NAS Community Services (Northamptonshire) is a domiciliary care agency. It provides personal care to older adults with learning disabilities living in their own homes in the community.

The first comprehensive inspection of the service took place on 30 November 2016, and we rated the service ‘Requires Improvement’. The provider was also in breach of Regulation 17 of the Health and Social Care Act Regulations 2014, Good governance. This was because sufficient quality assurance systems were not in place to assess the safety and welfare of people using the service. The provider completed an action plan telling us how they planned to improve the service to meet the breach in regulation.

This inspection took place on the 11, 12, 18 and 19 December 2017. We checked whether the provider had completed the actions as set out in their action plan. We found they had made sufficient improvement of the service and had met the breach in regulation.

At the time of our inspection, two people were receiving care under the regulated activity of ‘personal care’.

The registered manager had left the service in September 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider was actively seeking to recruit a new registered manager. The deputy manager was providing interim management of the service supported by the area manager. Soon after the inspection, the provider confirmed they had been successful in appointing a new manager and they would be submitting an application to register with CQC.

Lessons had been learned to improve safety across the service. The provider was committed to the continual improve the service and sought feedback from people using the service to increase their involvement in developing the service. Quality audits were taking place, to monitor the health, safety and wellbeing of people using the service. Meetings took place with senior managers to discuss and address areas identified from audits and action plans were in place with timescales for completion.

Staff had received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse. Risk management plans were in place to protect and promote people’s safety. The staffing arrangements were suitable to keep people safe. The staff recruitment practices ensured staff were suitable to work with people. The management of medicines followed best practice guidelines. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016. The AIS is a framework that makes it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given.

Staff received comprehensive induction training when they first commenced work at the service. On-going refresher training ensured staff were able to provide care and support for people following current practice. Staff supervision systems ensured that staff received regular one to one supervision and appraisal of their performance.

Where the provider took on the responsibility, staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet. The staff supported people to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People were encouraged to be involved in decisions about their care and support. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained peop

This unannounced inspection took place on 30 November 2016. This domiciliary care service is registered to provide personal care to people living in their own homes. At the time of the inspection the service supported two people in 24 hour live in care packages in one house.

Although there was a registered manager in post at the time of our inspection, they had been absent since July 2016. 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 provider had failed to ensure they had oversight of the service which had led to a prolonged period of time where people did not receive their planned care. Since July 2016 people had received care primarily from agency staff that had not received the managerial guidance they needed to provide care that met people’s needs. Although this had been recognised by the provider, it had taken until early November 2016 to employ a regular team of care staff and a team leader.

People were living with autism; they were cared for by a new staff team who were in the process of establishing trusting relationships. The provider was supporting new care staff with an experienced team leader and interim manager who could potentially build the team people required.

People were safeguarded by team leaders who supported staff to gain the knowledge and skills to safeguard them from potential harm and understand how to contact outside agencies if they had issues of concern.

People were receiving care from a new staff group who were undergoing training to gain the skills and knowledge they required to meet people’s needs. All new staff continued to be under close supervision from the team leader.

Systems and processes designed to maintain the quality of care were not embedded into practice as there was a complete new management and care team. Where the provider had identified issues these had not been actioned in a timely way.

People had been recently assessed for their risks and care plans were devised to mitigate these risks. People received their care as planned. The provider had plans to regularly include people in their reviews; however, this had not been embedded into practice.

Staff did not always understand their roles and responsibilities in recording where people had been assessed for their mental capacity to make decisions. People were asked for their consent to receive care.

People knew how to make a complaint and a new system to manage complaints was in place; this required embedding into daily practice.

People had enough staff allocated to them on a daily basis. People were supported to access their health appointments; however, the systems to ensure the support was available at the appropriate times required embedding into daily practice.

People could be assured that appropriate recruitment practices were in place.

There has been one breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of the report.

This service supplied care and support to persons with autism who lived in the community. We found the service to be compliant in the areas we examined. One comment we received from a member of staff we spoke with was "It's a pleasure to work for the NAS, I have worked for them for fifteen years, the training is very good, I started with them as a cleaner in a residential home I am now a supervisor and love my work."