This inspection took place on 8 and 10 November 2016 and was announced. We had previously carried out an inspection of Barnardo’s Disability and Inclusion Support Service in January 2015 and found breaches of legal requirements. We then inspected the service in November 2015 and found the provider had taken action to meet the legal requirements in relation to staff training and the governance of the service.

At this inspection we judged that the necessary improvements had been sustained and have changed our rating of the service.

Barnardo’s Disability and Inclusion Support Service provides short and longer term services which include provision of personal care to children and young people with disabilities and support to their families. At the time of our inspection services were being provided to 13 children under 18 years old.

The service had a registered manager. 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.

We found the care and support of the young people was well-planned to protect their personal safety and welfare. The service took steps to reduce risks and make sure that care was safely provided both in and outside of the home. Established processes were in place for preventing abuse and reporting any safeguarding concerns.

A thorough recruitment process was undertaken to ensure new staff were properly checked and vetted before they were employed. There was enough staffing capacity to deliver and co-ordinate the care services. Each person and their family had their own allocated sessional and project workers for continuity of care and communication.

The staff were supervised and given appropriate training to enable them to provide effective care. Staff worked closely with families and other professionals in supporting young people, where required, with their health needs. Suitable arrangements were made for managing medicines.

Wherever possible, services were provided flexibly to accommodate individual needs and requests. A proactive approach had been adopted in monitoring staff performance and obtaining feedback about people’s care experiences. There was a good level of satisfaction with the service and no complaints had been received.

Staff were given sufficient time and information to provide the support needed. Supportive relationships had been developed and we were told workers were caring and respectful. Care was taken to offer choices and promote the young people’s dignity and independent skills.

Care plans were personalised, agreed in consultation with the family and regularly reviewed. The service supported many of the young people to participate in social activities and access the community.

The management team provided leadership to staff and worked in partnership with the young people, their families, and other stakeholders. Structured methods to continuously assure and improve the quality of the service had been developed.

We carried out an unannounced comprehensive inspection of this service on 12, 13, 19 and 23 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staff training and governance of the service.

We undertook this focused inspection on 26 November 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barnardo’s Disability and Inclusion Support Service on our website at www.cqc.org.uk.

We found the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

Barnardo’s Disability and Inclusion Support Service provides a range of short and longer term services that include provision of personal care to children and young people with disabilities and support to their families. At the time of our inspection the service was supporting 39 children and young people.

A registered manager was in post at the time of the 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. The registered manager was taking planned absence and an acting manager was managing the service in the interim.

We found improved measures were now in place for staff to receive appropriate training that enabled them to meet the needs of the people they supported. The management team had taken action to ensure evidence of completed training could be more readily demonstrated.

Arrangements had been made to further develop management support and communication. There was a more structured system for monitoring the quality of the service to make sure that standards were being maintained.

We found that appropriate arrangements were now in place to safely support children and young people to take their prescribed medicines.

At the time of our inspection the service was providing personal care to children and young people in their own homes and during holiday schemes. We found that this care was well planned to meet their individual needs and give support to their families. We talked with a parent and two professionals who had experience of the service. They spoke highly of the care, the support staff, and how the service was managed. They told us, “The support workers have been great”; “My daughter is so very happy and the staff are lovely”; and, “They have, at times, delivered exceptional services".

Staffing was properly organised and enabled the children/young people to have consistent care from their own dedicated workers. Support workers were skilled and trained to provide care in a safe way. But appropriate arrangements had not been made to make sure workers were trained and competent in handling medicines safely. We were given assurance that action was being taken to address this during our inspection.

There were systems for checking the quality of the service, including getting people’s views of how the service could be improved. A clear procedure was also in place for making complaints, and any concerns were taken seriously and investigated.

During this inspection we had contact with parents of children who use the service. They told us they were involved in care planning and were happy with the care provided.

The support workers we spoke with told us they were provided with plenty of training, including training specific to individual’s care needs, and said they were well supported by management.

We also received positive feedback from some of the Local Authorities that commission services. Comments included, “Barnardo’s work in partnership with us as the Local Authority to try to ensure the very best outcomes for children and young people they work with”.

We undertook an announced inspection of Barnardo's Disability and Inclusion Support Service (NE region) on 12, 13, 19 and 23 January 2015. We last inspected the service in October 2013. At that inspection we found the service was meeting the regulation we inspected.

Barnardo's Disability and Inclusion Support Service (NE region) provides a range of short and longer term services, which includes the provision of personal care to children and young people with disabilities and support to their families. These services include personal support , community outreach and short break services, crisis intervention and mediation services and holiday schemes, throughout the North East of England. This allows children and young people to live their lives in their own homes and within their own communities.

The service had a registered manager who had been in post since July 2012. 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found shortfalls in how the quality of the service was monitored and staff did not always receive training they required. You can see what action we have told the provider to take at the back of the full version of this report.

One parent we spoke with told us, “(Support worker) deserves a medal for all they do. We’re very happy with the service and the level of support. I have no concerns at all over safety.”

There were safe and robust recruitment procedures to help ensure that people received their support from suitable staff. People had confidence in the service and felt safe and secure when they received their support.

Staff we spoke with were able to tell us what they would do if they suspected abuse, or that someone was at risk. There were effective processes in place to help ensure children were protected from the risk of abuse and staff were aware of safeguarding children procedures.

Staff had access to information relating to medicines and detailed policies were accessible.

Support workers and parents of children who were supported by the service told us that the provider’s current staffing levels were low. This meant that if their usual support worker was absent, then replacement cover was not usually available.

We found there were gaps in the provision of training for all staff. This meant people were at risk of unsafe working practice from staff who did not have the skills and knowledge to consistently meet their need. Some staff had not received, or were overdue medicines and emergency first aid training. Staff told us, and records we examined showed that regular supervisions and annual appraisals were being carried out.

The service were starting to take on young adults for support. They identified the staff needed further training on the Mental Capacity Act 2005 (MCA) and how this would apply to people and the service. We saw the registered manager and the senior permanent staff members were scheduled to attend a local MCA training session. As a result, a MCA training plan would be developed for other support staff.

Where required, children were supported to make sure they received food and drink which met their nutritional needs.

Parents of children currently using the service gave positive feedback about the care provided and the staff who provided their support. They also told us staff treated them with dignity and respect.

Staff were knowledgeable about the children they supported. They were aware of their preferences and interests, as well as their health and support needs. This enabled them to provide a personalised service. Support staff we spoke with confirmed they received equality and diversity training. Staff also told us that they were able to build caring relationships with people by supporting them to take part in activities important to them.

A complaints policy and procedure was in place. People told us they felt able to raise any issues or concerns. However, parents told us they had not received any information about how they would make a complaint, or a copy of a complaints procedure. Two previous complaints received had been had been dealt with efficiently. We noted the service had recently received a number of compliments.

Detailed care support plans were in place outlining the children’s care and support needs. Staff were knowledgeable about people’s support needs, their interests and preferences in order to provide a personalised service. However, we noted updates and changes made to them were unnamed and not dated.

The service had a registered manager, however quality monitoring systems currently being used did not always ensure the service was operating safely and effectively. Frequent and effective quality assurance audits were not being undertaken.

Support staff who were regularly based at the provider’s head office told us they appreciated the registered managers’ open-door policy and said they felt very well supported. Support staff who were not based at the provider’s main office told us they had limited contact and communication with managers. Therefore they did not always feel adequately supported.

Younger adults using the service and their parents were consulted about the service they received. This was done by means of a quality questionnaire, to obtain their views and feedback on important issues. People were satisfied and positive with the overall service provided.