Live & Learn

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. At the time of our inspection there was one adult and one child using the service.

Not everyone using Live and Learn receives 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.

People’s experience of using this service:

• The provider had continued to make improvements since our last inspection in April and May 2017.

• Staff received better training and continued to receive supervision and support to help them with their work.

• The provider continued to improve the records they kept and the checks they did to make sure people received good, safe care. This included new policies and procedures to make sure staff were up to date with legal requirements.

• People continued to receive safe care by staff who knew the risks people faced. Staff supported people to be independent while keeping them safe.

• The provider reviewed and updated support plans for the person and child using the service. These were personalised and gave staff guidance on the support they required to have their needs, wishes and choices met.

• People and children continued to be protected from abuse. Staff received refresher training in safeguarding adults and children and were aware of the reporting procedures to follow if they witnessed or suspected abuse had occurred.

• People and children continued to participate in a variety of social and recreational activities that met their social and physical needs. They were encouraged to eat and drink sufficient amounts to maintain good health.

• Staff continued to support people and children with their medicine safely .

• The provider and staff worked with healthcare professionals to make sure people and children had the support they needed, when they needed it.

• Relatives told us they thought the staff were good. People and children received support from the same staff, this meant there was a continuity of care and staff knew people and children’s needs well.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for this service after our inspection was “good”.

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

Rating at last inspection:

• At our last inspection the service was rated as “requires improvement”. Our last inspection report was published on 1 June 2017.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Follow up:

• We will continue to monitor this service to ensure people receive safe, compassionate and high-quality care. We will re-inspect in line with our schedule for those services rated as good. We will inspect sooner if we think there is a risk to people.

We carried out a focussed inspection in November 2016 to check the provider’s progress in meeting legal requirements. Although we found some improvement had been made the provider had not made all the changes needed. The provider told us unforeseen circumstances had impacted on their capacity to prioritise the improvements that were required but said these would be made by the end of December 2016.

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. At the time of this inspection there were two adults and one child using the service.

The service had a registered manager, who was also the provider, in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider had taken action to make the improvements needed to meet legal requirements. Measures were now in place to reduce identified risks to people and children. The provider assessed and reviewed risks to people and children due to their specific health care needs and those posed by the environment. They also ensured detailed plans were in place for staff to follow to reduce and minimise these.

Staff had received training and felt well supported in their roles by the provider. They were aware of their responsibilities in relation to The Mental Capacity Act 2005 (MCA). However staff were still not up to date with moving and handling procedures and any recent developments in this area to enable them to support people effectively. This training was scheduled for completion in May 2017. The provider had also reviewed and improved training provision. But it was too early at this inspection to assess the effectiveness of these new arrangements to check these were leading to improved outcomes for people and children using the service.

The provider had reviewed and updated support plans for each person and child using the service. These were personalised and set out for staff the support people and children required to have their needs, wishes and choices met. Relatives were actively encouraged to participate in planning and reviewing the care and support their family members needed. Where there were changes to people and children's needs, their support plans were updated and staff were immediately made aware so they knew how these should be met.

The provider had implemented a new computer based records management system. Information about people, children and staff was now stored in one place and was easily accessible when required. People and children’s care records were now up to date and accurate. Staff files contained details about the training and supervision they received and evidence of employment and criminal records checks. As these changes had only recently been made it was too early to assess the effectiveness of these arrangements and whether these changes could be maintained and sustained by the provider.

At our focussed inspection in November 2016 the provider told us they were planning to implement new policies and procedures for the service as existing policies required updating. At this inspection we found this had not yet been done. In the interim, any changes to current working practices had been verbally communicated to staff to mitigate, in the short term, any risks that could arise from out of date information about working practices. However the provider was aware new policies and procedures needed to be implemented to minimise risks further.

The provider also needed to make further improvements in relation to recording quality spot checks they undertook on staff. In the absence of this information, the provider might lack the ability to effectively challenge poor staff performance. We saw evidence of other quality checks made by the provider including checks on care records, staff records and other records relating to the management of the service. People and relatives were able to give the provider feedback about the quality of support they received and how this could be improved. The provider maintained arrangements to deal with their complaints and issues appropriately.

