Day and Nightcare Assistance

This service is a domiciliary care agency. It provides personal care which includes live-in services to people living in their own homes. It also facilitates 24 hour discharge to assess for people from local hospitals back to their own homes around Oxfordshire. It provides a service to older people and younger adults. At the time of our inspection, the service was supporting 80 people.

There was a registered manager in place. 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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. However, the well-led section required improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Day and Nightcare Assistance was led by a registered manager who promoted a service that put people at the centre of all the service did. However, we found the staff did not feel supported and they told us there was a lack of good working relationship between staff and the management team. Staff told us they felt not listened to by the provider and registered manager. Staff felt there was a bullying and blame culture within the service.

People remained safe receiving care from Day and Nightcare Assistance. Staff had a clear understanding on how to safeguard people and protect their health and well-being. Risk assessments were carried out and promoted positive risk taking which enabled people to live their lives as they chose. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable for their roles. There were sufficient staff to meet people's needs and staff had time to spend with people. There were systems in place to manage safe administration of medicines.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People had their needs assessed prior to receiving care from the service to ensure staff were able to meet people’s needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

The service continued to provide support in a caring way. People were involved in decisions about their care needs and the support they required to meet those needs. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People were supported to have access to activities of their choice in the community.

People knew how to complain and complaints were dealt with in line with the provider's complaints policy. People's input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.

The provider’s vision for the service was promoting independence and allowing people to live a normal life. This was shared throughout the staff team and embedded within staff practices. We evidenced these practices through people’s care plans and staff feedback.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care to people and promote a culture that was person-centred and achieved good outcomes for people.

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.

People who used the service felt safe. The staff had a clear understanding of how to safeguard people and protect their health and well-being. Staff had a good understanding of their responsibilities to report any suspected abuse. The service had sufficient numbers of suitably qualified staff to meet people’s needs. There were systems in place to manage and support safe administration of medicines.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and had received training in this area. The MCA provides a legal framework to assess people’s capacity to make certain decisions, at a certain time. Staff were supported through on-going meetings, individual one to one supervisions and yearly appraisals to reflect on their practice and develop their skills. Staff received training specific to people’s needs.

The service was caring. People’s relatives and healthcare professionals described the staff as excellent and providing very good care. There was a strong emphasis on key principles of care such as dignity, privacy, individuality, right to make decisions and right to lead as normal a life as possible. People felt they were treated with kindness and said their privacy and dignity were always respected. Staff had developed positive relationships with people.

People’s needs were assessed and care plans enabled staff to understand how to support people. Changes in people’s needs were identified through reviews thereafter. People's interests and preferences were discussed during assessments and these were used to plan their care. The service was flexible and responded positively to people’s requests.

The provider had a clear vision for the service which was shared throughout the staff team. The vision was promoting independence and allowing people to live a normal life. This was embedded within staff practices and evidenced through people’s care plans. Staff felt fully supported by the manager and the provider.

Leadership within the service was open and transparent at all levels. The service supported a positive culture committed to supporting people in regaining their independence. There were good quality assurance systems in place. The provider had systems to enable people to provide feedback on the support they received.