Community Solutions (part of Harrow Mencap) is a domiciliary care service which provides 24-hour respite support and personal care to people with learning disabilities living in their own home. The service runs also summer holiday activity scheme, day services and befriending service. On the day of our inspection Community Solutions (part of Harrow Mencap) provided care and support to five people.

At the last inspection on 4 June 2015, the service was rated Good.

At this inspection we found the service remained Good.

People were protected from harm and abuse and care workers demonstrated understanding of how to recognise different forms of abuse and how to report these. Risks in relation to treatment and care provided were assessed and robust risk management plans ensured that identified risks were minimised. The provider followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs had been met. Where people received support in taking their medicines appropriate procedures were in place and followed.

Care workers had access to a wide range of mandatory and specialist training and received appropriate support to carry out their duties. People had been supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible. The policies and systems in the service supported this practice. Where people received support at meal times this was clearly documented to ensure people’s choices and needs had been met.

The service ensured that a stable base of care workers provided support to people, which ensured consistency and professional relationships were maintained. People were consulted in all aspects of their care.

Care plans were of good standard and reflected people’s needs as well as people’s wishes how they required their care to be carried out. People told us they were confident to raise concerns with the agency and felt that they were listened to.

People who used the service and care workers told us that Community Solutions (part of Harrow Mencap) had been well managed. They told us that the manager and registered manager were accessible, listened to their suggestions and provided support as and when needed. Care workers told us that team work was strength of the agency and staff were able to rely on each other.

Further information is in the detailed findings below.

This inspection took place on 4 June 2015 and was announced, which meant we told the provider 48 hours in advance that we would be coming.

At our last inspection in August 2014 the service was not meeting one of the regulations we looked at. These were related to safe management of medicines. At this inspection we found that the service was now meeting this regulation.

Community Solutions is part of Harrow Mencap. The agency provides personal care for children, young adults and people with learning disabilities living in their home or with their parents. The agency also provides escort services to accompany people to their chosen activities and organise person-centred activities. Currently the agency provides personal care to 15 people, which includes two live-in care workers. The agency has fifty personal assistants employed. This number increases during school holidays, during which the agency organises holiday activity camps for people with learning disabilities.

At the time of our inspection 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 told us they were well treated by the staff and felt safe and trusted them.

Staff could clearly explain how they would recognise and report abuse and they understood their responsibilities in keeping people safe.

Where any risks to people’s safety had been identified, the management had thought about and discussed ways to minimise risks with people.

People told us that staff usually came at the time they were supposed to or they would phone to say they were running a bit late. They also confirmed that if two staff were required they would come at the same time.

The service was following robust recruitment procedures to make sure that only suitable staff were employed at the agency.

Staff we spoke with had a good knowledge of the medicines that people they visited were taking. People told us they were satisfied with the way their medicines were managed.

People who used the service and their relatives were positive about the staff and told us they had confidence in their abilities. Staff told us that they were provided with training in the areas they needed in order to support people effectively.

Staff understood that it was not right to make choices for people when they could make choices for themselves. People’s ability to make their own decisions, preferences and choices were recorded in their care plans and followed by staff.

People told us they were happy with the support they received with eating and drinking and staff were aware of people’s dietary requirements and preferences.

People confirmed that they were involved as much as they wanted to be in the planning of their care and support. Care plans included the views of people using the service and their relatives. Relatives told us they were kept up to date about any changes by staff at the office.

People and their relatives told us that the management and staff were quick to respond to any changes in their needs. Care plans reflected how people were supported to receive care and treatment in accordance with their needs and preferences.

People told us they had no complaints about the service and said they felt able to raise any concerns without worry.

The agency had a number of quality monitoring systems including annual surveys for people using the service, their relatives and other stakeholders. People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They felt the service took their views into account in order to improve service delivery.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with four people who used the service, four relatives and eight staff including the manager. We also reviewed records relating to the management of the service which included the care records of six people who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People’s care files contained a comprehensive risk matrix and related risk assessments. These included risks regarding accessing the community, using transport, challenging behaviour or falls. We saw actions staff needed to do were identified in order to reduce the risks and to ensure people’s needs were met as safely as possible. We saw the care records were signed by staff who were allocated to support them acknowledging that they read the plans. Staff we spoke with said they read people’s care plans prior to supporting them and “I wouldn’t support anyone without knowing their needs.”

There were arrangements in place to deal with foreseeable emergencies. There was a missing person’s procedure in place which included the actions staff had to take when the person who they visiting to support was not found at their home. Staff also had emergency first aid at work training and relevant emergency and other contact details were recorded in people’s care plan.

There were effective recruitment and selection processes in place as staff personnel records showed that they had been subject to appropriate and necessary checks prior to being employed by the service.

People were not fully protected against the risks associated with medicines because the provider did not have all the appropriate arrangements in place to manage medicines.

Is the service effective?

