Voyage (DCA) Norfolk

Voyage care is registered as a domiciliary care agency who provide care and support to people who have a physical and or learning disability. People have their own tenancies. The range of support varies according to people’s needs but some care packages are significant with 24 hours support in place, whilst others are just a few hours to support people in maintaining their independence. The agency also has a re-enablement service which provides intensive support for people who wish to live independently. The purpose of this service is to equip them with the skills they need to enable them to do so. The agency provided a service to many people but on the day of inspection 35 people were receiving a regulated activity.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

During our inspection we found people were happy and engaged well with staff supporting them. They talked eagerly about their plans for Christmas and their many trips out into the community. For those less able, staff ensured they were comfortable and provided them with excellent care, mental stimulation and support to do activities they enjoyed.

The agency carried out its role effectively with robust leadership and delegation. There were clear governance processes in place and the agency reviewed its performance against clear objectives. The agency had a clear business plan which identified areas for growth and improvement. This firmly established year on year improvements and reflected on people’s experiences.

People’s safety was given the highest priority and systems and processes helped to ensure that data was collated about any incidents or events affecting the safety and, or well- being of people using the service. Risk assessments were robust, and records showed clear actions taken to investigate the circumstances of an incident and consider what else could be put in place to lower the risk.

Safeguarding concerns were reported as appropriate and the agency operated in an open, transparent way, cooperating and sharing information with other health and social care agencies as appropriate.

Regular reviews of the care clearly established how the agency were operating effectively and in line with the necessary health and safety regulations. Audits viewed showed high compliance levels and the registered manager had oversight of all aspects of the service.

The agency delivered holistic care working in partnership with other services and health care professionals to ensure people’s needs were met as fully as possible. The organisation was very diverse in terms of the people it supported, and they ensured their workforce could meet the needs of people through good employment processes and training and development of its staff. We met people with rare medical conditions and staff had received bespoke training to enable them to meet their needs and educate others about their needs.

Staff helped to enhance people’s lives and give them confidence and opportunities to have useful, fulfilling lives. Clear care objectives were set and reviewed, showing how people were progressing and encouraged to be more independent, develop and maintain important relationships, life and work skills. Care and support plans were well written and gave an insightful view of the persons strengths and support needs. These were written and reviewed collaboratively.

People were supported to live healthy lives and access the services they needed to stay healthy. Staff regularly consulted health care professionals and reviewed medicines people were taking with the view of reducing or stopping medicines which were no longer necessary. There were robust systems in place to ensure people received their medicines as intended.

The agency had an individualised approach for each person they supported, and this included establishing people’s last wishes should they become ill and require palliative care. People’s needs were met sensitively, and people were supported to have a dignified death.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The agency recognised people’s capacity to live their own lives and encouraged people to make decisions about their care and support, providing, where necessary additional tools and support to do this.

Rating at last inspection was good (published 5 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Voyage, (DCA) Norfolk on our website at www.cqc.org.uk.

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’s feedback about the safety of the service showed that staff had a high level of understanding of this whilst understanding the importance of people remaining independent and able to challenge themselves. People were supported by staff who understood safeguarding procedures and were able to recognise the signs of potential abuse.

Risks to people had been thoroughly assessed and innovative plans put in place to manage these risks while enabling people to live their lives without unnecessary restriction and in the manner they wished.

Robust recruitment procedures had been followed to reduce the risks of employing staff unsuitable for their role. There were sufficient numbers of staff deployed to meet people’s needs. Staff received comprehensive training to enable them to meet people’s care and support requirements.

People were given support to take their medicines as prescribed and medicines were stored and managed safely.

People’s nutritional needs were met and they were supported to access healthcare services if they needed them. People’s health needs were closely monitored and any changes to their needs were immediately reflected in their care plans and the care that they received. The service worked in collaboration with the people who used the service and healthcare professionals in order to ensure people’s wellbeing and quality of life was not only promoted but improved.

The manager and staff had a solid understanding of the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance. People were fully involved in the decision making process and, where required, best interests decisions were made with appropriate others.

