Islington Council Shared Lives

The service is run by Islington Council social services department. 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.

The inspection took place on 3 and 17 December 2018 and was announced. The provider was given 48 hours’ notice because the location provides a community based care service and we needed to be sure that someone would be available to speak with us. At our previous inspection on 8 January 2016 the provider met all of the legal requirements we looked at.

At our last inspection on 9 and 12 May 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People and Shared Lives carers told us they felt safe using the service and no one had any concerns about letting someone know if they ever felt unsafe. There were detailed procedures in place for responding to any care and welfare concerns and we noted none had been raised since our previous inspection.

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 who used the service had a variety of support needs. In all cases people were enabled to maximise the degree of autonomy and independence they could exercise in living their day to day lives. Any risks associated with people’s needs were assessed and the action needed to reduce risks was recorded. Risk assessments were updated regularly and did not place restrictive limitations on the reasonable risks that people were free to take.

Staff and Shar3ed Lives carers [these were the people providing support for people in their own home or in the community] respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. People’s preferences about how they wanted to be supported were recorded and carers worked very well at respecting these preferences and enabling freedom of choice. There was a continuing commitment to promote independence and community involvement which was not restricted by procedures or systems. Invariably people believed that the service was very caring, and a lot of trust existed between people using the service, family carers and staff working for the service. The ethos of care and support is notable across the service and underpins the way in which the service promotes shared lives as a positive model of care.

Care plans were compiled in a way that demonstrated these were designed to reflect each person’s unique personal needs and lifestyle. The appropriate guidance for meeting each person’s needs was in place and care was regularly reviewed.

The training records of staff and Shared Lives carers showed that training considered mandatory by the provider had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff supervision was regular. Shared Lives carers had readily available access to support as and when they needed this aside from times they were visited by staff of the service or attending planned carer meetings.

The comments people made demonstrated that people were able to complain and felt confident to approach staff and management of the service if they needed to.

People who used the service, Shared Lives carers and stakeholders had a range of opportunities to provide their views about the quality of the service. Their views about how the service was run were respected and were taken seriously.

Further information is in the detailed findings below.

Islington Council Adult Placement Shared Lives Scheme provides long term or short break placements for adults with learning disabilities or mental health problems within family homes. The families provide the day to day care and support to the adults who are placed with them. At the time of our inspection 13 people were using the shared lives and 8 people were using the short breaks service.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

From the discussions we had with people using the service, carers and other stakeholders, we found that people were highly satisfied with the way the service worked with people. Relatives, carers and stakeholders told us they were confident about contacting staff at the service to discuss anything they wished to. They believed that staff were highly knowledgeable and skilled.

The service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with and only used best interest decisions when absolutely necessary and in consultation with people using the service. Deprivation of Liberty Safeguards were not applicable for anyone but staff and carers understood, and were trained, about these safeguards.

People who used the service had a variety of support needs, although in all cases people were able to exercise a high degree of autonomy and independence in living their day to day lives. Their carer’s and other community support colleagues were readily able to offer support as and when needed. The four care plans we looked at showed that the information and guidance provided to staff and carers about people’s care and support needs was clear. Any risks associated with people’s needs were assessed and the action needed to mitigate these risks was recorded. We found that risk assessments were updated regularly and did not place restrictive limitations on the reasonable risks that people were free to take.

During our review of care plans we found that these were tailored to people’s unique and individual needs. Communication methods of providing care and support with the appropriate guidance for each person’s needs were in place and were regularly reviewed.

The training records of staff and carers showed that training considered mandatory by the provider had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff supervision was regular and geared to support staff and to address their development and work with the service. Staff appraisals were taking place yearly and staff had development and training objectives set arising from the appraisal system.

Staff and carers (these were the people providing support for clients in their own home) respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. From the conversations we had with people, our observations and records we looked at, we found that people’s preferences had been recorded and that the service worked well to ensure these preferences were respected. It was evident during our inspection that people were placed at the heart of how the service operated. Staff and carers designed the support provided around each person as a unique individual. There was a clear commitment with ensuring that people’s support was not restricted by procedures or systems but care was individually designed and the resources required were governed by their needs.

As an example we found a range of support, not just by the service, being provided to a person who had used the service previously and was doing so again for a specific period of time. We spoke with the person who was receiving this support and they told us in detail not only why they needed to use the service but also about how helpful they found everyone who was assisting them.

The comments people made, whether they used the service or were carers demonstrated that people were able to complain and felt confident to approach staff and management of the service if they needed to. People told us they felt that any concerns they had would be listened to and the service was open about action taken and any changes made as a result. We noted that no one told us they had ever needed to make a complaint as the open communication with the service meant that anything they raised was dealt with quickly and well.

People who used the service, carers and stakeholders had a range of opportunities to provide their views about the quality of the service. Their views about how the service was run were respected and were taken seriously. People who had contact with us, whether they used the service, were carers or other professionals all believed the service had a highly positive and inclusive culture. In our communications with care staff we also found they demonstrated a positive and inclusive approach and this was also shown in the flexible way in which the service operated.

At this inspection we found that the service met all of the regulations we looked at.

We found the provider made suitable arrangements to ensure that the dignity, privacy and independence of those using the service were respected. One person who used the service told us, "I like having my own room, it is my special place to go."

We found that people's care needs were met and that care workers were provided with an appropriate level of support from the registered manager. We saw that each person using the service had a care plan specific to their needs. We noted that there were procedures in place to deal with emergencies. A person who used the service told us, "I love living here. I don't want to live anywhere else."

We found that people who used the service were protected from the risks of abuse as robust safeguarding procedures were in place.

We saw that there were effective recruitment procedures in place.

There were suitable arrangements in place to ensure staff were appropriately trained and were told by a care worker, "the training is very good, and there is plenty of it." We were also told that they felt supported by the registered manager, who was always quick to respond, with one staff member saying; "all I have to do is ring for advice and she will either chat over the phone or come out and see me."

We met with seven of the 16 carers on the day of our inspection and attended one of their monthly meetings. The registered manager held monthly meetings with carers to discuss any issues and to offer training and support as necessary. When we later spoke to some of the carers they told us that they valued the opportunity to share experiences with other carers in these monthly meetings.

We found that people's independence was supported with carers and local services supporting adults to find employment and accommodation of their own where suitable.

We found that people's care needs were met and that carers were provided with an appropriate level of support from the registered manager.We found that people who used the service were protected from the risks of abuse as robust procedures were in place.

We found that systems were in place to make sure that the quality of the care being delivered was assessed.