This inspection took place between 29 March and 10 April 2018. The provider received short notice of the inspection.

Keyfort North West is a domiciliary care service. It provides personal and nursing care to people living in their own homes in the community who have a significant physical, neuropathic and complex care needs. The office is located near Carlisle but it provides support across the county of Cumbria. There were 15 people using the service at the time of this inspection. The service also provides a social, community-access service for several other people. CQC only inspects the service being received by people provided with the regulated activities of personal and nursing care.

At the last inspection of Keyfort North West (formerly known as Neuro Partners North West) in March 2016 we found the provider had breached two regulations. These related to the lack of contingency arrangements in place to cover unexpected absences of staff and the lack of access by management staff to current records about people’s care needs.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good. During this inspection we found improvements had been made to both areas, although we have made a recommendation about making continuing improvements to contingency staffing arrangements.

There was a registered manager in place at the service. 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 said they felt safe and comfortable with their support staff team. Staff were trained and confident in how to report any concerns or safeguarding matters. There were detailed risk assessments in place to show staff how to keep people safe, for example when using specialist mobility equipment or when managing people's health needs. People’s medicines were kept in their own homes. If people need assistance with their medicines they were supported safely and appropriately by staff

Staff felt they had very good training and their competencies and skills were continuously checked. Staff were supervised and supported in their roles. People were supported to have choice and control of their lives and staff sought permission before assisting them. People were assisted to access health services when they needed them and their staff teams worked well with health care professionals.

People and relatives told us support staff were friendly, caring and helpful. They said staff treated people with dignity and respect. Staff respected people’s choices and decisions and supported them in a way which promoted their independence wherever possible.

People (or their relatives where appropriate) were fully included and involved in decisions about their care service and how their staff teams were managed. This meant people received a personalised service that was tailored to their individual needs. Support staff were very familiar with the way people wanted and needed to be supported.

The registered manager and management team were all relatively new to the service and had worked hard over the past year to look at ways of improving the service. The provider had quality assurance systems in place and a clear, achievable business plan that aimed to continuously develop the service.

This unannounced inspection took place on 26, 29 February and the 1 March 2016. This service was last inspected in April 2015 and we gave it an overall rating of ‘good’

Neuro Partners North West (Neuropartners) is a provider of domiciliary care and nursing services. They provide support for people with acquired brain injury or other complex needs. Their office is located in Carlisle but they provide support across the county of Cumbria.

The registered manager had recently left the employ of Neuropartners. 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. There was a temporary manager in place and we were aware of this prior to our inspection as Neuropartners had informed us of their interim management arrangements.

Staff in the service were aware of different types of abuse and knew how to report it.

Medicines were stored in people’s own homes and managed appropriately.

Staff had been provided with mandatory training and given additional training specific to their role.

The service assessed people’s nutritional and hydration needs and provided support accordingly. Staff recorded people’s food and fluid intake.

Staff worked with other health and social care provider’s to help ensure good outcomes for people who used the service.

Staff had developed good relationships with people and communicated in a warm and friendly manner.

Staff were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

Support plans were based on assessment and reflected the needs of people.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. We found evidence that the temporary manager and her team were dealing with complaints in accordance with the provider’s policy.

The temporary manager and her team carried out audits and quality checks to try and ensure the service was meeting the requirements of the Health and Social Care Act.

People told us that the service was currently well-led.

We found evidence of the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 18 – Staffing (1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed.

Regulation 17 – Good Governance (2) (c) Maintain securely and accurate, complete and contemporaneous record in respect of each service user.

We also made the following recommendations:

We recommend the service considers current good practice guidance in relation to supporting people to make informed choices.

We recommended that the service consider current guidance to continue to operate effective recruitment and selection procedures.

People receiving services from Nero Partners had consented to their support following assessment and agreement to provide a service to them. In instances where people lacked mental capacity or physical capacity to consent, next of kin or advocates provided consent on their behalf. One person we spoke with told us, “We had everything explained to us prior to consenting to my relative support commencing. I feel I made an informed decision to receive the service on their behalf”.

