Archived: Independent Living Alliance Liverpool

Independent Living Alliance Liverpool is a service that provides personal care and support to people in their own homes. The service provides support to people who have physical disabilities, sensory impairment,

mental health support needs, a learning disability or autism. At the time of the inspection the service supported over 200 people however just 11 people received personal care. CQC only inspects where people receive personal care.

The monitoring systems in place did not identify the issues we highlighted during the inspection regarding some aspects of record keeping. The registered manager acted quickly to address the issues raised during the inspection.

Medication systems and procedures were regularly reviewed. People received their medicines as prescribed, by trained and competent members of staff. However, some areas of record keeping needed improvement to ensure staff appropriately signed records.

Each person had a detailed support plan stating their needs and requests how they wished to be supported. They were supported to take risks and to make decisions which reflected their preferences and individual needs. However, some aspects of their records needed further review to ensure record keeping was accurate and consistently maintained.

The outcomes for people using the service reflected the principles and values of 'Right care, right culture, right support' and other best practice guidance. However, some staff had no knowledge of this guidance.

We have made a recommendation for all staff to have training and awareness in these values.

People were positive about the service and the staff supporting them.

Staff were very positive about the management of the service and felt well supported. Staff felt they received lots of relevant training necessary for their role. Training records and quality checks were submitted by the registered manager who agreed to review information to show improved clarity how they monitor staff records.

We were assured that infection prevention and control (IPC) measures were appropriately followed. Staff had access to regular training and supplies of protective equipment (PPE ) to help keep people safe from cross infection.

There were sufficient numbers of staff recruited who were safely recruited. Management of staffing levels and rotas were not fully available initially. The registered manager has submitted information to show they have safe oversight to check people have enough staff in place to support them.

Rating at last inspection and update

The last rating for this service was rated 'good' published (4 September 2019.)

Why we inspected

We carried out an announced inspection to follow up on concerns we had received following a safeguarding referral to the Local Authority. The information The Care Quality Commission (CQC) received indicated that there were concerns around governance procedures. Please see the safe and well-led sections of this full report.

Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were not looked at during this visit. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

We looked at infection prevention and control measures under the ‘safe’ key question. We look at this in all services even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively

The overall rating for the service has remained ‘good’. This is based on the findings at this inspection. We found evidence that the provider needs to make improvements. under well-led.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Independent Living Alliance Liverpool on our website at www.cqc.org.uk

Independent Living Alliance Liverpool is a service that provides personal care and support to people in their own homes. The service provides support to people who have physical disabilities, sensory impairment, mental health support needs, a learning disability or autism.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection eight people received personal care.

People’s experience of using this service and what we found

People told us that they had positive relationships with the support staff supporting them. Staff knew people well and used respectful humour in their interactions with people. One person told us, “The staff look after me well. I’m safe with them.” People told us that the support they received and the approach from staff had helped improve their wellbeing.

People told us that their support staff offered the right level of support, they helped people when they needed it but did not take over. People told us support staff empowered them to take control and make decisions, but also knew when to stand back. We also saw that people’s privacy was treated with the upmost respect.

There was a culture of positive risk taking that had benefitted people. Risk assessments had the information staff needed to reduce risks and support people to remain safe. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff had supported people to achieve their goals as part of support planning. People’s care plans and support was reviewed regularly with them, to ensure that it met their needs and wishes.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Senior staff met regularly with the registered manager to discuss the quality of the service provided and to ensure all aspects of the service were being managed appropriately. The registered manager and senior staff had a good knowledge and understanding of the support offered to people, the quality of that support and areas requiring improvement, the current risks and how these were being reduced.

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

Rating at last inspection

The last rating for this service was good (published 6 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Independent Living Alliance is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing in the community. Independent Living Alliance provides care and support to people with learning disabilities, physical disabilities, mental health conditions and acquired brain injury. At the time of the inspection 10 people were using the service.

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations and how the service is run.

At the previous comprehensive inspection which took place in November 2016, the registered provider was rated as ‘Good’ in all five key areas (safe, effective, caring, responsive and well-led).

This focused inspection was carried out due to notifications of concern which CQC received in relation to clinical support people received, particularly in relation to nutrition and hydration risk management.

