The inspection took place on 16, 17 and 25 May 2018 and was announced to ensure that the management team and people using the service would be available during the inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and supported living homes. It provides a service to children, young people, adults and older people, with physical disabilities and a wide range of diagnoses and health needs. Active Assistance provided support with personal care to 392 people across the country when we inspected. Active Assistance has a registered office in Sevenoaks and five regional managers based across the country. The regional managers have care service managers and personal care assistants who support people who use the service. All paperwork and information is sent to and stored in the Sevenoaks office.

At the time of our inspection there was a registered manager at the service. 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 being kept safe from abuse. Staff understood their responsibilities in keeping people safe from abuse and had been trained to know how to report any possible concerns. People were supported safely around risks and were encouraged to take positive risks after control measures were applied. Staffing levels met people's needs safely and people told us that they had staff to support them when they needed it. There were emergency plans in place for people living at home who required staff to meet their medical needs.

People received their medicines safely and when they needed them by staff trained to administer them. The risk from infection was reduced by effective assessment, training and the provision of personal protective equipment. When things went wrong the service had learned from these and had shared that learning with staff teams.

People had received an assessment of their needs and their needs were tracked though care plans to ensure effective outcomes were achieved. Staff had the necessary skills and competencies to support people and had been trained in key areas such as safeguarding, moving and handling, and food safety as well as in additional areas that met people’s needs, such as catheter care. Staff were supervised effectively and had annual appraisals

People received enough food and drink to maintain good health. Staff worked in partnership to provide consistent support when people moved to or from the service. People had access to healthcare professionals and were supported to maintain good health. Staff responded in a timely way when people were unwell and medical guidance was followed correctly.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked and valued their staff. People, and where appropriate, their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to maintain their independence as safely possible.

There was a complaints policy and form, available to people. Complaints had been utilised to improve the service. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams.

The inspection was announced and was carried out on 01and 02 September 2015 by two inspectors.

Active Assistance is a domiciliary care agency. They provide specialist services for adults and children with physical disabilities. They specialise in supporting people living with spinal cord or brain injury and people with progressive and neurological conditions such as Multiple Sclerosis, Motor Neurone Disease and Muscular Dystrophy. They employ a nursing team and therapists who supervise the service they provide to their clients. The service operates nationwide and their headquarters are situated in Sevenoaks.

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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The provider followed safe recruitment practices.

Each person’s needs and personal preferences had been assessed before support was provided and were regularly reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff knew each person well and understood how to meet their support needs. People told us, “They [staff] know me well; they know when I need my own space; We get on with our lives and they are there when I need them.”

Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

All care staff and management were knowledgeable in the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation.

Staff sought and obtained people’s consent before they provided support. People told us that staff communicated effectively with them, responded to their needs promptly and treated them with kindness and respect. People were satisfied with how their support was delivered.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People’s privacy was respected and people were supported in a way that respected their dignity and independence.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual support plans, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

People’s individual assessments and support plans were reviewed regularly with their participation. People’s support plans were updated when their needs changed to make sure they received the support they needed.

The provider took account of people’s comments and suggestions. People’s views were sought and acted upon. The provider sought and obtained their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the manager’s leadership. The manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and remedial action was taken when necessary.