Barnardo's Disability Support and Inclusion (DSI) Service

Barnardo's Disability Support and Inclusion (DSI) Service is registered for the regulated activity 'personal care'. The remit of the service has changed slightly due to changes in service contract agreements with local authorities and the clinical commissioning group. At the time of this inspection Barnardo's DSI Service provided 'short break services' to the families of children or young people who have special needs because of a disability. 'Short break services' can include time spent with children or young people in their home or in the community on an activity, or taking part in a pastime.

Not everyone using Barnardo’s Disability Inclusion and Support Services 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in place at the time of our inspection. 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.

Staff were aware of the different types of abuse, how to recognise them and how to report them to senior management or other external agencies.

Procedures were detailed around practices for medicines administration. Parents and carers told us these were always administered appropriately and on time.

The induction process was comprehensive and additional courses could be accessed by staff to continually develop their skills and knowledge. The management team encouraged partnership working such as specialist training with health professionals. Staff had built strong working relationships with partner agencies to achieve positive outcomes for people.

Recruitment processes were robust and included pre-employment checks to ensure people were suitable to work with children and young people.

Activities were varied and took into consideration people's likes, dislikes and suggestions. We saw positive feedback from people that received services and their parents and carers.

Care plans were personalised and included information about peoples likes, interests and preferences. The provider was in progress of improving collation of information around people's life histories.

Risk assessments were detailed and provided personalised information to enable staff to support people in line with best practice whilst considering people's preferences.

Parents and carers told us that staff practiced good standards of personal hygiene. All staff completed infection prevention and control training.

Reviews of care were completed regularly and parents and carers were encouraged to participate. Staff were keen to ensure children and young people had their views heard. The provider demonstrated positive outcomes for people and this was an area they were looking to record in more detail in the future.

Staff had a good understanding of equality and diversity and gave examples of how they supported people's diverse needs.

Regular staff and management meetings addressed current issues. Actions plans showed that staff views and opinions had been listed to and measures taken to improve the working environment.

The service was proactive in engaging with parents and carers through meetings, home visits and annual satisfaction surveys.

Feedback around communication and the leadership of the service was positive. Parents and carers praised staff for their continued support and described staff and management as 'amazing'.

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.

The registered manager had good oversight of the service and had introduced positive changes to drive improvements in the service.

Further information is in the detailed findings below.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager that had been registered and in post for the last four and a half years. A registered manager is a person who has registered with the Care Quality Commission (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.

Over the years the remit of Barnardo’s Disability Support and Inclusion Service (Yorkshire Region) has changed with changes in contract service agreements with local authority social services departments. At the time of our inspection it operated a ‘Short Breaks’ service via a contract with Hull City Council, to parents and carers, whose children have a disability and require 24 hour support and supervision. It operates a ‘Spot Purchase’ contract with East Riding of Yorkshire Council to provide respite to parents and carers. It also facilitates ‘All Stars’ sessions and a ‘Flying High’ group, both of which involve children and young people coming together to share experiences, enjoy activities, develop their skills and knowledge and support each other. At the time of our inspection there were approximately 35 children and young people being supported by the service.

'Short Breaks’ and the ‘Spot Purchase’ can involve support workers spending time with children or young people in their home or in the community on an activity or taking part in a pastime. Some personal care and support with nutrition or taking medication, for example, is provided where required, but only as necessary. This service provides respite to parents and carers who care for their children 24 hours a day and ensures parents and carers are able to take a break from those responsibilities.

‘All Stars’ participants meet weekly and are supported by support workers to enjoy activities, learning and experiences that they might otherwise be excluded from in the community. The emphasis is on developing children and young people to achieve their potential. ‘Flying High’ participants are young volunteers who work with Barnardo’s and support other young people with disabilities to participate in all areas of life.

Children and young people were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Support workers were appropriately trained in safeguarding children from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that children and young people avoided injury of harm.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Support worker numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the people that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure support workers were ‘fit’ to care for and support children and vulnerable people. On the rare occasions that support workers were required to handle medication for children and young people, this was safely carried out.

Children and young people were cared for and supported by qualified and competent support workers that were regularly supervised and received appraisal regarding their personal performance. Communication was effective and children and young people’s rights were protected. They received support with adequate nutrition and hydration to maintain their levels of health and wellbeing, if required of support workers.

Children and young people received thoughtful support from kind support workers and support workers knew about their needs and preferences. Parents and carers were supplied with the information they needed to ensure they knew what support was provided and when. Support workers understood the importance of obtaining children and young peoples’ consent before they undertook support tasks.

Children and young people’s wellbeing, privacy, dignity and independence were monitored and respected and support workers worked to maintain these wherever possible. This ensured children and young people were respected and protected.

Support was provided according to person-centred support plans, which reflected children and young peoples’ needs well. These were regularly reviewed. Children and young people were supported to engage in pastimes and activities and any family or friend networks were encouraged and facilitated. There was an effective complaint procedure in place and parents or carers were able to have any complaints investigated without bias.

The service was well-led and those that used the service had the benefit of this because the culture and the management style were positive. There was an effective system in place for checking the quality of the service through the use of audits, satisfaction survey/checks, meetings and good communication.

Parents and carers had opportunities to make their views known through direct discussion with the registered provider or the support workers and through more formal complaint and quality monitoring processes. Recording systems used in the service protected children and young peoples’ privacy and confidentiality, as records were well maintained and were held securely on the premises.

We found people that used the service and project workers were aware of the procedures and practice to obtain consent before people received any care or treatment. Information told us people were asked for their consent and the provider acted in accordance with their wishes.

We also found people that used the service, parents or carers and children or young people, experienced effective, safe and appropriate care and support that met their needs and protected their rights. People said, "The workers are lovely, they do whatever I ask" and "I have recently come back to Barnardo's for support...I now have someone who...is fantastic".

We found there were effective systems in place to reduce the risk and spread of infection. People that used the service, parents or carers and children or young people, experienced good standards of infection control and were not put at risk of harm from infection because workers had been trained in the prevention of infection and their practice followed good guidelines.

We found that people that used the service were given their medication in a safe way, if workers were responsible for giving them it, because workers had been trained to administer it safely, at the right time and according to the prescribed instructions.

We saw there was evidence that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

From looking at the quality assurance systems and speaking with people that used the service we found that the provider had an effective system to regularly assess and monitor the quality of service that people received. This meant people benefitted from safe quality care due to effective decision making and management of risks.

We found people that used the service experienced open and transparent systems for handling complaints and so they were listened to and their views were effectively acted on.