People and children continued to be protected from abuse. Staff received refresher training in safeguarding adults and children and were aware of the reporting procedures to follow if they witnessed or suspected abuse had occurred.

People and children continued to participate in a variety of social and recreational activities that met their social and physical needs. They were encouraged to eat and drink sufficient amounts to meet their needs, supported to maintain good health and received the medicines prescribed to them. Any concerns about the health and welfare of a person or child were referred promptly to an appropriate healthcare professional promptly.

Relatives were satisfied with the care and support provided by staff. They said staff were kind and caring and respectful of the rights of people and children. There were enough staff to meet people and children’s needs. The provider ensured the same staff provided support so that people and children experienced continuity in their care. Staff turnover at the service was low but the provider continued to maintain recruitment procedures to enable them to check the suitability and fitness of staff.

We undertook this focused inspection on 3 November 2016. We checked the provider had made the improvements needed to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Live and Learn on our website at www.cqc.org.uk

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. Most people using the service have had their care funded by their local authority. At the time of this inspection there were three people, mainly young adults, using the service.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider had not yet made all the improvements needed to meet legal requirements. The provider told us, since our last inspection, due to unforeseen circumstances they had had to step in and provide direct care and support to people for a significant period of time to ensure they received the care and support they required. The provider said as a result, this had impacted on their ability to prioritise the actions required to make the improvements needed.

The provider told us they had taken some action to make improvements. They had made arrangements to attend training in moving and handling procedures and the Mental Capacity Act 2005 to update their knowledge and skills in these areas. They were also working with an external company to help them identify specific training staff required so that appropriate courses could be arranged for them to attend. The external company was also supporting them to implement new service policies and procedures that would guide staff in how to care for and support people appropriately.

The provider told us the improvements that still needed to be made. These included ensuring information about managing identified risks to people was current and easily accessible, people's care and support plans were current and reviewed regularly to check for any changes to their needs, quality spot checks undertaken on staff were recorded and other records relating to the management of service, such as staff training information was current. The provider said these improvements would be made by the end of December 2016. We will visit the provider after this date to check these improvements had been made.

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. Most people using the service have had their care funded by their local authority. At the time of this inspection there were ten people, mainly young adults, using the service.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider in breach of their legal requirement with regard safe care and treatment. The provider had not done all that they should to identify and manage risks to people and staff to ensure they were sufficiently protected from the risk of injury and harm.

We found the provider in breach of their legal requirement with regard staffing. The provider had not ensured staff had received all the appropriate and up to date training they needed to support people effectively.

We found the provider in breach of their legal requirement with regard person centred care. The provider had not ensured that the service arranged their own regular reviews to ensure that the care and support provided to people continued to meet their needs.

We also found the provider in breach of their legal requirements with regard to good governance. The provider’s systems to assess and monitor the quality and safety of care that people experienced were ineffective. Records kept by the service had not been maintained in such a way as to ensure these were complete, accurate and up to date.

You can see what action we told the provider to take with regard these breaches at the back of the full version of the report.

People’s relatives and staff had mixed views about the management of the service. Relatives said they preferred to deal with staff providing care to their family member rather than contacting the provider’s main office where management and administration staff were based. A relative described the main office as ‘chaotic’ and said the office was short staffed. A staff member however told us they felt well supported by the registered manager in terms of dealing with any issues or concerns they had and their own personal development. The registered manager confirmed there had been changes in current staffing arrangements in the main office and they planned to take on all the current administration and management duties themselves.

People’s relatives said staff had the skills and experience to support people with their care. Although staff said they were well supported, the provider had not followed their own policy for ensuring staff received regular formal supervision. The registered manager acknowledged current arrangements were not enough to assure themselves of staff’s on-going competency and ability to carry out their roles effectively. They said these would be reviewed and amended.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. The provider could not be fully assured that all staff were aware of their legal responsibility to act within the principles and codes of conduct associated with the MCA, when obtaining consent from people they supported. This was because they had not ensured staff received training on the MCA. The registered manager agreed to undertake training in the MCA after the inspection. However staff sought people’s consent before providing care and support wherever possible. Outcomes from best interests meetings held by care professionals, when people lacked capacity to make specific decisions about their care and support, were used to inform staff how care and support should be provided in these circumstances.

