About the service: J S Parker provides support to people with acquired brain injuries. Professionals refer to the service for assessments of people's needs and assistance in setting up a personal care service in people's own homes. Case managers employed in the service coordinate assessments and support people to recruit their own staff team. The service employs occupational therapists to carry out individual assessments and provide person centred care plans. The service trains and supports staff teams around each person to provide a bespoke service. Reviews of people's on-going needs were carried out.

People’s experience of using this service:

People and their relatives for the most part had a very positive experience of this service. They felt well supported by the case managers and the staff employed to deliver personal care.

We found where agency staff had been engaged, checklists to ensure they were suitable to work in the service had not been used. We made a recommendation about this.

It was drawn to our attention that whilst staff worked out of hours and overnight there was not an on-call service to support staff should they experience difficulties or become unwell. We made a recommendation about this.

Staff told us they felt supported through induction, training, supervision and appraisal. We found there was a supervision policy for staff who were directly employed by the provider. There was also a guidance sheet for staff who were employed by people using the service and who were delivering personal care. These staff were not routinely receiving 1:1 supervision. We made a recommendation about this.

Pre-employment checks were carried out on staff to see if they were suitable to work with people in their homes.

Case managers supported by occupational therapists and other professionals had drawn up person-centred care plans to guide staff providing personal care. Personal risks were identified and steps had been taken to reduce each person's risks. Relatives reported to us that staff engaged with other professionals and took their advice to meet people's needs. Case managers carried out reviews which ensured people's care plans were up-to-date

People's medicines were safely administered by staff who had been assessed as competent to do so.

Staff had been trained in safeguarding and understood how to report concerns.

Accidents and incidents were reviewed by case managers to prevent re-occurrences. Staff understood they were required to report these incidents as soon as possible.

Staff supported people to devise menus, shop for food and eat and drink in their own homes and in the community.

Case managers held team meetings around each person. Staff confirmed they attended these meetings. The minutes of the meetings showed staff were involved in planning people's care.

We checked whether the service was working within the principles of the MCA, whether any restrictions on people’s liberty had been authorised and whether any conditions on such authorisations were being met. Staff understood where restrictions were in place and their role in keeping people safe.

People and their relatives told us staff were kind and caring. They were complimentary about case managers and staff who provided personal care. Relatives spoke with us about staff being respectful towards them. Staff knew people well and told us about people's likes and dislikes. We observed them responding promptly to people's need and providing reassurance. They promoted people's independence.

Relatives told us communication between them and the staff was good. Arrangements were in place to ensure staff were kept up to date with relevant information about people's needs.

People were enabled by staff to participate in community based activities of their choice. Participation was supported by risk assessments and staff helped people maintain their routines.

Quality audits were carried out by the quality team. Actions to improve the quality of

J.S. Parker Limited North East provides a service where care and rehabilitation is managed for people who have suffered an injury, either as a result of an accident, clinical negligence or another traumatic event. Each person has a 'case manager' who ensures that care needs are met and the delivery of care is monitored and adapted. J.S. Parker Limited North East provide care and rehabilitation services to people within their own homes, however, this may initially be in a care home environment.

Our last inspection of the service was in July 2014 when the provider was found to be meeting all of the regulations that we assessed. This inspection took place on the 21 April 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be present at the office to assist with our inspection. The inspection team consisted of one inspector. At the time of this inspection there were 42 people in receipt of personal care from the service.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the service since January 2015. 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 spoke very highly of the staff who supported them and said that they always felt safe in their presence and when they received care from them. Systems were in place to protect people from abuse and there were channels available through which staff could raise concerns. Historic safeguarding matters had been handled appropriately and referred on to either people’s social workers or the relevant local authority safeguarding team for investigation. Staff had been trained in safeguarding vulnerable adults and they recognised their own personal responsibility to report matters of a safeguarding nature.

People’s needs and risks that they were exposed to in their daily lives were assessed, documented and regularly reviewed. Medicines were managed appropriately and policies and procedures were in place support and guide staff. Staffing levels were determined by people's needs and each person had a team of staff who were recruited by the service, specifically to support them. Recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled and physically and mentally fit.

