LDC Supported Living

LDC Supported Living is a supported living service for people with a learning disability and autism. Some people lived with others and shared houses and shared amenities such as kitchens, bathrooms and lounges with other people. Other people lived alone. People received care and support to help them live independently in the community. There were 41 people receiving a personal care service at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Staff received safeguarding training, however, we found this had not always been effective with staff’s actions on occasions leaving people at risk. Staff did not always feel confident that all the managers in the service would take action about concerns. The provider did take appropriate actions when made aware of issues.

Staff recruitment systems were not always effective in ensure staff were suitable for their roles. Action was taken by the provider to resolve this after the inspection. Some records relating to people’s care were not accurate or required updating. Documents were not always easily accessible and on occasions used language about people which could be perceived as derogatory. Information was not always shared with other professionals in a timely fashion. After the inspection, the provider put in place a new system for recording information which should address many of these concerns.

People were supported to take part in a range of activities they enjoyed. This gave them the opportunity to develop new skills and have new experiences. People were supported by staff who knew them well and who gave them information in the way they understood such as pictures or their first language. People were supported and encouraged to maintain relationships with friends and family who were important to them.

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 provider and staff advocated for people and supported them to challenge discrimination. People were supported in the way they preferred by staff who had the training and support to carry out their roles. People were supported to stay healthy, by attending health appointments and having a healthy diet.

The provider used recognised tools such as person-centred planning and positive behaviour support to form the foundation of people’s care. The provider worked with other agencies such as the police and educational organisations to raise awareness of the needs of people with a learning disability. The provider was an active member of local care organisations and took part in projects with the NHS. People’s complaints were responded to appropriately. People, staff and relatives were asked for their views of the service, which were used to form the basis of action plans.

The service applied the principles and values 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.

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 8 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding risks, poor communication, low staffing levels and staff not working with professionals to meet people’s needs. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to safeguarding, staff recruitment, governance and leadership.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

LDC Supported Living is registered to provide personal care to people with learning disabilities, living in their own homes. Some people lived in their own flats or houses and others in shared accommodation, such as two/three bedroom houses, where they shared communal areas with other people. At the time of the inspection the service was supporting 28 people across Dover, Ashford and Folkestone.

The service had a registered manager who was available on the days of the 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.

We received positive feedback about LDC from people, relatives and professionals. We heard about good standards of care and support which improved people’s wellbeing and the quality of people's lives. We observed warm, caring attitudes from staff and a drive to provide a quality service for people.

People trusted staff and felt safe whilst being supported by them. Staff had received training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. People's needs were met promptly and effectively by staff who knew people and their preferences very well. Staff had completed comprehensive induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. Management staff carried out routine checks of staff knowledge and capability.

Staff received a comprehensive programme of training and were supported to develop their skills and knowledge. The provider encouraged progression and supported staff to attain qualifications. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and support.

Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

The registered manager and management team provided clear leadership to the staff and led by example. Staff were motivated and felt well supported by management and the provider. Staff felt that the provider was committed to their wellbeing and were committed to the values of LDC. Staff treated people as individuals and each person received person centred support. Staff told us the registered manager and management team were very approachable and they were positive about their style of management.

Medicines were stored and administered safely. People were supported in safe environments and possible risks to people had been identified and were managed to keep people as safe as possible whilst enabling people to live as independent a life as possible. People's health was monitored and professional advice sought quickly and efficiently as needed. Staff worked collaboratively with health professionals, especially from the local community teams, forming working relationships which had led to good outcomes for people.

People’s health care and nutrition needs had been comprehensively assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff were knowledgeable about people’s health care needs and liaised with health professionals and family members when appropriate.

People received care that was tailored specifically to them, needs had been assessed to identify the care they required. Care and support was planned and reviewed with people to make sure they continued to have the support they needed. People were actively encouraged to be as independent as possible. Detailed, specific guidance was provided to staff about how to provide all areas of the care and support people needed. Staff knew people well which enabled them to support people in a personalised way.

Bespoke packages of care were planned for people who had challenged traditional services. They identified suitable properties, made adaptations specific to the person and sought appropriate staff. For example; staff who spoke the person’s first language.

Staff listened to what people told them and responded appropriately. Staff knew people very well and responded to noises, gestures and body language. People were treated with respect and their privacy and dignity was maintained. People and their relatives told us that they had no complaints and if they did they would speak to the staff who would listen to them and take action.

Staff actively encouraged people to be involved and feel included in their environment. People chose what they wanted to do throughout their days and staff supported them. Staff were fully committed to ensuring people participated in the activities of their choice and had supported people to fulfil their goals of meeting people, visiting places, attending college courses or securing jobs. People told us about the different things they did and holidays that they had planned and organised with staff.

The registered manager encouraged an open culture; and people, relatives, visitors and staff were all enabled to speak out with any concerns; so that they could be put right. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements. People, their relatives, professionals and staff were asked about their experiences of the care. These were used to improve and develop the service.

People, relatives and staff told us that the service was well led and staff felt supported by the registered manager to make sure they could support and care for people safely and effectively. Professionals told us the registered manager and staff provided responsive care and support for people. Accurate records were kept about the care and support people received and about the day to day running of the service. This provided staff with the information they needed to provide safe and consistent care and support to people. The registered manager and management team had good oversight and was able to fully assist us in all aspects of our inspection.

The people we spoke with told us about the support they needed from staff. They said they would go to staff if they had any problems, concerns or worries. They told us that the staff supported them well. One person said 'they all need medals as a special award'. We saw that care records included people's views and the choices they had made about their individual support plans. The staff we spoke with were aware of people's preferences and individual support needs.

We found that staff were supported by the provider to effectively meet the needs of people who used the service. A member of staff told us that they felt 'well supported and valued'.

We found that the provider had undertaken surveys and collated feedback from people's representatives and health care professionals who supported people who used the service. We saw that some of the comments included 'the management team always go the extra mile to find solutions to problems' and 'excellent communication with health care professionals'.

We found that the service kept records safely and stored them appropriately, to ensure people's details and information was protected.

People who used the service that we spoke to were positive about the staff who supported them and comments included, 'he's a good driver, like him" and "all good get on well with staff."

We saw how staff supported people to understand their care plans by making them as relevant to the individual as possible by personalising them with the use of colour, personal stories, history of events and photographs. We saw that these were reviewed regularly with the person who used the service to ensure that people got the right support.

In order to protect the people who used the service, we saw that the provider carried out a rigorous staff recruitment process which included relevant criminal record checks. We saw that people who used the service participated in the providers interview process and had a say in who should be appointed.

We saw that staff were knowledgeable about people's needs and preferences, were observed to treat people as individuals and care was person centred with the focus on delivering positive outcomes for people in a personalised way.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires, reviews and one to one discussions.