West House Domiciliary Service

West House Domiciliary Service provides care and support to people living with a learning disability or autism. Seven people live alone in their own properties, eight people live in houses with one other person. There are 41 people who live with 3 or 4 other people in shared accommodation.

Not everyone using West House Domiciliary Service 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.

People’s experience of using this service

People told us they felt safe and staff had received suitable training about protecting vulnerable adults. Accidents, incidents, complaints and concerns were responded to appropriately. People told us they had good support from staff. The registered manager kept staffing rosters under review as people's needs changed. People or their relatives were involved in recruitment. New members of staff were specifically selected to work with individuals and had been suitably vetted.

People told us staff understood their needs. Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles.

People saw their GP and health specialists. People told us they were supported to budget, shop and cook healthy meals and to look after their health. Staff took the advice of nurses and consultants. The staff team completed assessments of need with health professionals and with the learning disability teams. People were happy with the arrangements for medicines support. Medicines were suitably managed with people having reviews of their medicines on a regular basis.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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.

People told us the staff were caring. We also observed kind and patient support being provided. Staff supported people in a respectful way. They made sure confidentiality, privacy and dignity were maintained.

Risk assessments and care plans provided detailed guidance for staff in the home. People in the service, their social workers and relatives, where appropriate, had influenced the content. The registered manager had ensured the plans reflected the person-centred care that was being delivered. People told us they enjoyed the activities, interests and hobbies on offer. Staff could access specialists if people needed communication tools like Makaton or braille. Staff worked with psychologists and psychiatrists when necessary.

The service had three registered managers who dealt with operational matters, complaints and concerns, staffing and quality assurance and training. They consulted people and their representatives in a number of different ways. They were analysing quality monitoring reports to complete the new business plan, 'Transforming West House'. People, their relatives and the staff were enthusiastic about the immanent changes

Rating at last inspection

At the last inspection the service was rated Good (published 8 December 2016).

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

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up

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

West House Domiciliary Service is part of West House. The organisation is a charitable trust which provides residential care and support in the community to people living with a learning disability. The provider has a number of small care homes, this domiciliary and supported living service and also operates cafes, a therapeutic centre, day centres and community contact hubs, and a market garden where people who use services can have work placements.

West House Domiciliary Service provides care and support in the Carlisle, Allerdale and Copeland areas. They support nearly sixty people who are living with a learning disability. Support is given in people's own homes and can range from a few hours a week to full support twenty four hours a day, seven days a week. Some people live in tenanted properties referred to as supported living. People in these supported living services share a home with other people with learning disability and there is a staff team who deliver the care and support to all of the people living in the property. Others live in their own properties, either on their own or with families, and are supported according to their needs.

The service had two registered managers. 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 service had good arrangements in place to ensure people who used the service were kept as safe as possible. Staff were trained to help prevent people from being subject to harm and abuse.

We saw that staff received good levels of training and supervision to help them to understand the issues around discrimination and human rights.

We had evidence to show that there were detailed and up to date risk assessments and risk management plans in place for all aspects of the service. The organisation had an emergency plan which was put into operation in December 2015 during the Cumbria floods.

There were suitable arrangements in place for staff to voice their concerns because the service had a 'whistleblowing' procedure and staff felt confident that they could approach management with any concerns.

Arrangements were in place to monitor any incident or accidents and the service was prompt in notifying the Care Quality Commission, safeguarding teams and social work staff.

Staffing levels were suitable to meet the needs of people using the service. New staff were appropriately recruited, given suitable induction, closely monitored and supervised for the first few months. Staff received good levels of training in a wide range of subjects. We saw that staff received this kind of support throughout their career and all aspects of staff development were given a high priority. Good disciplinary and grievance systems were in place.

Good arrangements were in place to help staff support people with their medicines. The staff managed all aspects of medicines management for some people and this was done well.

Staff received training and supervision in relation to infection control and good hygiene standards so that they helped people to have clean and safe homes.

The registered managers had a very good understanding of the Mental Capacity Act 2005 and were working with the local authority to ensure they had suitable arrangements in place where there was any suggestion that someone was being deprived of their liberty. There was good evidence that the organisation sought consent from service users where possible.

Staff received regular training on supporting people whose behaviour could challenge. No one had been restrained in the service as de-escalation was used.

Staff helped people to budget, shop and prepare food. They supported some people with all their hydration and nutritional needs. Other people were supported to follow special diets or to maintain their weight.

People were given the right levels of support to see their GP, community nurses and specialised health care professionals. Learning disability nursing teams were involved with people's care and support needs.

Staff had a caring yet professional approach and people told us that the staff were respectful and caring. Independence was promoted as much as possible in the service and the registered managers and the staff teams were actively supporting people to move on to more independent living. People had good access to advocacy services.

People who used the service had detailed and up to date care plans, health action plans, challenging behaviour plans and very good risk management plans.

Staff supported people to go out into the community to socialise, pursue leisure pursuits and to take up education, voluntary work and paid employment. The organisation had staff who ran the businesses where people had work placements but the organisation also supported people to gain paid employment.

The organisation had a management structure which integrated their care homes and this service. The registered managers had responsibility for the service but they delegated some aspects to other managers. This arrangement worked effectively. The management team were suitably experienced and qualified.

The culture was one where people were included and disability was no barrier. The service had an enablement agenda and the core values of the organisation were sound yet realistic and sensible.

Good audits of quality were in place and these were part of a robust system of total quality management.

Record keeping was detailed and up to date. The service was transitioning over to a 'paperless office' system and some aspects of this were being progressed to ensure the keeping of records was suitable. Records were secure yet accessible.

The people we spoke with said that they did not have any concerns about the service. They told us that they knew who to contact at the office if they did have any concerns or problems.

From our observations we saw that people received the support they needed and were given choices about their care. We observed that staff treated people with respect. Staff encouraged people to maintain their independence and control over their lives. People were being supported to lead interesting and meaningful lives of their own choosing through the input of the agency.

We saw that the provider had an effective system to regularly assess and monitor the quality of service that people receive.They regularly asked people what they thought of the service and made changes in light of what people said.

People were involved in the development of their care and support plans. They told us that they knew what was recorded in their care plan and that 'staff provide the support needed.' Saying, "All the staff are great" and "I do amazing things like go to college, have a job, go bowling and to the cinema and the gym. The staff help me to do all of this".

From our observations we saw that people received the support they needed and were given choices about their care. We observed that staff treated people with respect. Staff encouraged people to maintain their independence and control over their lives. People were being supported to lead interesting and meaningful lives of their own choosing through the input of the agency.