Avocet Trust Domiciliary Care Service

Avocet Trust Domiciliary Care service provides care and support to people with learning disabilities and autism, so they can live in their own home as independently as possible. At the time of this inspection one person was receiving the regulated activity personal care.

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

Staff were trained, skilled and well-supported by the provider. Enough staff were employed to provide support. Some staff had worked at the service for a long time and this provided consistency for the person. Systems were in place to recruit staff safely.

Staff had positive links with health care professionals, which promoted the persons health and wellbeing. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks. The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness safety and how to minimise risks.

The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interest; the policies and systems in the service supported this practice.

Care and support was tailored to the persons needs and preferences. Staff worked well with other professionals and services to ensure the person received the support they needed to stay well and safe. Professionals spoke positively about the caring nature of the staff and the service provided.

The registered manager led by example to ensure the person received a good service. Relatives and staff told us the registered manager was approachable and listened to them when they had any concerns. Feedback was used to make continuous improvements to the service.

The outcomes for the person using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. The persons support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This announced inspection took place on 10 January 2017. The last inspection of the service took place on the 4 and 11 March 2016 when we found the registered provider was non-compliant with the regulation relating to maintaining complete and accurate care records. We also asked the registered provider to improve the recording of complaints and concerns together with the information recorded in risk assessments.

During this inspection we saw that the registered provider had taken action to ensure that detailed records were maintained in care records and risk assessments and all concerns and complaints received by the service were recorded, identifying what action had been taken by the service to resolve these.

The service had a registered manager. 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.

The person who used the service had complex needs and was not always able to tell us in detail about their experiences. We relied on our observations of care and our discussions with staff and other professionals involved.

The person who used the service required received continuous support from staff and needed to be supervised whenever they went out. It was clear from our observations that the person who used the service trusted the staff that supported them and positive relationships had been developed. They were supported by caring and attentive staff who understood their individual needs and knew their preferences for how care and support should be delivered. Staff explained things in a way that the person could understand; they made eye contact and treated people with dignity and respect.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns. Medicines were handled safely and staff had received training in this area.

Staff understood how to gain consent from people who used the service; the principles of the Mental Capacity Act 2005 were followed when people were unable to make specific decisions themselves. The person who used the service was supported to eat a healthy diet and drink sufficiently to meet their needs and were supported by a range of healthcare professionals to ensure their needs were met effectively.

The staff and registered manager were responsive to people’s changing needs. Reviews of the person's care took place on a regular basis; the individual and their appointed representative were involved in the initial and on-going planning of their care. Care plans had been developed which focused on supporting the person who used the service to maintain and develop their daily living skills whilst remaining safe.

The person who used the service took part in a range of activities and went to social events. The registered provider had a complaints policy in place that had been created in a format that made it accessible to the people who used the service.

The service was led by a registered manager who understood their responsibilities to inform the CQC when specific incidents occurred. A quality assurance system was in place that consisted of audits, daily checks and questionnaires. Action was taken to improve the service when shortfalls were identified.

The last inspection was completed on 16 April 2014 and was found to be compliant with the regulations inspected at that time. This inspection took place on 4 and 11 March 2016.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found improvements needed to be made to ensure updated information in people’s care records were signed by staff in a timely way to acknowledge they understood the changes that had been made. Records in relation to care provided including the monitoring of people’s weight, their food and fluid intake and support with care tasks also required improvement to ensure current information was in place and there were no gaps in records.

People we spoke with told us that comments, concerns and complaints were not always well managed and that communication was not always effective. Complaints and concerns raised were not logged in the service complaints log. Although the registered manager and staff were working with relatives and professionals to resolve their concerns, records of the nature of these and actions taken had not been recorded within the service.

Improvements needed to be made to ensure accurate and up to date records were maintained in relation to both care and the recording of concerns and complaints. This is a breach of Regulation 17(2) (c) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the report.