People who used the service had varying levels of difficulties to express their views to us verbally with regards to the quality of the care and the support they received. We spoke with four people who used the service and they all told us they were happy with staff and the way they were supported. We also spoke with four different people’s relatives who said “Everything is excellent”, “Very satisfied (with the service)” and “Its’ excellent.” They said they had no complaints and had “no issues whatsoever.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at seven people’s care records that showed their needs were assessed and a care plan was written prior to the commencement of the service. Records showed home visits, spot checks and monthly monitoring calls were carried out to ensure staff provided care in line with people’s care plans.

Is the service caring?

People who used the service expressed their views and were involved in making decisions about their care and support. Staff told us people had the opportunity to raise any issues with staff who supported them on a daily basis during their visits or when the ‘field supervisor” carried out home visits or spot checks on a regular basis. Records showed that people and/or their representatives were called on the telephone to obtain their feedback regarding their support. We saw it was checked whether people were happy with staff who supported them, asked if they had any concerns and any new information about the person and their needs were recorded. People’s care plan had also been reviewed on a six monthly basis.

People's diversity, values and their rights were respected. We found that people who used the service had various cultural backgrounds, disabilities and communication difficulties. The care plans contained information regarding people’s communication needs and how best to support them. We were told by the manger that interpreters or advocates were involved when it was necessary. We were also told that issues regarding people’s rights, dignity, equality and diversity were discussed as part of the every staff’s induction. Staff were also given a handbook that provided further details regarding what was to be considered when they provided support to people in order to ensure professional standards in providing care.

Is the service responsive?

People’s care files contained their one page profile, weekly schedule and their individual support action plan including the required support, desired outcomes, likes/dislikes and communication needs. We found the plans were kept up to date by evaluating and reviewing them on a six monthly basis.

We found that the service took account of complaints and comments to improve the service. We saw another log about the complaints that were raised to the service. Most of these related to staff and the outcomes were to address the issue with he staff directly and to allocate different staff to provide the required support in the future. A log was also kept about any compliments and these were said to be shared with the involved member of staff accordingly.

Is the service well-led?

The service had a system in place to assess and monitor the quality of its service. We were told by the manager that a quality improvement plan was being implemented. We saw new records regarding the recording of home visits, spot checks, telephone monitoring calls that became the responsibility of the recently recruited field supervisors as part of the improvement plan. Records showed home visits, spot checks and monthly monitoring calls were carried out. We saw people and their relatives were asked for their views about their care and whether they were satisfied with the service they received. Staff’s performance was also monitored through supervisions, monthly group supervisions and appraisals which was confirmed by staff we spoke with.

There was evidence that learning from accidents and incidents took place and appropriate actions were implemented.

Staff told us about their job “I love it”, “I like the amount of variety” and “it’s a very fun place to work with a strong emphasis on quality care.” They also said “It’s fun and vibrant; not easy but it’s very rewarding” and “I think it’s a happy and welcoming place to work.”

We spoke with two people who used the service and with four families who used the service for their relatives. We were told by families and people who used the service that they enjoyed their time with the staff. One person who used the service told us, "staff always ask me what I would like to do".

One relative described the service as being, "Well organised and always helpful". Another relative told us that, "The service has good care assistants who work well with my child". One person told us that they could always make use of the communication notebook if there were any problems and how they valued telephone calls from the office.

People's care and support needs were identified in conjunction with each person and their family. Staff ensured that people were given information which helped them to make decisions and to give consent.

There were arrangements in place to ensure that people were cared for in a safe environment and staff had been trained in safeguarding vulnerable people. Staff were supported to develop their skills in order to look after people using the service safely and effectively. Staff had supervision and feedback on their performance.

There were systems in place which enabled the provider to monitor the quality of its services.

We spoke with 4 people who use the service, or their relatives, and 3 care workers. People using the service told us that they felt safe with their care staff and they were given the care and support they needed.

People’s comments included “the carer is brilliant, I couldn’t ask for better support” ” and “we get the same person each time and they make sure we are OK.”

The care needs of people using the service were assessed and clearly recorded in their care plans. Risk assessments were completed to make sure that people were cared for safely. The agency had thorough recruitment policies and procedures to make sure that all required pre-employment checks were carried out. This meant that people using the service were cared for and supported by suitable staff.

The agency had clear procedures for responding to complaints.

People who use the service told us that they were happy with the support they received from the agency. They said that their support workers treated them with respect and described them as “kind” and “very good”. They told us that their support workers always arrived on time and helped them to take part in activities they enjoyed.

Relatives of people who use the service provided positive feedback about the support provided by the agency. One relative told us, “They work very well with her. We asked for a same gender carer, which they were happy to provide. My daughter and her carer get on very well; they have a lot in common”. Another relative described the support workers provided by the agency as “very good, very competent”.

Care managers from local authorities that commission the service told us that the agency supported their clients well. One care manager told us, “My experience of the service is very good. They support our clients very well. They promote independence and get people out and about in the community. The care workers know what they’re doing – they undertake training and they understand people’s needs”.

Another care manager said, “It’s a fantastic service. From the beginning it’s been very impressive. They’ve engaged Gujarati speaking staff and involved her family. They’ve got her going out, which she never did before. She’s doing two or three things a week now, which is fantastic for her”.