Active Social Care Limited (Kirklees, Calderdale and Bradford)

This service is a domiciliary care agency. It provides personal care to people living in their own homes with physical disabilities, learning disabilities, and behaviours that challenge, especially autism. This service also provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Active Social Care Limited receives a regulated activity; 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. At the time of the inspection the service supported 104 adults and 84 children. 19 adults and four children required support with ‘personal care’. Five people were provided with care and support in a ‘supported living’ setting.

There was a well-established registered manager in post who was also the director of the company. 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 and their relatives told us they felt completely 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.

Risk assessments were extremely detailed to ensure staff supported people to remain safe. 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. Behavioural support plans were exceptional in their detail, ensuring restrictions were kept to a minimum and the risks around behaviours which challenged could be managed. The service recognised the risks around using medicines to manage behaviours that challenged and were actively seeking measures to minimise this. Systems were in place to manage medicines administered in people's own homes and audits were undertaken regularly to ensure staff were meeting the required standard of practice.

Staff had an excellent working knowledge of the key requirements of the Mental Capacity Act 2005. All staff demonstrated a commitment to promoting the rights and choices of people who used the service and ensured people's human and legal rights were respected. Feedback from professionals confirmed staff at the service excelled in their understanding of the Act, and were truly committed to the purpose of the legislation to protect people’s rights and freedoms. Decision specific assessments were in place and staff encouraged people to be involved in decisions about them in their best interests.

Values based recruitment practices ensured staff with the right skills were employed. There was a proactive support and appraisal system for staff, which recognised that continuous development of skills, competence and knowledge was integral to ensuring high quality care and support. Staff were supported through individual supervision. Unannounced observational checks of staff performance were carried out at regular intervals in people's homes to ensure staff provided a high quality service.

The provider had an excellent person-centred culture and this underpinned their service and was the foundation for their vision and values. 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, telling us they could not manage without it. The service went to great lengths in ensuring that people and care staff were well matched, and shared the same interests in life or had similar personality traits. People had a choice in who cared for them and their feedback was sought on the effectiveness of the relationships.

People were given encouragement and support to reach their full potential and live life to the full, assisted by passionate staff who were responsive to their needs. Staff were innovative in supporting people into employment and saw the impact they had on people’s lives when these outcomes were achieved.

People's care and support was planned proactively in partnership with them and their involvement was recognised as key to providing person-centred care. The views of people using the service and their relatives were at the core of quality monitoring and helped shape service delivery. The service was moving towards electronic records to ensure they provided real-time evidence of the person-centred care they were providing.

The service was exceedingly well-led with the emphasis on continuous improvement. The registered manager encouraged staff to be innovative and there was a dynamic, positive and open culture at the service. Staff were “buzzing” with ideas and examples of how they had implemented new ways of working to benefit the people using the service.

Excellent links with the local community and other providers in the area had been fostered by the registered manager. They set up and chaired a registered manager forum to share good practice amongst other registered providers. They shared their knowledge, policies and procedures with other providers and supported them by providing training opportunities which ultimately benefitted people using services in the local community. They provided training to parents on how to manage behaviours that challenged to ensure consistency of approach when dealing with their relatives.

There was a consistent teamwork approach from members of the management team to those providing care and support. Staff told us about the excellent support they received from colleagues which enabled good team working.

Staff were continually reminded of the management's appreciation of their hard work and dedication. Staff received public acknowledgement and financial rewards as recognition they had gone 'above and beyond' in their role. Staff told us they felt extremely valued by the management team and that there was an open, friendly and honest culture, where they did not feel afraid to discuss anything and were very supported by the managers at the service.

Active Social Care Limited provides a variety of services to support adults and children with disabilities in the Bradford, Kirklees and Calderdale area. Support is given to people with physical disabilities, learning disabilities, and behaviours that challenge, especially autism. In addition to supporting people in their own homes the provider offers services through day centres. Day centre services are not regulated by the CQC. Active Social Care Limited is the main provider for children’s services in Kirklees and Calderdale. Children’s services are monitored and inspected by OFSTED. At the time of the inspection the registered manager told us they were delivering around 3,000 personal care hours a week to approximately 26 individuals, some of whom had 24 hours care packages.

At the time of our inspection there was a registered manager in place, who was also a director of the provider company. Our records showed she had been formally registered with the 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 and relatives told us they felt safe when receiving care and that they trusted the care staff. Staff told us they had received training in relation to safeguarding adults and would report any concerns. The provider had failed to identify one incident as a potentially serious safeguarding matter and had not reported the matter to the local authority. Extensive processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced to support people.

