Liberty Support - North

People’s experience of using this service: The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service receive planned and coordinated person-centred support that is appropriate and inclusive to them.

Relatives were happy with the support provided to their family members.

People were able to live their lives with full support from staff who respected their diverse needs.

Staff knew people well, helped them make choices and decisions and encouraged them to be as independent as they could.

The management of medicines was carried out safely. However, some improvements were required in the level of detail in documentation for 'when needed (PRN)' medicines.

People were protected from the risk of cross infection. During our inspection we found two shower chair covers that were heavily stained. These have since been replaced.

There were systems in place to recruit staff safely. There were sufficient staff to provide support to people.

Staff had considered risks to people's health, safety and wellbeing and had taken reasonable steps to prevent them coming to harm.

Staff had received sufficient training and ongoing support to help them carry out their roles.

The service worked closely with other health and social care professionals and supported people to access appropriate health care services when needed.

Staff supported people to take part in activities of their choice.

The service had a process for handling complaints and concerns.

We found improvements were required in care documentation. We have made a recommendation that the service improve its system for reviewing care and support documentation to ensure that all records are completed fully and are up-to-date.

There were systems to maintain and improve the quality of service through audits, surveys and meetings. However, the audits had not identified the discrepancies we found in care records.

Rating at last inspection: At the last inspection the service was rated as ‘Good’ (report published 10 November 2016).

Why we inspected: This was a planned inspection, in line with our inspection schedule.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme. If any concerning information is received we may inspect

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

This was the first inspection of the service since it registered in October 2015. It took place on the 4 October 2016 and was announced.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) to carry on a regulated activity since October 2015. 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.

One of the people we visited could not communicate verbally but indicated to us that they were happy. The other person we visited told us they were happy and safe being supported by the staff in their own home. The registered manager and the staff we met had a thorough understanding of safeguarding procedures. They were fully aware of their responsibilities with regards to protecting people from harm or improper treatment. Historic incidents of a safeguarding nature had been dealt with appropriately. Policies and procedures were in place to ensure the service was operated well.

The registered manager employed enough staff to ensure the service was run safely and effectively. There were no current vacancies for permanent staff. The registered manager had a rolling recruitment programme to build up a bank of staff to cover services in the event of staff absence. There was a robust recruitment process in place and we confirmed this process was followed through by examining staff records. We saw staff rotas were planned in advance and people received a consistent and reliable service.

Care records known as ‘Essential Support Guides’ were very person-centred. Individual care needs were assessed and the risks people faced in their daily lives were regularly reviewed and updated. Explanations of how to reduce risk and avoid incidents were in place to support the staff in the likelihood of an event occurring.

Accidents and incidents were recorded, investigated, reviewed and monitored by the service managers and overseen by the registered manager. The registered manager was aware of her responsibility to report certain incidents to external bodies, such as the local authority and CQC as necessary.

Medicines were safely managed and staff demonstrated that they followed best practice guidance. People were encouraged and supported to self-medicate whenever possible. Medicines were administered safely, timely and hygienically. Medicine Administration Records (MARs) were used to record any assistance given. We saw these were well maintained, accurate and up to date.

The provider had a thorough induction process in place and staff confirmed they had completed the induction and had shadowed more experience workers. Training in topics deemed mandatory by the provider had been undertaken. For example in safeguarding, safe handling of medicines, infection control, first aid and food hygiene. Specific training in dementia care and autism awareness had also been resourced for staff who worked with people with these needs. Formal staff supervision sessions, including a probationary period review had taken place as well as annual appraisals and regular informal discussions. The service managers were in daily contact with the staff through telephone, email and visits to the supported living properties. Periodic staff meetings were held with the staff at each supported living property and monthly service managers meetings took place in the office. The staff we spoke with told us they felt supported and valued at work by the management team.

The registered manager and staff displayed a thorough understanding of the Mental Capacity Act 2005 (MCA) and their own responsibilities within its principles; staff had been given training, people’s mental capacity had been considered and assessed and we saw examples of people being supported to make decisions in their best interests with relevant others involved in the process.

Staff supported people to maintain a well-balanced and where possible, healthy diet. People were supported to shop for and prepare their own meals depending on their abilities. Others were provided with choices and assisted to plan menus for the week ahead. Nutrition and hydration intake were recorded and monitored by staff if necessary. Staff had been made aware of allergies and food intolerances. We saw evidence that staff involved external health and social care professionals as required to provide specialist input into people’s care.

The staff we spoke with displayed friendly, kind and caring characteristics. They spoke with affection and passion about people they supported and they knew them very well. The information they told us tallied with the information we read in the ‘Essential Support Plan’. Staff described to us how they respected people’s privacy and maintained their dignity with actions such as closing the curtains during personal care and always knocking on a door and waiting to be invited in. Notes that were documented on a daily basis by care staff and service managers reflected the caring and respectful values we observed.

There had been three complaints made about the service in 2016. We reviewed the provider’s complaints policy and saw the registered manager had followed the procedures. Complaints were investigated and responded to in a timely manner. Where necessary a meeting had been held with the complainant in order to give a full explanation of what happened and ensure a satisfactory solution was reached. The people we visited indicated they had nothing to complain about. The complaints procedure had been shared with the people who used the service and their relatives.

Monthly satisfaction surveys were used to gather the views of people and their relatives about the service they received.

All of the records we examined were well maintained, accurate and up to date. Records containing sensitive information were stored securely. Regular audits and ‘spot checks’ of the service were carried out by the service managers and the registered manager. Provider audits were carried out by representatives from the provider organisation. This demonstrated the registered provider and the registered manager had oversight of the service and monitored its safety and quality.

There was a positive culture within the service and strong leadership was evident. The registered manager attended regional meetings with managers from other services within the provider organisation. She also chaired a local network meeting for registered managers from other providers in the Oldham area and she worked in partnership with the local authority and outside agencies to develop and share best practice throughout the care industry.