At the last comprehensive inspection in March 2016, the service was rated Good.

At this announced inspection on 22 April and 2 May 2018, we found the service remained 'Good'.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last comprehensive inspection.

Age UK Northamptonshire provide dedicated support to people who are thought to be in the last eight weeks of their life and who wish to die in their own home. At the time of our inspection the service were supporting 14 people.

Staff had a good understanding of what safeguarding meant and the procedures for reporting abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by the registered manager. Staffing levels were sufficient to meet people's current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Staff were trained in infection control, and supplied with appropriate personal protective equipment (PPE) to perform their roles safely. Arrangements were in place for the service to reflect and learn from complaints and incidents to improve safety across the service.

People’s needs were assessed and their care was provided in line with up to date guidance and best practice. People received care from staff that had received the right training and support to carry out their roles. Staff were well supported by the registered manager and one to one supervisions and observations of their practice took place.

Staff supported people with dietary choices to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals and worked in partnership with other organisations to ensure that people received coordinated and person-centred care and support.

People's consent was sought before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice

Staff treated people with kindness, dignity and respect and spent time getting to know people. People were happy with the way that staff provided their care and support and they were encouraged to make decisions about how they wanted their care to be provided.

People were listened to, their views were acknowledged and acted upon and care and support was delivered in accordance with their assessed needs and wishes. Records showed that people were involved in the assessment process and their on-going care reviews. There was a complaints procedure in place to enable people to raise complaints about the service.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and any improvements identified were worked upon as required.

The service had an open culture that encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems to review all aspects of the service to drive up improvement.

This announced inspection took place on the 2, 9 and 10 March 2016. Age UK Northamptonshire provide dedicated support to people who are thought to be in the last eight weeks of their life and who wish to die in their own home. At the time of our inspection the service were supporting 12 people.

There was a registered manager in post at the time of our inspection. 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 had care plans that were personalised to their individual needs and wishes. Records contained detailed information to assist care workers to provide care and support in an individualised manner that respected each person's individual requirements and promoted treating people with dignity.

Relatives told us that they felt their relative was cared for safely in their own home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staff understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005.

Staffing levels ensured that people received the support they required safely and at the times they needed. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home.

People received care from staff that were kind, caring and compassionate. Staff had the skills and knowledge to provide end of life care and were supported by a management team which was receptive to ideas and committed to providing a high standard of care.

The registered manager was approachable and had systems in place to monitor the quality of the service provided. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

Our inspection was carried out by one inspector who visited the service. During the inspection we sought answers to five key questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with staff and the registered manager, looking at records and talking to people who used the service.

Is the service safe?

People were treated with respect and dignity by the staff. The provider had a recruitment system to make sure all staff had appropriate checks before starting work at the service. Staff training had also been improved to make sure staff met people’s needs in a safe way. The provider had introduced an assessment of needs to make sure any risks relating to people’s care were identified before they started to use the service.

Is the service effective?

People and their relatives told us they were happy with the care received and that this met their individual needs. The service worked closely with other providers to make sure people received joined up care that met a range of needs.

Is the service caring?

People were supported by kind and attentive staff. People and their relatives told us that staff were of a caring nature. One person said “I am very happy with the care, staff are caring and polite”. A relative of a person who used the service told us that the staff had provided sensitive and individualised care to their family member. They told us the staff always involved their family member in any decisions about their care and understood their family member’s preferences for care.

Is the service responsive?

People told us that staff were responsive to a range of their individual needs. The provider had undertaken a satisfaction survey in order to find out whether people were happy with the care provided by the service and had taken appropriate action to make improvements to the service where required. Staff told us how they responded to people’s needs and worked with provider’s to make sure people received responsive care. This included liaising with nursing services when people required additional pain relief.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. Staff had a good understanding of the ethos of the service which was to provide good quality care and that there were quality assurance processes in place. This helped to ensure that people received a good quality service at all times. Staff were responsible for completing a range of spot checks to make sure basic standards such as infection prevention control were being adhered to. Staff told us that the registered manager reviewed this information and took the necessary action to resolve any concerns and improve the service. Staff told us that the registered manager expected high standards of care to be maintained at all times.

We conducted a compliance review at Age Concern Northamptonshire in May 2012 and found that the provider was not meeting outcome 16: Assessing and monitoring the quality of service provision. We went back to the service to review the improvements that the provider had made on 3 September 2012.

On the day of the visit we were unable to speak to people using the service about their experience of using Age Concern Northamptonshire. Instead we reviewed the improvements the provider had made to the system for assessing and monitoring the quality of service provision.

We spoke with five people using the service who were all pleased with the care and support they received. They told us that the staff were very caring and that they made a huge difference to their lives.

One of the people told us that they were completely satisfied with the service. They told us that to begin with they were worried about having carers to stay over night; however the staff were so good that they were soon reassured about this. They told us that the staff could not do enough to help them and that they would recommend the service to anyone.

Another person told us how the staff acted in a professional manner and came across as being well trained. They also told us that the staff looked after them really well and that the care had been, “a wonderful experience”.

Although people had a positive experience of care and support, we found some concerns in relation to the arrangements for assessing and monitoring the quality of service provision.

We spoke with two people and two relatives of people who used the service. We also spoke with four members of staff and the registered manager. We spoke with four health professionals who worked for other providers and provided care in co-operation with Age Concern Northamptonshire.

The people and relatives we spoke with told us that the care provided by Age Concern was very good. One person told us “They are a lovely team and are very well trained”. One relative told us that the staff were “respectful” and explained everything to their family member.

People and their relatives also told us that they knew how to make a complaint and that they were confident the service would deal with their complaint seriously. Four health professionals told us that the care provided by the service was of a high standard. However, some health professionals told us that sometimes staff did not have enough information about people’s requirements.

We found that people gave their consent for the care they received. We also saw that the provider had a complaints system to ensure that people’s complaints were dealt with appropriately. We found that the service had procedures in place to prevent infections spreading while delivering people’s care. We had some concerns that staff had not received enough training to meet people’s needs. We also had concerns that people did not receive a formal assessment of their needs before they started to use the service.