This inspection took place on 20 February, 8 March and 12 March 2018 and was announced. This was to ensure someone would be available at the office to speak with us and show us records.

North STSS (Short Term Support Service) Alnwick is provided by Northumberland County Council in partnership with Northumbria Healthcare NHS Foundation Trust. It provides three distinct services; re-ablement, crisis intervention and a ‘bridging’ service. Re-ablement concentrated on supporting predominantly older people following a recent illness, hospital admission or an exacerbation of a longer term condition, with the aim of getting them back to an optimal level of independence. The crisis intervention service supported those who required immediate support due to a sudden change in their circumstances such as an accident or acute illness. The bridging service supported people until a long term provider was assigned.

At the time of the inspection, the service was providing personal care and support to 31 people in their own homes.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

North STSS (Short Term Support Service) Alnwick was last inspected by CQC in November 2015 and was rated Good. At this inspection we found the service had improved to Outstanding.

The service was very flexible and extremely responsive to people’s needs. We saw and heard how staff went above and beyond their role.

The service used a number of research based assessment tools to ensure the best possible outcomes for people, and employed occupational therapists and physiotherapists to work alongside care staff.

People’s care and support was planned proactively with them in a person centred way. People’s preferences and choices were clearly documented in their care records and people told us they were involved in the care they received. The service had used case studies to review the support people had received and identify good practice or lessons learned.

There were consistently high levels of constructive engagement with staff and people who used the service. Staff felt supported by the registered manager and said there was an “open door policy” at the service. Policies and procedures were in place to keep staff safe, and management and office staff provided outstanding support to care staff.

People who used the service and health and social care professionals were extremely positive about the service. The service worked collaboratively with other organisations and local charities.

Governance was well embedded into the running of the service. Service quality and improvement was high on the organisational agenda and was measured through a variety of audits, satisfaction questionnaires and performance dashboards.

There was a strong emphasis on continually striving to improve. The service had an electronic monitoring system in place. The registered manager told us it helped them “effectively manage resources” and achieve “value for money”.

People who used the service and family members were extremely complimentary about the standard of care at North STSS (Short Term Support Service) Alnwick.

Staff respected people’s privacy and dignity. People spoke positively about how staff respected their privacy and dignity while carrying out personal care, and the support they received to help them regain their independence.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff, and described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vu

We considered all the evidence we gathered under the outcomes 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?

Below is a summary of what we found –

Is the service caring?

We visited two people in their homes and spoke with a further three people on the telephone. People told us they were very happy with the service. They told us that staff knew what to do and always turned up when expected. Comments from people included, “I’ve been very fortunate with carers; they have been exceptional”; “They are all good but these three (providing care for the current period) have that extra something”; “I think it is an excellent service, they all do a good job”; “They are all good in their own way; every one is different” and “They are very caring. They make sure all the bits are dry, even between your toes.”

We spoke with four members of staff. Care workers told us they would be given details of the care to be delivered and any other important information before they visited. They also told us they checked the care plan kept in people's homes. Staff told us there were always a supervisor and manager on call, who they could contact if any issues arose. This meant there were arrangements in place to deal with foreseeable emergencies.

Is the service responsive?

We looked at ten care plans and found that they were reviewed, as appropriate, within the six week period that people were supported by the service. A supervisor told us that reviews were undertaken at a minimum two weeks, but probably more often because people’s needs changed so quickly. People we spoke with confirmed that staff from the service visited to review their progress and ongoing needs.

We noted that the service had received 18 formal letters of compliment. One comment from a written compliment state, “Very caring and willing at all times; which I much appreciated.”

Is the service safe?

The provider had in place a safeguarding policy. Information about action to be taken in the event of a safeguarding incident and contact details of agencies to be kept informed was maintained in a dedicated file. The manager told us, and records confirmed that there had been no recent safeguarding incidents.

Staff we spoke with told us that they had undertaken safeguarding training and certificates in staff personal files confirmed this.