Staff training was well maintained and staff told us they felt supported by the registered manager and provider organisation. Supervisions and appraisals took place regularly as did individual staff team meetings for all each person in receipt of care. Staff told us they felt supported by management and could approach them at any time, about anything.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. There was evidence to show the service understood their legal responsibility under this act and that they assessed people’s capacity when their care commenced and on an on-going basis if necessary. Decisions that needed to be made in people’s best interests had been undertaken and thorough records about such decision making were maintained.

People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and they had continuity of care from the same members of the care staff team whenever possible, which they appreciated.

A complaints policy was in place and people told us they felt both comfortable and confident enough to complain, but they had not needed to do so. People’s views and those

People told us they were happy with the care and support they received from J.S. Parker Limited North East. The service was dedicated to promoting people's independence and rehabilitating people back into the community following an accident or illness. People confirmed that this was always done in a positive way. We found that people's care and support needs were appropriately assessed and their care was planned. One person said, "I am very happy with everything." Another person said "The staff are very good you know, they answer all of my care needs." A relative of a person who received care from the service said, "Without our case manager I would be pulling my hair out. They talk things through with us and keep us well informed."

We found that people felt safe when in receipt of care and staff were aware of their responsibilities in relation to protecting people from harm or abuse. Staff were appropriately trained and the service had adequate systems in place to monitor the quality of the service that it provided. However, although people who received care and support from J.S. Parker Limited North East told us they were happy and we saw they were well supported, we found that failures to maintain records appropriately may put people at risk.

At the time of our inspection there were 35 people in receipt of care from J S Parker Limited North East and a further 16 people received a case management service only, where care was provided by another organisation. Due to their health conditions and complex needs not all people were able to share their views about the service they received. During our visit we spoke with people who used the service and we observed the care they received. We spoke with the regional manager, quality assurance manager, administrative staff, nursing staff, care staff, and relatives of people who used the service. We also reviewed records related to care and the operation of the service.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

We saw that people were supported by attentive staff who displayed patience and gave encouragement when helping people. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required and the relationship between staff and people was good. Those people who could told us that they were happy with the care and support they received from the service and this was supported by the comments that their relatives made. One person said, "They are pretty good. I am happy with the care." One relative told us, "I am happy with everything at the moment thank you and the staff are fine."

People’s diverse needs had been assessed and recorded appropriately in care and support plans developed in line with people's wishes for staff to refer to. Staff displayed knowledge which demonstrated that they were fully aware of people's care and support needs.

Staff told us, and people confirmed that they were supported to partake in activities in the community such as shopping, visiting coffee shops and swimming. This showed the provider promoted people's well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly and there was evidence to confirm this was done. We saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists, speech and language therapy teams or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place. We found that people and their relatives felt confident in raising concerns with the regional manager, or any members of staff who in turn understood their responsibilities to escalate these concerns or complaints.

Is the service safe?

People told us they felt safe in relation to the standards of care and support that they received and in the presence of the staff who cared for them. The care that we observed during our inspection was delivered safely. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.

People's nutritional needs were met appropriately and where there was a need for monitoring their weight, or fluid and food intake, this was done. We saw that where necessary people received input into their care from dieticians and speech and language therapists.

We reviewed the arrangements in place for the management of medicines including how medicines were obtained, stored, administered. We found that these arrangements were both appropriate and safe. Staff with responsibility for medication administration had been appropriately trained.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care providers. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The regional manager confirmed they will be contacting the relevant local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for one person in their care who requires a DoLS application to be submitted and assessed.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "I am happy with the care." Another person told us, "Everything's great." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

People who could told us they felt involved in their care and all of the relatives we spoke with told us they felt fully informed about their relation's care needs. One relative told us, "We talk about things and change things if need be. They discuss everything with me."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored the care that staff delivered.

Staff told us they were clear about their roles and responsibilities and they had a good understanding of the ethos of the service. The provider had a range of policies and procedures in place which gave direction and instruction to staff. A number of audits were carried out regularly, and the views of people and their relatives were gathered at set intervals to ascertain their opinions of the service they received. This showed the provider measured the effectiveness of the service they delivered and sought to protect people's welfare.