The people who used the service were supported by a small core group of staff who were familiar with their individual needs and preferences. Over the previous months there had been a need for agency and bank staff to be used. Professionals and relatives told us they considered the agency staff and turnover of staff had detracted from the provision of continuity of care, with subtle changes to care and support having an impact on the people’s well-being.

There were policies and procedures to help guide staff in how to keep people safe from the risk of harm and abuse. Staff understood the various types of abuse and knew how to report any concerns. We found staff were recruited safely and full employment checks were carried out before new staff started work. Staff received an induction and had access to training, supervision and support to help them to develop and feel confident when caring for people and carrying out their roles. Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely.

We found that people who used the service were supported to make decisions in line with principles of the mental Capacity Act 2005 and that potential instances where people using the service were deprived of their liberty had been alerted to the supervisory body, which was the contracting local authority. Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest

People had risk assessments in place which helped to guide staff in how to minimise the reoccurrence of incidents. Staff had read the risk assessments and were aware of their responsibilities and the steps to take to minimise risk, but this was not always reflected in daily records maintained. This was discussed with the registered manager to address.

We found people had access to a range of health professionals and staff were clear about how they monitored people’s health in order to seek medical attention quickly. Relatives told us this was not always their family members experience of the service, but things had stated to improve. Professionals told us staff were proactive in seeking advice and support when people’s needs changed.

Menus did not show alternatives were available and records did not confirm choices and alternatives were available for each meal; we observed drinks and snacks were served between meals. Records maintained for eating and drinking needed to be improved to ensure these accurately reflected what people had consumed. The registered manager told us they would address this with staff.

A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. The previous system had sought views about how the service was run, but where comments had been made, it did not reflect the action the organisation had taken in respect of these.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

' Is the service caring?

We observed staff speaking to people in a friendly and professional way. We saw that staff gave people time to respond to questions and encouraged them to make decisions for themselves.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People who used the service and their relatives completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

' Is the service responsive?

People had access to a range of health and social care professionals such as mental health nurses, community nurses, the orthotics department, chiropodists and GPs. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations.

Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated periodically.

' Is the service safe?

The manager set the staff rotas and they took into consideration people's care needs when deciding on the numbers of staff on duty and the skills they required to meet people's needs.

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

Staff had completed training in how to safeguard vulnerable adults. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly so people who used the service were not put at unnecessary risk.

' Is the service effective?

Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

People's health and care needs were assessed. Specialist equipment needs had been identified in people's care plans where required.

The home had been had specialised equipment to meet the needs of people who used the service.

' Is the service well led?

The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people and their relatives about how the service was run and took account of their views.

Staff had a good understanding of the ethos of the service and told us they enjoyed their work. Staff had policies and procedures to guide their practice and received regular training, supervision and support from management.

What people who used the service and those that matter to them said about the care and support they received.

We used a number of different methods to help us understand the experiences of the people who used the service, because the people had complex needs which meant they were not able to tell us their experiences. We spent time observing the care that was provided, reviewed care records, support plans and spoke with the staff who supported people.

Each person had a care file which provided comprehensive information about their assessed needs as well as their preferences, interests, and any risks associated with their care. The people we spoke with said they were happy with the care and support provided, and staff helped them to be independent. One person said, 'I like to clean the kitchen and do things for myself. I make sure things are switched off before we leave the house, so it's safe.' A relative told us, 'My son receives the support he needs, it's tailored to him.'

People were provided with a choice of suitable and nutritious food and drink. The care plans we looked at recorded people's nutritional needs in good detail so staff had all the information they needed to support the person appropriately and monitor their wellbeing. One person told us, 'I help choose meals, the food is nice.'

Robust background checks had been carried out on staff before they started to work for the organisation to make sure they were suitable to work with vulnerable people. One person said, 'The staff are friendly and nice.'

We found the provider assessed and monitored the quality of the service. One person's relative told us, 'I'm very happy with the service and care, I see the manager regularly and everything is going well at present.'