We looked at the support documentation held by the provider and used this information to assess that standards of quality and safety were being met. We found there were detailed support plans in place that enabled staff to provide the level of support needed. Staff we spoke with told us the information they received aided them to provide a specialist service. Service users received a level of care designed to meet their individual needs. Comments included, “This is the best service I have worked in. It really is rewarding”. Also, “Service users get the best service because it is well planned and monitored”.

We looked at training records that demonstrated staff supporting people had been provided with a range of opportunities to develop skills and competence to carry out their roles safely. In addition to mandatory training, staff were provided with service specific training in order to have the skills and competencies to meet the needs of individual service users.

We saw there were systems in place to make sure the agency was being managed and monitored in the best interests of people using the service.

The information we received from people who used or commissioned services, indicated that people were able to express their views and were involved in making decisions about their support.

People told us that their support workers 'are always respectful of my privacy' and that they were 'involved in the development' of their care and support plans. They told us that they knew what was recorded in their care plan and that 'staff provide the support needed. '

People told us that they were 'very happy with the service' and that they 'have the same carers. They listen to what I have to say.'

The people we spoke with said that they did not have any concerns about the service. They told us that they knew who to contact at the office if they did have any concerns or problems.

We spoke with socialworkers who have contact with the agency. They told us that 'communication is good. I have no concerns about this service.' They told us that the service carried out frequent reviews with people who used the service and that written reports were always provided.

This announced inspection took place on the 22 & 29 April 2015. The provider was given 48 hours’ notice of the inspection visit because the location provides personal care and support to people in their own homes. As the people who use this service often accessed community activities we needed to make sure people were available to speak to us.

This inspection was carried out by the lead adult social care inspector.

The organisation is registered to provide personal care for people living in the community. They also provide a range of nursing needs for people with brain acquired injury and other complex needs. The provider works with people and their families, legal representatives and healthcare professionals. They develop, deliver and monitor a package of care for people to meet their needs, support their rehabilitation, and provide for their care and support. At the time of this inspection Neuro Partners were providing care and support for 16 people with nursing needs and 11 people who received personal care and support in their own homes.

The last inspection of this service was completed under the wave 2 project on the 30 July and 1 August 2014. At this inspection the provider was rated good having met all the standards and regulations we looked at during the visit.

There was a registered manager in post at the time of our inspection visit.

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 and associated Regulations about how the service is run.

Since our previous inspection in July 2014 the operations manager, who was the registered manager for the provision of personal care in the community, had left the organisation. The other registered manager now had overall responsibility for the community care service to people in their own homes and the nursing care for people with acquired brain injury and other complex nursing needs.

We found that the service was safe and members of the staff team were aware of their role and responsibility to keep people safe. There had been safeguarding issues prior to this inspection visit which had been notified to us, The Care Quality Commission (CQC) but these had been dealt with prior to our visit.

We saw that the provider had robust recruitment policies and procedures which ensured only suitable people were employed to care for vulnerable people with complex needs.

We found that the service worked well with external agencies such as social services, Clinical Commissioning Group (CCG), other care providers and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

We found that Neuro Partners employed sufficient suitable and trained staff to provide an appropriate level of care. No new packages of care were set up until there were sufficient numbers of staff to provide care to meet peoples’ assessed needs.

Risk assessments covering all aspects of care and support were in place and reviewed every month.

We found that staff training was up to date. Mandatory subjects were covered in the induction programme. Following this staff then completed bespoke training according to the physical and nursing needs of the people they supported.

Staff confirmed they had regular supervision meetings with their line manager.

The service followed the requirements of the Mental Capacity Act 2005 Code of Practice. This helped to protect the rights of people who were not able to make important decisions for themselves.

The service promoted healthy eating with those people who were assisted with eating, drinking and nutrition.

Prior to the service starting each person had a detailed assessment of their needs. This ensured the most appropriate level of care was provided. Suitable personal care and support plans were in place and up to date.

Staff had formed close relationships with the people they supported. Privacy and dignity were respected at all times. People were encouraged to access activities in the community if they were able so to do.

There was an appropriate internal quality monitoring procedure in place to monitor service provision. Checks or audits were completed in respect of, medicines administration, care plans, personal involvement, health and safety and risk assessments. These checks ensured people were cared for and supported in the way they chose themselves.