The Regard Partnership Domiciliary Care Agency provides personal care and support to people living in their own homes. The people supported by the service have learning disabilities, physical and mental health needs and other associated conditions such as autism.

Some people are supported in their own homes, and others receive support within supported living settings. Supported living is where people live either on their own or with a small group of others, and have their own tenancy agreement. Care and support is provided in order to promote their independence. The care people receive in supported living settings is regulated by CQC, but the accommodation is not. The service supported some people on a 24-hour basis and others at specific times during the day and night.

At the time of the inspection The Regard Partnership Domiciliary Agency were supporting 12 people with personal care tasks either in their own homes or in a supported living setting.

We checked the service was working in line with ‘Registering the Right Support’ which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people’s community.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of good in the areas of Safe, Effective, and Responsive. We found further improvements had been made in relation to Caring and Well-led, and these areas were now rated as Outstanding. This means that at this inspection we have rated the service as Outstanding overall.

There was a very positive, open and inclusive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service. Comments included, “Communication is spot on” and “The manager and the team follow advice and recommendations, and are always thinking about people’s quality of life and independence”. We observed positive and compassionate interactions between staff and people they supported. Staff said they loved their work and were passionate about providing an excellent quality service.

Exceptionally good governance of the service by both the provider and the registered manager benefitted people because it ensured the quality of care was maintained and enhanced. The registered manager was supported by the provider and effective governance of the service was visible with the registered manager, regional manager and regional director regularly involved and present within the service. Regular audits were carried out, which included checks of health and safety, staffing levels, training, and medicines. Checks were carried out by management and support staff to ensure records held in people’s homes were appropriate, accurate and up to date. There was a computer system, which was kept up to date so the provider could see how the service was performing at any time.

The provider and registered manager recognised the benefits of multi- agency working and external agencies were very positive about the management and care provided to people. A professional from the local learning disability service said, “It was one of the best and smoothest young person’s transitions I have ever worked with, they worked really well with the family, communication was spot on”.

Information gathered about people was used to aid learning and drive continuous improvement across the service. The registered manager and provider had worked hard to learn from incidents, near misses and mistakes. Investigations were carried out when required and systems were in place to identify any trends or patterns, to help make changes when needed. The provider and registered manager promoted the ethos of honesty, learning from mistakes and admitted when thi

The inspection took place on the 9 and 16 March and was announced. We gave the provider 24 hours’ notice of the inspection because the service is small and we needed to be sure the registered manager would be present in the service when we arrived.

The Regard Partnership Domiciliary Care Southwest is registered to provide personal care and support to people living in their own homes and supported living premises. People being supported may have a learning or physical disability and other associated conditions such as Autism and Aspergers. People may also be supported who are living with conditions associated with sensory impairment and mental health needs. The service supports some people on a 24 hour basis and others at specific times during the day and night.

At the time of the inspection ten people received support with personal care needs.

There was a registered manager in post who was responsible for the day to day running of 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 told us they felt safe. We observed people as they were being supported by staff. We saw people looked relaxed and comfortable in their home and people’s body language, laughter and smiles suggested they felt happy and safe with the staff supporting them.

Staff had received training in how to recognise and report abuse or poor practice. Staff were confident any allegations or concerns would be taken seriously and investigated to help ensure people were safe and protected.

There were sufficient numbers of suitably qualified staff to meet people’s needs. The recruitment and induction process for new staff was thorough and helped ensure staff were safe and suitably prepared to work with vulnerable people.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People told us they always knew who would be supporting them and were kept informed of any changes. The registered manager said they considered people’s needs and preferences when recruiting staff, “We have a diverse team, and when recruiting try to consider the needs of people we support particularly in relation to, age, gender, personality and interests”.

People’s support needs were clearly documented. Staff had the information they needed to provide support in a way people chose and preferred. In addition to people’s personal care needs staff supported people with other daily tasks such as shopping, cooking, support with medicines and accessing opportunities and activities outside the home. These arrangements formed part of the person’s support plan and were reviewed and discussed on a regular basis.

The registered manager and staff had a clear understanding of the Mental Capacity Act 200. Staff made sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

Staff respected people’s privacy and recognised they were providing support within people’s own homes. Staff talked with a great deal of warmth and affection about the people they supported One staff member said, “I know how much [….] loves their home and it is really important that we help them remain living here”. Another said, “We always remind [….] it is their home. Sometimes family may want to make decisions, but we have to gently remind them it is […] home and choice”.

There was a management structure in the service which provided clear lines of responsibility and accountability. People and staff knew who to speak to if they had any concerns and felt any issues would be addressed.

Information was used to aid learning and drive improvement across the service. We saw accident and incident forms had been completed

We spoke with the registered manager, a team leader, two care staff and a family member. We also spoke with and met people using the service. People we spoke with told us they were very happy with the service they received from the agency and they were enjoying their lives. One person told us "My carers make me feel safe; I know I couldn’t cope on my own”. A member of staff told us “we have so many success stories with our clients I feel privileged to work with them and for our company”.

We saw that people had specific and individualistic care plans. These had been updated daily in accordance with people's wishes. Care plans were easy read with pictures and colour coded charts. This demonstrated an awareness of the individual persons understanding and abilities to read and understand their own care plan.

Support staff worked at a level required by the individual and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient support workers to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

We met with two people in their own homes, spoke with the registered manager, a team leader and two members of staff supporting people with personal care.

The people we met told us the staff were, "Helpful and very good at their jobs." We observed people in their own homes with staff and they seemed happy and relaxed.

Staff had a good understanding of capacity and involved people in decisions about their life where possible and respected their choices. Appropriate arrangements were made for people to support them to manage aspects of their life they had difficulty with. Where people did not have the capacity to make certain decisions the necessary legislative processes had been followed and these discussions and meetings were clearly documented in people's care plans.

We saw detailed care plans enabling staff to provide the necessary support and intervention to help people meet their needs and keep them well and safe. We saw evidence of discussions with health professionals and social workers where required to meet people's physical and mental health needs.

We met with staff who were well trained and confident at recognising signs of abuse and understood when situations needed to be discussed with more senior staff or outside agencies to protect people.

There was a system in place to manage complaints. Staff felt confident to discuss complaints with the management team and felt able to support the people they cared for raise complaints they may have.