This inspection took place on 19th November 2015 and was announced. The last inspection was in January 2014, and the service was compliant in all areas apart from consent to care and recruitment. We found that changes had been made and there are now appropriate assessments to show consent had been sought. There were also robust recruitment records on file, showing those working for Smile Support and Care services, had the appropriate checks and were suitable to have worked there.

Smile Support and Care services is a Domiciliary Care Agency which provides daily support and respite care for children and young adults. At the time of the inspection they were providing support for 24 children with a variety of care needs, including people with physical disabilities as well as mental health needs who required support with their personal care.

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.

The feedback we received from family’s members was mostly positive. They felt their children were safe with the care and support provided by the staff from Smile. The registered manager and staff were aware of their responsibility to provide the care and support to the child. There were systems in place to ensure the risks to the children’s safety and wellbeing were identified and addressed.

The registered manager ensured that staff had a full understanding of the children they were to be supporting, prior to them starting work with them. They knew the child’s care needs and ensured the staff had the appropriate skills and knowledge to be able to support them. Families felt safe and secure with the support they were currently receiving.

Parents said their children had positive relationships with the support workers and had ‘chosen’ the support worker for their child by looking at a matched portfolio. Parents felt their children were treated with respect and dignity and the staff were mindful of the child and families privacy.

Children received a service which was based on their personal needs and their family’s wishes. Changes in their care needs were identified and amended as required. The service was flexible to changes if they were requested.

The registered manager demonstrated the importance of effective quality assurance systems. They were part of a quality assurance team, which met every 5-6 weeks to look at different areas such as support plans and reviews and policies and procedures. The service was committed to continuous improvement and feedback from people whether it was positive or negative. This feedback would then be used and actions taken.

Staff were motivated and proud of the role they had. They said they felt fully supported by the registered manager and had received a full induction with training and supervision. Staff raised concerns that training was now online and struggled to find the time to complete this.

During our inspection we spoke with five parents, four members of care staff and the registered manager. We reviewed four support plans and four staff files.

Where young adults did not have the capacity to consent, the provider had not acted in accordance with legal requirements. Mental capacity assessments had not been carried out to determine whether the young adult was able to give valid consent.

Parents were all complimentary about the care staff. One parent told us “the carers are really good.” Another said “I have no fault whatsoever, absolutely none, and I am very very critical.”

The provider did not have a system in place to carry out appropriate risk assessments if criminal convictions were identified on a potential member of staff’s criminal records check.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon. A survey had been carried out during February 2013. Overall feedback from the survey was positive; parents felt that the support their child received was friendly and helpful.

Children/young adults and their relatives were involved in making decisions about their care and treatment. Parents told us that they had been involved in the development of their child’s care plan and that they had expressed views on the way care was to be given.

Children/young adult’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at care plans and records of four children/young adults who used the service and found them to be detailed, up-to-date and person centred.

We asked five support workers about the term ‘safeguarding’ and vulnerable adults and children. Staff were aware of the causes of potential abuse of children and vulnerable adults and were aware of their responsibility in reporting it.

Three parents confirmed that they were happy with the service provided and had received a continuity of care. One of these parents told us, ”the staff we have are good and come out and do regular hours.”

Care workers received appropriate professional development. Care workers we spoke to confirmed that they felt well supported. One care worker told us “all in all I can’t fault the management – all round very supportive and caring company and I really enjoy my job.”

The provider took account of complaints and comments. A log of all issues and complaints was maintained. At that time there were no outstanding actions outstanding which were past their ‘complete by’ date.