Background to this inspection
Updated
27 June 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place between 23 April and 14 May 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit. We visited the office location on 23 and 25 April 2018 to see the manager and office staff; and to review care records and policies and procedures. We visited one person in their own home and spent time at the registered provider’s supported living home. The inspection team consisted of two adult social care inspectors.
Before the inspection we gathered and reviewed information from statutory notifications. The provider completed a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. The inspection was informed by feedback from questionnaires completed by a number of people using services, relatives, staff and professionals. We contacted the local authority commissioning and monitoring teams and reviewed all the safeguarding information regarding the service. We also contacted Healthwatch to see if they had received any information about the provider and they shared the information they had about this service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We spoke with the registered manager, three assessment and reviewing coordinators, the positive behaviour manager, the communications manager, the monitoring and development manager, the human resources manager, the training and development manager, two senior support workers, the rota senior and two care workers during the inspection. We spoke with a visiting social worker during the inspection. We met two relatives and spoke with one person using the service over the telephone during the inspection. We met with four people using the service during our inspection and two senior care workers and a support worker at the supported living home. We reviewed three care plans in detail as part of this inspection and a further four care plans to look at particular aspects such as falls prevention and behaviour management. We looked at all the quality assurance information and records relating to the management of the service, their policies and procedures.
After the inspection we spoke with two commissioners and emailed a third. We spoke with one local authorities lead around deprivation of liberty and emailed one person from Skills for Care for their feedback. We spoke with five relatives, and six care staff following the inspection.
Updated
27 June 2018
This inspection took place onsite 23 and 25 April 2018 and was announced. We also spoke with relatives and professionals up to 14 May 2018. The service had been inspected previously on 4 and 5 October 2016 and was found to be in breach of a regulation. The registered provider had immediately resolved this matter and implemented systems to ensure this did not happen again.
This service is a domiciliary care agency. It provides personal care to people living in their own homes with physical disabilities, learning disabilities, and behaviours that challenge, especially autism. This service also provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Not everyone using Active Social Care Limited 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. At the time of the inspection the service supported 104 adults and 84 children. 19 adults and four children required support with ‘personal care’. Five people were provided with care and support in a ‘supported living’ setting.
There was a well-established registered manager in post who was also the director of the company. 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 and their relatives told us they felt completely safe and comfortable with staff who visited their home. Robust policies and procedures were in place to assist staff to safeguard people from harm and abuse and the staff we spoke with understood their responsibilities with regards to protecting people.
Risk assessments were extremely detailed to ensure staff supported people to remain safe. These were frequently reviewed and updated as people's needs changed. Staff were confident about how to react and what actions they would take in an emergency situation. Behavioural support plans were exceptional in their detail, ensuring restrictions were kept to a minimum and the risks around behaviours which challenged could be managed. The service recognised the risks around using medicines to manage behaviours that challenged and were actively seeking measures to minimise this. Systems were in place to manage medicines administered in people's own homes and audits were undertaken regularly to ensure staff were meeting the required standard of practice.
Staff had an excellent working knowledge of the key requirements of the Mental Capacity Act 2005. All staff demonstrated a commitment to promoting the rights and choices of people who used the service and ensured people's human and legal rights were respected. Feedback from professionals confirmed staff at the service excelled in their understanding of the Act, and were truly committed to the purpose of the legislation to protect people’s rights and freedoms. Decision specific assessments were in place and staff encouraged people to be involved in decisions about them in their best interests.
Values based recruitment practices ensured staff with the right skills were employed. There was a proactive support and appraisal system for staff, which recognised that continuous development of skills, competence and knowledge was integral to ensuring high quality care and support. Staff were supported through individual supervision. Unannounced observational checks of staff performance were carried out at regular intervals in people's homes to ensure staff provided a high quality service.
The provider had an excellent person-centred culture and this underpinned their service and was the foundation for their vision and values. The management team and staff were extremely committed to delivering a service which was exceptionally caring and empathetic. People and relatives overwhelmingly expressed their satisfaction about the service, telling us they could not manage without it. The service went to great lengths in ensuring that people and care staff were well matched, and shared the same interests in life or had similar personality traits. People had a choice in who cared for them and their feedback was sought on the effectiveness of the relationships.
People were given encouragement and support to reach their full potential and live life to the full, assisted by passionate staff who were responsive to their needs. Staff were innovative in supporting people into employment and saw the impact they had on people’s lives when these outcomes were achieved.
People's care and support was planned proactively in partnership with them and their involvement was recognised as key to providing person-centred care. The views of people using the service and their relatives were at the core of quality monitoring and helped shape service delivery. The service was moving towards electronic records to ensure they provided real-time evidence of the person-centred care they were providing.
The service was exceedingly well-led with the emphasis on continuous improvement. The registered manager encouraged staff to be innovative and there was a dynamic, positive and open culture at the service. Staff were “buzzing” with ideas and examples of how they had implemented new ways of working to benefit the people using the service.
Excellent links with the local community and other providers in the area had been fostered by the registered manager. They set up and chaired a registered manager forum to share good practice amongst other registered providers. They shared their knowledge, policies and procedures with other providers and supported them by providing training opportunities which ultimately benefitted people using services in the local community. They provided training to parents on how to manage behaviours that challenged to ensure consistency of approach when dealing with their relatives.
There was a consistent teamwork approach from members of the management team to those providing care and support. Staff told us about the excellent support they received from colleagues which enabled good team working.
Staff were continually reminded of the management's appreciation of their hard work and dedication. Staff received public acknowledgement and financial rewards as recognition they had gone 'above and beyond' in their role. Staff told us they felt extremely valued by the management team and that there was an open, friendly and honest culture, where they did not feel afraid to discuss anything and were very supported by the managers at the service.