Archived: Durham Share Lives Scheme 1

Updated 26 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the registered 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 scheme, and to provide a rating for the service under the Care Act 2014.

One adult social care inspector completed this announced inspection of Durham Share Live Scheme 1 on 21, 22 and 26 October 2015. We announced this inspection because we wanted to be able to meet with people and the shared lives providers in their own homes.

Before the inspection, the provider completed a Provider Information Return [PIR]. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection we reviewed all the information we held about the scheme. We reviewed notifications that we had received from the scheme and information from people who had contacted us about the scheme since the last inspection. For example, people who wished to compliment or had information that they thought would be useful.

Before the inspection we reviewed any information from the local safeguarding team, local authority and health services commissioners, no concerns were raised by these organisations. Prior to the inspection we also contacted the local Healthwatch and no concerns had been raised with them about the service. Healthwatch is the local consumer champion for health and social care services. They give consumers a voice by collecting their views, concerns and compliments through their engagement work.

During the inspection we spoke with nine people who used the scheme and six shared lives providers in their homes. We also met with, three support managers (who co-ordinate the care people received) and observed them carrying out supervision and monitoring with shared lives providers in their homes and meeting with people who used the service. We met with the registered manager and the scheme administrative staff.

We also spent time looking at records, which included five people’s care records, and records relating to the management of the scheme.

Updated 26 May 2016

This inspection took place on 21, 22 and 26 October 2015 and was announced. This meant we gave the provider two days’ notice of our visit because we wanted to make sure people who used the service in their own homes and staff who were office based were available to talk with us.

Durham Share Lives Scheme 1 offers adults with learning disabilities short term, long term or emergency care. This is provided by people who are known as ‘shared lives providers’ who are supported by ‘support managers’ from the scheme. The care takes place in the home of the shared lives provider.

108 people were using this service when we visited and there were 46 shared lives providers. The scheme offered people a mixture of permanent, respite and long term placements.

There was a registered manager in place who had been in their present post at the service for over fifteen years. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 found people were actively engaged in decisions about their care and shared lives carers and support managers helped people to express their wishes, likes and dislikes about their lifestyle and the activities they wanted to do.

People’s care plans were very person centred, detailed and written in a way that accurately described their care, treatment and support needs. This meant that everyone was clear about how people were to be supported and their lifestyle objectives met. These were regularly evaluated, reviewed and updated. The care plan format was easy for people using the service to understand and also included pictures and symbols which helped people to remain actively involved and this enabled people to tell shared care providers how they wanted their care, treatment and support to be delivered. Care planning arrangements were continually overseen and reviewed by support managers and with people who used the service.

Being part of the scheme had led to many positive outcomes for people who used it. People had fulfilling lifestyles, were engaged in their home and in the communities in which they lived. People we met with were happy, confident and empowered to make decisions about their lives. Relationships with shared lives providers were strong, some people said ‘like another family.’ Shared lives providers were friendly, open, caring and diligent; people using the scheme trusted them.

The Mental Capacity Act 2005 [MCA] provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. All necessary applications to the Court of Protection had been considered, or were in the process of being submitted by the provider. We found in care plans that necessary records of assessments of capacity and best interest decisions were in place for people who lacked capacity to decide on the care or treatment provided to them by the provider. The registered manager explained how they had arranged and taken an active role in best interest meetings with other health and social care professionals to discuss people’s on-going care, treatment and support to decide the best way forward. We saw records of these meetings and decisions undertaken.

Throughout the day we saw shared care providers interacting with people in a very caring and professional way. The registered manager, scheme staff and shared care providers that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that everyone knew people who used the scheme very well. This included their personal preferences, likes and dislikes and had used this knowledge to form very strong therapeutic relationships. The scheme spoke up for people and their rights, to make decisions, to be heard and to receive support when they needed it. We saw all of these details were recorded in people’s care plans.

We found that scheme staff and shared lives providers worked in a variety of ways to ensure people received care and support that suited their individual needs and personality. This meant that people received a versatile and in some cases unique service based on their needs preferences and lifestyle goals. This demonstrated that people who used the service were regularly involved and consulted about the service in meaningful personal ways, helping to drive continuous improvement.

People were supported by well-trained personnel. The provider had its own training department which supported scheme staff and shared care providers to gain the skills and knowledge they needed to meet the needs of people who used the service.

People were protected from the risk of abuse. Shared care providers and support managers understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. When asked they were able to describe what actions they would take if they witnessed or suspected abuse was taking place and what they expected of scheme colleagues and statutory agencies.

People received a balanced diet. Some people using the service had specific diets and preferences and shared care providers were very knowledgeable about these. We saw shared care providers offered a selection of preferred meals and people chose what they wanted to eat. People were encouraged to have a healthy diet and shared care providers also encouraged people to try new meals. Some people prepared their own meals and were supported to do their own shopping.

We saw the provider had policies and procedures for dealing with medicines and these were followed by shared care providers. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.

The scheme had a complaints policy which provided people who used the service and their representatives with clear information about how to raise any concerns and how they would be managed. We saw pictures had been used to help people understand the information. The shared care providers we spoke with told us they knew how important it was to act upon people’s concerns and complaints and would report any issues raised to the registered manager or provider.

We found that the registered manager had comprehensive systems in place for monitoring the quality of the service. This included monthly audits of all aspects of the service, such as medication and learning and development, which were used to critically review the scheme. We also saw the views of the people using the scheme, their advocates and shared lives providers were regularly sought. The registered manager produced action plans, which clearly showed when developments were planned or had taken place.

The provider was subject to internal and external scrutiny to ensure that regional and national government targets are met and good governance could be demonstrated. The scheme is subject to on-going scrutiny and quality monitoring from the providers specialist practitioners throughout a yearly cycle. Results are circulated to lead officers and publically elected council members as part of the local authority’s local and national accountabilities. We looked at recent quality assessments which showed that in the areas of record keeping and medication management Share Lives Scheme 1was following the providers good practice guidance and was the highest performing of the services operated by the provider in these areas.

The registered manager also carried out regional and national benchmarking against key performance indicators for similar schemes and other types of care. This included outcomes for users, scheme scope, size cost and best value. Share Lives Scheme 1 scored highest of its comparators.