People and relatives felt involved in determining their staff team. People’s care was delivered through the provision of individual teams. People and relatives said they had consistent team members for support and there were no instances where support was not provided. Staff told us there were enough staff to deliver care.

The provider had in place plans to deal with emergency situations through the use of an on call out of hours system, manned by senior staff. People’s care needs had been risk assessed to ensure those most vulnerable would receive prioritised support in the event of adverse weather.

Medicines were well managed and appropriately supported. Extensive details of the various medicines people were taking were available and medicine administration records were clear and well kept. Checks were undertaken on medicines administration.

People told us they felt well supported by staff. The provider had a detailed system in place to ensure that all staff had completed a detailed induction process, linked to the Care Certificate, before they were allowed to support people on their own. Checks were made to ensure appropriate training had been completed and updated and all care staff were automatically enrolled on level 2 of the care diploma once they had successfully completed their induction. Senior staff had also completed all the elements of the Care Certificate. Staff told us they could request additional training at any time and external or specialist advice was available to train staff in exceptional practices. Records showed staff received regular and detailed supervision. Annual appraisals or reviews were also undertaken and covered a range of work related issues. The manager was aware of the Mental Capacity Act (2005) and worked with local authority staff to assess if people needed protecting under the Act. Consent was sought and where people did not have capacity, best interests decisions were taken. People were supported by care staff to maintain appropriate intake of food and drinks.

People told us that they found staff very caring and supportive and talked about their relationships with care staff in very positive ways. People and relatives both said they felt involved in determining and reviewing care. Staff were aware of the need to protect people’s privacy and dignity during the delivery of personal care and support. People’s well-being was supported with individuals assisted to attend hospital or health appointments and staff worked with community professionals

Broad ranging assessments had been undertaken of people’s care needs and care plans contained detailed and comprehensive risks assessments and instruction for care staff to follow, to deliver highly personalised care. Care plans and risk assessments were regularly reviewed and people and relatives said they were involved in these reviews. People were supported to maintain as active a lifestyle as possible and staff were selected to match people’s particular needs or interests. The provider had in place a complaints procedure and dealt appropriately with any concerns raised. People told us they had few complaints and any issues raised were dealt with.

The provider had in place systems to manage the service and monitor quality. The provider had failed to notify the CQC of a limited number of incidents that they were required to do so. Senior staff undertook regular spot checks on care workers to ensure they were providing appropriate levels of care. People told us they were contacted and asked their views on the service and discuss any concerns. Daily care records were up to date and contained good details.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to Safeguarding. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our visit there were 50 clients receiving personal care from the service. During the visit we spoke with the registered manager, who was also one of the company directors, the area manager, in-house training officer (who also had a child cared for by the service), three support workers, a volunteer on work experience (who had also been a client of the service), the communications and policy officer (who also worked as a support worker) and the monitoring and development manager

The manager told us the service had recently inspected by Ofsted and that they had a day centre at Newsome and a soft play gym in Halifax, both of which were registered with Ofsted.

The manager explained that there were a variety of services offered by Active, depending on each client's needs. These included:-

' Respite services during the day

' Short breaks

' School holidays and after school service seven days a week.

' Domiciliary care

' Supported living

' Sitting service, including nights

' Taking people out in the community

' Organised trips

They told us the adults using the service were mostly young and middle aged; there were very few elderly adults.

Feedback from clients and families using the service included:-

'People turn up on time, I'm very happy with the service it all works well.'

'Active has made it possible for me to live with my brother and sister; I was not happy where I was living before.'

'The service enables me to get a full night's sleep.'

'I trust them to provide a good service.'

'Staff follow my person centred plan and all are very helpful and aim to please.'

'The service is working well. It makes a big difference. I'd be in a home without it.'

'The care provided is very good. Staff are always polite and very helpful. If I have a problem it is sorted out as soon as possible.'

'They support clients brilliantly and match staff to clients fabulously.'

'They provide top quality support and are always very helpful.'

'They provide regular carers and that counts for a lot.'

'I cannot fault any of the staff they have really made a difference for the better and really do care about my relative.'

'They provide good cares and work to solve problems.'

'The standard of care is much higher than other agencies, the staff try harder.'

'Staff respect people and understand cultural expectations. They provide a high standard of care.'

'It's working well at the moment, it makes a difference and allows us to have a life.'

'Carers provide high quality care and are always on the ball. I am pleased with the service I get.'

'I am highly satisfied with the service, my relative's communication and independence skills are improving.'