People’s care records and support plans were not as comprehensive and detailed as they should be. Information about people’s needs was not always detailed and did not always reflect their preferences and likes and dislikes. People’s plans did not always explain how people’s needs should be met by staff. This did not give us assurance that the provider had taken steps to ensure people were not put at risk of receiving inappropriate care from staff unfamiliar with their specific care and support needs.

However, people’s relatives were satisfied with the care and support provided by staff. They spoke positively about the support provided by staff to their family members. Relatives said staff were patient, kind and caring. People were supported by regular staff members so that they experienced consistency and continuity in their care. This meant staff had a very good understanding of people’s specific needs. They knew people’s life histories, their likes and dislikes, their interests and hobbies and demonstrated flexibility in responding to people’s specific wishes. Staff supported people to undertake activities and outings of their choosing and to maintain relationships with the people that mattered to them. They respected people’s right to privacy and dignity. They encouraged people to be as independent as they could and wanted to be.

People were safe when receiving care and support from staff. Staff appropriately managed risks to people on a day to day basis. They knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults and children at risk and knew how and when to report their concerns if they suspected someone was at risk of abuse. People were encouraged to eat and drink sufficient amounts and supported to keep healthy and well. Staff made sure people received their prescribed medicines promptly. The registered manager planned staffing levels to ensure there were enough staff to meet the needs of people using the service. The provider carried out appropriate checks on staff to ensure they were suitable and fit to work for the service.

Staff supported people on a day to day basis to express themselves using their preferred method of communication. The provider formally asked people and their relatives for their views about the quality of care and support they received through quality questionnaires. This process had recently been reviewed to improve the current response rate from people and their relatives. The provider had appropriate arrangements in place to deal with any concerns or complaints people had about the service.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

The provider's staff recruitment and selection process was adequate. Care workers had completed training in keeping vulnerable people safe. Assessments were carried out by staff to make sure that people's needs were identified so care plans could be developed about how to meet them.

Is the service caring?

People we spoke with were positive about the care provided by care workers. Comments included, 'They (care worker) are very calm and placid, just what my child needs'. Another parent said, 'She (care worker) was part of our family'.

People were involved in making decisions about how they wanted to be cared for. They told us that care staff respected their privacy and dignity, and that they were involved in making choices about their care.

Is the service responsive?

People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. We found that care workers monitored people's conditions and where necessary sought the advice and assistance of other community based health professionals such as GPs and district nurses.

Is the service effective?

People received care from care workers that were well informed and trained to meet their needs.

Is the service well-led?

The agency did not have a registered manager as required by legislation. We have asked the provider to tell us what they are going to do to meet the requirements of the law. We will make sure that appropriate action is taken by the provider by completing a follow up inspection in the near future.

On the day of our inspection, the manager/owner was unable to be present. The inspector was therefore assisted by an experienced care worker who was in day to day charge of the service whilst the manager was off sick.

We contacted two sets of parents of children who used the service. This was because the children themselves were not able to communicate verbally over the telephone to us to express their views. We also spoke to two members of staff who provided the direct care to the families.

This inspection was carried out as part of the 2012/13 inspection programme. It was also to follow up on two compliance actions which had been made at the previous inspection in February 2013.

We contacted three sets of parents of children who used the service. This is because the children themselves were not able to communicate verbally over the telephone to us to express their views. We also spoke to three members of staff who provided the direct care to the families.

This service was a small independent agency who had worked with families for some years. The manager was also the owner, and often worked with individual families; there was a small, permanent staff team. This meant that there was continuity and consistency with each child having a main worker who did the majority of the visits.

Parents were positive about the support provided by the staff and the level of consistency that they had. One comment we received was, 'she (the member of staff) is an absolute God-send' and from another parent, 'she (child) always enjoys going out with them'.

There were significant areas that the service could improve on, namely staff training and written documentation relating to the children themselves.