People we spoke with told us that they felt safe when care staff visited them. One person told us, “Yes I feel safe. They are not just young bits of stuff; they are sensible and mature.” Other people said, “I feel safe with all of them; they are all capable staff” and “I feel safe with all of them; exceptionally safe.”

Staff told us, and records confirmed that the provider had in place a lone worker system. Staff stated that they could contact a supervisor or manager at any time.

Is the service effective?

A supervisor showed us how the new electronic system helped in scheduling support visits and allocating staff. We saw there was a checking system to ensure that all required visits had been appropriately allocated. They told us that staff were also required to scan in and out of visits. This meant the system could log that calls had been made and alert the office to missed or late calls.

People told us that they found the service helpful. One person who used the service told us, "I think it is a wonderful service. They are very wise in caring and know stuff that helps you." Staff understood about people’s needs and the role of the service in supporting people. One member of staff stated, "We involve them in their care and encourage them.”

Is the service well led?

In this report the name of a registered manager appears who, due to retirement, was not in post at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The provider is currently undertaking a recruitment process to appoint a new manager.

The deputy manager, a supervisor and staff confirmed that supervisors carried out spot check observations on care delivery.

Staff told us they felt supported by the supervisors and the managers. One staff member told us, “I have the out of hours number but also my supervisor’s number. I can ring her at any time.”

A team supervisor told us, and staff confirmed that there were twice weekly team meetings when any issues could be discussed in relation to people's care or any associated problems. The deputy manager told us, and staff and records confirmed that there were monthly operational meetings.

The deputy manager told us that there had been one formal complaint within the last 12 months. We saw letters and documents from the investigation of this complaint and saw that processes had been followed appropriately.

This inspection took place on 19 and 23 November 2015 and was announced because we wanted to ensure there would be someone at the office when we called.

North Locality Homecare (Alnwick) is a short term support service providing domiciliary care and support to people in their own homes, often following hospital discharge. It is registered to deliver personal care. At the time of the inspection the registered manager told us they supported around 33 people over the wider rural area of north Northumberland. He said this number fluctuated regularly depending on when people were discharged from hospital or if people were referred by professionals to try and prevent hospital admissions.

A registered manager was in post and had been registered with the CQC since September 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. The day to day running of the location was carried out by a service manager, who would report to the registered manager.

People told us they felt safe when care staff were supporting them with personal care and other matters. They told us care workers were very helpful and they looked forward to them visiting. Staff told us they had received training in relation to safeguarding adults and would report any concerns. Processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced. People told us staff attended appointments within prescribed time slots and there were no excessively late calls or missed appointments.

The provider had in place plans to deal with emergency situations and an out of hours on-call system, manned through a call centre system, was in operation. The service also had access to four wheel drive vehicles in the event of adverse weather and plans in place to prioritise care in such circumstances.

People receiving support with their medicines were assisted appropriately. Appropriate processes were followed when dealing with medicines and staff confirmed they had received training in the safe handling of medicines.

People told us staff had the right skills to support their care. Staff said they received training and a recently introduced electronic system supported ongoing training and development. Staff told us they received regular supervision and appraisals. Documents we saw supported this. Staff were aware of the Mental Capacity Act 2005 and issues relating to personal choice. The registered manager confirmed that no one using the service was subject to restrictions imposed by the Court of Protection. People said they were supported by care staff to maintain appropriate intake of food and drinks.

People said they found staff caring and supportive. They said their privacy and dignity was respected during the delivery of personal care. People were also supported to maintain their well-being, as staff worked with health professionals or therapists, who told us care staff contacted them if they were concerned about people.

People’s needs were assessed and care plans detailed the type of support they should receive. Care plans contained goals that people wished to achieve and these were reviewed and updated as support progressed. The registered manager told us there had been one formal complaint in the last 12 months. This had been dealt with appropriately. People told us they were happy with the care provided and they had no complaints about the service.

The provider had in place systems to effectively manage the service and monitor quality. Regular spots checks took place to review care provision and ensure people were receiving appropriate levels of care. People were also contacted to gain their views of the service. Staff told us there were regular meetings and information was provided to ensure they were up to date about any changes in care. Records were up to date and stored securely.