we spoke with said the care and support provided was consistent and of good quality. From our observations we saw that care and support was effective and consistent.

We saw that staff knew the people they were supporting and caring for and that the people receiving the care and support were happy. We noted that if something was not right that staff moved quickly to resolve matters.

Is the service well led?

The agency was well managed. Although the regional manager had a large number of sites to manage there was a good relationship in place across the management structures to support people using the services. Managers demonstrated a good knowledge of the provider’s sites, supporting staff and of people using the service.

Views of people using the services and of their families were obtained and opportunities were in place for social gatherings where further views and opinions of the services, and staff, could be gained.

Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged.