About the service: Acute Need CIC is a Domiciliary Care Agency located in St. Helens, Merseyside. The service provides care and support for up to five adults with complex needs due to an acquired brain injury. Support is provided to people in their own homes.

People’s experience of using this service:

People were supported to live enriched lives and did what they chose. Staff encouraged them to be as independent as possible whilst ensuring they remained safe. A proactive approach was taken to anticipating and managing risk to people to ensure they remained safe. People were encouraged and supported to take positive risks to allow for an unrestricted and meaningful life. Staff showed an excellent understanding of their roles and responsibilities for keeping people safe from harm. Medicines were managed safely and people received medication at the right time. People told us they felt extremely safe whilst being supported by staff and felt able to live a safe, fulfilled life.

A holistic approach had been adopted in the assessing, planning and delivery of people’s care and support. Care plans were extremely detailed and identified intended outcomes for people. Staff provided excellent care and support that was met in a way people preferred and provided consistent and positive outcomes that exceeded expectations. Staff worked hard to provide a consistently better quality of life for people by supporting them to develop in areas such as communication, social interaction, education and independence. People spoke highly of the support provided and told us how they had achieved improvements in their own abilities, independence and confidence.

People and family members spoke enthusiastically about how consistently kind and caring staff and managers were. Staff were highly motivated to provided a person-centred culture and delivered care in a kind and compassionate way that was based on people’s preferences. The management team and staff had developed strong familiar relationships with people and family members and were described as ‘going above and beyond’ in order for them to live an excellent quality of life. People and family members told us staff had become more like friends and family and spoke highly of the support they provided not only to people but those close to them.

The leadership of the service demonstrated a high level of experience and capability to deliver excellent care; they were extremely knowledgeable and inspired confidence and passion in the staff team. They promoted a culture that was extremely person-centred and inclusive and which provided high-quality care with good outcomes for people. The management team placed strong emphasis on the importance of not only supporting people but their family members also. They were described as supportive and approachable and always putting the needs of people first. They showed a continued desire to improve on the service and worked closely with other agencies and healthcare professionals to do this. Effective systems were in place to check on the quality and safety of the service and improvements were made when required.

Rating at last inspection: Good (report published 17 March 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved on the quality of care provided and has been rated outstanding overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an announced inspection of the service on 18 January 2016. The last inspection took place on 6 February 2014 during which we found there were no breaches in the regulations.

Acute Need CIC is a Domiciliary Care Agency located in St. Helens, Merseyside. The service is registered with the Care Quality Commission for the regulated activity of personal care .The agency currently employ staff to provide care and support to five people who live in their own homes across the Merseyside area. The amount of support people receive varies depending on the person’s individual needs.

There is a registered manager at Acute Need CIC. 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.

The registered manager has managed the service since it commenced in 2008. He was knowledgeable and inspired confidence in the staff team. Both he and the registered provider had a proactive approach to developing a positive culture in the service.

Staff were recruited in a safe way and full employment checks were completed before they started work in the service. Staff were well trained. They also had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills and knowledge. We saw that staff had competed safeguarding training and knew what to do to keep people safe from abuse or harm. There were policies and procedures available for additional information and guidance.

We found people’s care was delivered safely and in a way of their choosing. They were supported in a manner that reflected their wishes and supported them to remain as independent as possible.

People praised the staff for their kindness and consideration and were happy with the care and support they received.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) legislation. Documentation on people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. We saw information to show that the service understood their responsibilities as a domiciliary care agency and would make an application to the court of protection if people were thought to be deprived of their liberty. They did this to make sure that people’s legal rights were protected. Staff worked with other health care professionals when ‘best interest’ decisions had to be made on behalf of people using the service.

We observed the culture of the service was one of openness and sound values based on putting the people who used the service at the centre of the services they provided. There was a quality monitoring system to enable checks of the services provided to people and to ensure people were able to express their views so that any improvements identified could be addressed.

The registered manager was seen as a good leader by both staff and people using the service. He was trusted and had created a strong sense of commitment to meeting people’s diverse needs and supporting staff.