This inspection took place on 25, 29 and 31January 2018 and was announced. This service is a domiciliary care agency based in Newcastle upon Tyne. It provides personal care to people living in their own homes in Newcastle and North Tyneside. Services were provided to adults with a wide range of health and social care needs including physical disabilities, sensory impairments, learning disabilities, mental health needs and dementia. At the time of our inspection there were approximately 275 people receiving a service.Not everyone using St Anthony of Padua Care Services (known locally as St Anthony's) receives regulated activity; The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
Our last inspection of the service was carried out in November 2015 and we rated the service as ‘Good’. At this inspection we found that the service had improved further and was ‘Outstanding’.
The service had a well-established registered manager in post who had been registered with the CQC since February 2016. A registered manager is a person who has registered with the 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.
Staff told us that the Chief Executive Officer (CEO) for the provider organisation was an exceptional leader and that the service has become much better since their appointment over two years ago. We saw the service had significantly developed the quality assurance processes and improved their engagement with people who used the service for example. We found the CEO had a clear vision for the service which put people at the heart of it.
Both the CEO and registered manager had extensive employment histories supporting vulnerable people who require personal care and assistance. The service benefitted from a reliable and steady team of devoted staff who told us they were proud to work for the provider and loved their jobs.
The service was based in the heart of the community it served where people and staff were welcomed into the office and community day centre. As the provider was a charitable organisation they were especially keen to make strong links with the community and neighbouring services. We saw a host of successful collaborations had been made with other local businesses which helped local people including those who used the provider's care at home service. The provider used a wide range of methods to engage with people and empowered them to voice their opinions. A recent ‘service user’ survey had been carried out in October 2017 which was positive.
There was a strong quality assurance framework in place across the service to ensure that the monitoring of the service was methodical, meaningful and in-depth. Audits carried out by the management team and provider’s board of trustees demonstrated that checks on the service were systematically undertaken and where issues were identified, action was taken. The senior management team and board of trustees had oversight of all matters arising to make sure these had been effectively and correctly dealt with in line with the provider’s policies and principles. A detailed action plan for continuous improvement had been drafted and was used to direct the management team and support them to focus on the provider’s key priorities.
The service had an excellent person-centred culture. The management team and staff were extremely committed to delivering a service which was exceptionally caring and empathetic. People and relatives overwhelmingly expressed their satisfaction about the service and told us their care workers provided first class sensitive and compassionate support and they respected their homes and their belongings. People said staff consistently maintained their dignity and privacy and continually treated them as individuals.
We found staff were highly motivated and inspired to provide individual care to people by their senior managers who were described as “open and really nice”, “supportive” and “approachable” by the staff. Staff we engaged with displayed remarkably kind, caring and considerate attitudes and spoke professionally and passionately about their job role. The equality and diversity policy was fully embedded into the service and staff were able to easily describe many positive outcomes which had been achieved for people with a variety of differing needs.
People were consulted in innovative ways to gather their opinions and encouraged to get fully involved in the running of the service. The provider operated a day centre and they always invited and encouraged people who used their care at home service to attend. Coffee morning drop-in sessions and scheduled ‘service user’ meetings took place. People and their relatives were actively encouraged by the provider to become involved with management decisions and in developing the service further through these meetings and regular informative newsletters.
Staff were continually reminded of the management’s appreciation of their hard work and dedication. We saw the registered manager sent memo’s and newsletters to staff as well as individual emails of thanks to care staff who had gone ‘above and beyond’ in their role.
People told us they felt very safe and comfortable with staff who visited their home. Robust policies and procedures were in place to assist staff to safeguard people from harm and abuse and the staff we spoke with understood their responsibilities with regards to protecting people. Incidents of a safeguarding nature has been thoroughly investigated, reported, recorded and monitored. Lessons learnt from incidents were a fundamental part of the continuous improvement of the service. The local authorities involved told us they had no concerns about this service.
Care workers supported people within their own homes to maintain their health, safety and welfare. Risk assessments were routinely carried out where staff had identified specific risks to people. We saw these were frequently reviewed and updated as people’s needs changed. Staff were confident about how to react and what actions they would take in an emergency situation. Preventative measures were taken to minimise the risk of cross contamination as staff often visited multiple people in their own homes.
Staff told us there were enough of them employed by the provider to look after people safely and to meet their varying needs. People told us that they had regular care workers who were consistent and punctual.
A safe, transparent and vigorous recruitment process was in place. New staff had received a comprehensive induction in line with best practice and staff training was up to date. Staff attended regular supervision sessions, annual appraisals and meetings in order to discuss any issues, share best practice and develop their skills and knowledge. Staff told us they felt extremely valued by the management team and that there was an open, friendly and honest culture, whereby they did not feel afraid to discuss anything.
People told us they received their medicines in a safe and timely manner. Regular competency checks were conducted with care workers to ensure that the high standards of care which the CEO and registered manager expected, continued to be delivered. Medicine administration records were reviewed often and we saw they were completed to a good standard.
All staff demonstrated an understanding of the Mental Capacity Act 2005 (MCA) and worked within its principals, including gaining appropriate consent to care for people who lacked mental capacity. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Care workers promoted a healthy and stable diet among the people they supported. People told us their care workers made them meals of their choice in line with their likes and dislikes. Dieticians and other external health professionals were involved with people’s continuing care needs to ensure their well-being.
There was a complaints policy and procedure in place. Lessons learned from complaints were shared with the staff to improve their practices. Everyone we spoke with had no complaints about the service. Staff who had received a compliment about the work were commended by the CEO or the head of the trustees.