Background to this inspection
Updated
27 April 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 on 27 and 29 November 2017 and 10 January 2018, and was announced.
The provider was given 48 hours’ notice because the location was a domiciliary care agency providing support to younger adults with learning disabilities living in their own or rented accommodation. People were often out during the day, so we needed to be sure that someone would be available to speak with us.
On the first day the inspection consisted of one inspector and an expert-by-experience, with a further two days completed by one inspector. The expert-by-experience made phone calls to people and their relatives on the initial day of the inspection to gain their views about the service. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had knowledge and experience of caring for someone with autism and learning difficulties.
We used information the provider sent us in the Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about what the service does well and improvements they plan to make. We contacted the local safeguarding team and other health professionals that regularly visited the service.
During the inspection we spoke with ten people using the service, three members of staff, one team leader, the registered manager and business manager. We observed interactions between staff and people supported by the agency. We also reviewed records, including training and recruitment for five staff; four people’s care plans and reviews, minutes of meetings and other documentation relevant to the running of this service.
Following the inspection we were contacted by three health professionals that gave us feedback about the service and we spoke with a further two members of staff by telephone.
Updated
27 April 2018
The Inspection took place on 27 and 29 November 2017, and 10 January 2018 and was announced. After the second day of inspection we received some concerns from health professionals in relation to how transitions between services were managed. We returned to the service on 10 January 2018 to discuss these with the registered manager. At the last inspection, the service was rated good. At this inspection the service remained good overall and had improved to outstanding in the responsive domain.
This service is a domiciliary care agency. It provides personal care to people living in individual houses, bungalows and self-contained flats maintained by the provider. It provides a service to adults with learning disabilities or autistic spectrum disorder. There were 33 people being supported by the service in their own homes.
We found the service had considered the national plan to develop community services for people with learning disabilities and/or autism - ‘Building the Right Support’. This plan was introduced in 2015 and advises certain criteria that providers should meet when delivering good quality care, these are; quality of life, keeping people safe, and choice and control.
There was a registered manager in post. 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 live extremely fulfilled and independent lives. Staff supported people to access educational and employment opportunities that were meaningful to them. Activities, events and holidays were chosen by people supported by the agency and they were involved in planning them each year. Staff went that extra mile to make people feel comfortable and accepted as individuals, celebrating their diverse needs.
Staff were passionate about the delivery of person centred care to meet individual needs and preferences. They worked closely with people to ensure they achieved their aspirations and worked as a team to improve the experiences for those supported by the agency.
The management actively sought people’s views and opinions about the service and utilised their experiences to improve practice within the organisation. Relatives felt they could have frank and honest discussions with the registered manager and staff, who were responsive when dealing with concerns, and always listened to their views.
The service worked in partnership with health professionals to meet people’s needs, this included additional specific training.
Staff used different methods of communication to ensure people understood and were able to make informed decisions about how they wanted to live their life.
Care plans were detailed and included important information about how people wanted to be supported including preferences, interests, and life histories.
People and their relatives felt they were safe in their home environments and that staff supported them appropriately to access the community. Risk assessments were in place which identified risks and guided staff in how to minimise them. Medicines were managed, administered and stored safely.
Inductions were comprehensive and included introductions to people using the service, training, shadowing more experienced member of staff, and competency checks. Regular monthly supervisions, informal chats and annual appraisals supported staff to carry out their roles effectively.
Staff were caring and compassionate about delivering person centred care. They respected people’s dignity and privacy. They obtained people’s consent prior to delivering care and support and where people were unable to make decisions for themselves best interest meetings were held to support them. 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 support this practice.
Quality assurance processes were in place to identify any improvements that needed to be made. Audits were completed to ensure staff were competently carrying out their roles and identified any areas where additional training was needed.