People were supported by staff who showed respect and cared for them as individuals whilst maintaining their dignity. People were encouraged to make their own decisions where possible and their consent was sought appropriately. Staff understood the importance of people being in control of their own lives and realising their ambitions and wishes.

People and those important to them were involved in planning their care and agreeing how it was delivered. People’s independence was promoted and their care was delivered in the way they wished by staff who were knowledgeable about their needs, wishes and preferences. Care and support was delivered in a respectful and highly personalised way.

People who used the service and staff who supported them were able to express their views on the service and actively encouraged to think creatively in order to improve the service. People were supported to make complaints and were confident that these would be heard and acted upon. The service maintained good communication with people who used the service and their families.

People were supported to pursue a wide range of leisure activities of their choosing and to maintain contact with their families and other people important to them where they chose to. With the assistance of staff, plans were put in place and actioned to help people meet their wishes and aspirations.

The manager had an excellent overview of the service and regular in depth audits were carried out to monitor the quality of the service. Their approach was one of innovation, commitment and dedication. People described the manager as exceptional.

The service promoted a clear and delivered ethos of promoting the independence and interests of the people it supported. It continually strived for excellence and improvement and put the people who used the service at the heart of its development and decision making. Staff felt valued and respected by the service and spoke highly of the benefits of working for a forward thinking and caring company.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with eleven people who used the services, four relatives of people who used the services and eight staff members. In addition we looked at four people's care and support plans.

Is the service safe?

Risk assessments were in place to ensure that as far as possible people were safe in their homes and that staff were safe in their working environments. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with ongoing support and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs.

Is the service caring?

People we spoke with said that staff treated them with respect and consideration. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing the care.

We observed that staff were kind and caring in their interactions with people.

Is the service responsive?

The provider had a system of dealing with complaints. We found that people's complaints had been dealt with in a timely manner. There were two outstanding complaints which were going through internal investigation at the time of the inspection.

People told us that the provider responded to their changing needs in a timely manner.

People who used the services and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

At the time of the inspection the provider was in the process of moving from a semi paper based quality assurance system to a fully computerised one. This meant that all of the provider's sites would have access to the same system for information gathering and sharing.

All of the people using the services that we spoke with said the care and support provided was consistent and of good quality. From our observations we saw that care and support was effective and consistent.

We saw that staff knew the people they were supporting and caring for and that the people receiving the care and support were happy. We noted that if something was not right that staff moved quickly to resolve matters.

Is the service well led?

The agency was well managed. Although the regional manager had a large number of sites to manage there was a good relationship in place across the management structures to support people using the services. Managers demonstrated a good knowledge of the provider's sites, supporting staff and of people using the service.

Views of people using the services and of their families were obtained and opportunities were in place for social gatherings where further views and opinions of the services, and staff, could be gained.

Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged.

The service carried out an assessment of people's needs before they used the service. Risk assessments were in place to ensure that people's day to day living was safe.

Recruitment checks on staff members had been carried out before they commenced employment with the service. We found that staff had been trained to deliver safe and effective care.

There was an effective system in place to monitor the quality of the service provided.

People told us that the service was responsive to their feedback and any complaints they had made. An effective system was in place to monitor complaints. Records were available for inspection when required. These were in the main, accurate and up to date.

A relative told us, "We did have a problem with staff not turning up on time but after speaking with the manager this got sorted out and now we don't have a problem."

We observed that staff were caring and understood the needs of the people they were supporting. This meant that the needs could be met.

During this inspection we found shortfalls in the management monitoring the quality of the service. The service did not have robust mechanisms in place to ensure that important decisions in relation to the provision of care and treatment for people who used the service were taken at the appropriate level. This meant that people using the service could not be assured that there was someone in overall control of the service who could identify risk and make decisions that protect the health, welfare and safety of people.

We spoke with four care staff. Two staff recently employed by the service told us they had received induction training which included mandatory training in safeguarding people from abuse, equality and diversity and first aid.