The inspection took place on the 4 and 13 July 2017 and was announced. We gave the provider 24 hours’ notice because the service is a domiciliary care agency and we wanted to make sure that staff would be available at the office to assist us with our inspection. There has been a delay in reporting on our findings, due to no fault of the provider, we therefore conducted a third date in December 2017 to validate our initial findings and produce an inspection report.

At our previous inspection in June 2015 the service was rated good overall, with the responsive domain being rated as outstanding.

West STSS (Short Term Support Service) Hexham provides 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 52 people over the wider rural area of West Northumberland. She said this number fluctuated regularly depending upon when people were discharged from hospital and referrals from primary care services.

The service had a registered manager who had been registered with the Care Quality Commission since October 2010. 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.

All staff we spoke to were confident in the safeguarding policies that were in place and how they would ensure people were protected from abuse. Staff were also knowledgeable in relation to whistleblowing and said they would have no concerns in speaking up if they felt people were not receiving appropriate care.

We saw that medicines were managed safely. The service had a pharmacist who regularly supported the provider and was assisting them in continuously reviewing their medicines systems and audits to ensure people were safe.

People we spoke with were all very positive about the skill set of the staff. Staff themselves told us they received a variety of training which equipped them to do their job. They told us how they had raised that one particular area they would like more education on. We spoke to the registered manager and noted they had already acted upon the staff request and training had been sourced and booked to support them. We noted how responsive the manager was to staff identifying learning needs.

We reviewed the service in line with the Mental Capacity Act and concluded they were meeting all requirements of the Act. People’s consent was clearly documented and they told us they were involved in planning their care.

Everyone we spoke to was extremely positive about the service and in particular they mentioned the caring nature of the staff and how much emphasis was placed on helping them to regain their independence. We saw that people had clear risk assessments in place and also measurable goals around promoting independence and building confidence.

Staff were exceptional in enabling people to become independent in various activities of daily living. On reviewing people’s care plans we noted that each area of improvement was clearly documented. We saw that people had set regular goals and staff encouraged people to strive for improvement. People we spoke to told us how the staff supported them to gradually make improvements and to change their life.

People told us how the service was very responsive. They mentioned that the service always adapted to their need. Staff told us they completed regularly reviews of people’s care to ensure it was meeting their needs and also so they could listen to people’s feedback and tailor the care if needed. We found the service was exceedingly flexible and responsive to people’s individual needs and preferences. People told us that if it was not for the service t

We visited the homes of three people who used the service and spoke with them about the care they received and the support they were given with taking medicines. They all felt that the service provided was very good and were happy with the care workers who assisted them. One person told us, "It's very nice to have them coming. I feel comforted that people are coming in; that they are checking up on me - in a nice way."

We noted that following referral to the service an assessment led to a clear action plan, detailing the type of support people required and a clear indication of when support should be offered. Contact numbers for the person's GP, care manager and the local pharmacy were also readily available in the file.

The manager told us they had implemented a range of changes including asking the hospital or GP to confirm the types of medication people were on. We saw evidence in people's care files that this was done.

There were regular audits of the medicine administration records (MARs) by the team supervisors and managers. Gaps in the record were followed up and an explanation obtained. Staff told us, and the manager confirmed that all staff had training in handling of medicines.

Staff were able to describe the process they would follow for both administering medicines and prompting people to take medication, which reflected the service's guidelines.

This inspection took place on 2 and 3 June 2015 and was announced. A previous inspection of the service in October 2013 found there were no breaches of legal requirements.

West Locality Homecare 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 52 people over the wider rural area of west Northumberland. She said this number fluctuated regularly depending on when people were discharged from hospital and referrals from primary care services.

The service had a registered manager who had been registered with the Care Quality Commission since October 2010. 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 when care staff were supporting them with personal care. They told us care workers were very helpful and they valued their visits. 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 and were of good character to work with people who were potentially vulnerable. People told us staff generally attended appointments within prescribed time slots and there were no missed appointments.

The provider had in place plans to deal with emergency situations and an out of hours on-call system, manned by senior staff was provided. Provision was also in place to prioritise care delivery in the event of adverse weather conditions.

The provider had a comprehensive policy on how people should be supported with medicines. Staff had received training on the safe handling of medicines and had their competency checked on a regular basis. Staff had a good knowledge of the important aspects of prompting and administering medicines and records related to this activity were complete and up to date.

People told us staff had the right skills to support their care needs. Staff said they received training and there was a system in place to ensure this was updated on a regular basis. Staff told us they received regular supervision and appraisals and documents we saw supported this. Staff were aware of the Mental Capacity Act 2005 and issues relating to personal choice and best interest decisions. 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 access adequate food and drinks.

People told us 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. Staff talked about how they encouraged people to access local health and support services.

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 no formal complaints in the last 12 months. People told us they were happy with the care provided and they had no complaints about the service. A number of compliments had been received by the service about the support provided by staff.

The provider had in place systems to effectively manage the service and monitor quality. Regular spots checks took place to review care provision, hand hygiene, medicines management and ensure people were receiving appropriate levels of care. People were also contacted to solicit their views and there was a high level of satisfaction with 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. A new electronic contact system supported care workers and allowed them to be aware of changes to people’s care needs quickly, through the use of mobile technology. Records contained good detail, were up to date and stored appropriately.