This focused inspection was carried out to ensure people received effective care and the registered provider was meeting all legal requirements. The team inspected the service against two of the five key questions we ask always ask: is the service effective and is it well-led?

No risks or concerns were identified in the remaining 'Key Questions' (safe, caring and responsive) through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these 'Key Questions' were included in calculating the overall rating in this inspection.

During this inspection we looked at the care people received in relation to clinical conditions they required support with. We did this in order to assess whether relevant risks had been appropriately assessed. People's health conditions were clearly recorded and staff followed specific care and treatment plans to support their overall health and well-being.

We reviewed clinical support processes that were in place to manage and mitigate risk. These included nutrition and hydration risk assessments, speech and language therapist (SALT) guidance, eating and drinking screening tools, dysphagia, (swallowing difficulties) eating and drinking training and competency assessments.

The day to day support needs of people receiving support from Independent Living Alliance were being met. Staff effectively liaised with healthcare professionals such as social workers, GP’s, dieticians, district nurses and SALT in order to provide effective high-quality care.

Staff received regular supervision and were supported with training, learning and development opportunities. Staff told us they felt supported and were able to develop the necessary skills and competencies to deliver effective care. Relatives also told us that staff were well equipped and trained to provide the care which was expected of them.

Consent to care was obtained in accordance with the principles of the Mental Capacity Act (MCA) 2005. The principles of the MCA were being followed and it was clear to see that people were involved in the decisions which were made in relation to the care they required.

Quality assurance systems were reviewed during the inspection. Audits, checks and tools were in place to assess, monitor and identify areas of improvement and development. Some of the feedback we received during the inspection and satisfaction surveys we reviewed indicated that further developments were required in the area of quality assurance.

The registered provider had a variety of different policies and procedures in place. These contained relevant and up to date information and were accessible to staff. Staff discussed a number of different policies with us during the inspection and understood the importance of complying with such policies.

The registered provider was aware of their responsibilities and had notified CQC of events and incidents that occurred in accordance with their regulatory requirements. The ratings from the previous inspection were on display at the registered address, these were also available on the registered providers website, as required.

Independent Living Alliance Liverpool is a registered domiciliary care agency that provides personal care and support to people in their own homes. The organisation provides care to people with learning disabilities, physical disabilities, mental health conditions and acquired brain injury. At the time of the inspection 10 people were using the service. As part of the inspection we were invited to meet with two people living in specialised housing which catered for their health needs.

A registered manager was 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.

The people that we spoke with had no concerns about the safety of services and spoke positively about how safe they felt.

The provider had delivered an extensive training programme for staff and managers regarding adult safeguarding. The staff that we spoke with confirmed that they had attended the training and were able to explain the different types of abuse and what action they would take if they were concerned that abuse or neglect were taking place.

The care files that we saw showed clear evidence that risk had been assessed and reviewed regularly. Risk was reviewed by staff with the involvement of the person or their relative and maintained a focus on positive risk taking to support independence.

Staff were safely recruited following a process which included individual interviews and shadow shifts. People using the service were invited to be part of the recruitment process up to and including participation in interviews.

Staff were trained in the administration of medicines, but because the services were community-based, they were not always responsible for storage and administration. Some people who used the service were able to self-administer their medication, others required prompting. Self-administration had been risk assessed to ensure that it was safe.

Staff had been recruited and trained to ensure that they had the rights skills and experience to meet people’s needs. Staff were required to complete an induction programme which was aligned to the Care Certificate.

Staff were supported by the organisation through regular supervision and appraisal. We saw evidence of these processes during the inspection. Staff also had access to ‘team and practice development’ days where a range of issues were discussed and actions set to generate improvements.

The service operated in accordance with the principles of the Mental Capacity Act 2005. Staff understood their responsibilities in relation to the act.

People were supported to shop for food and prepare meals in accordance with their support plans. Some people were supported with menu planning to improve their nutrition or manage a health condition.

People’s day to day health needs were met by the services in collaboration with families and healthcare professionals. Staff supported people at healthcare appointments and used information to update support plans.

The houses that we visited had been built with the needs of the tenants in mind. They made good use of assistive technology to maximise people’s independence.

We had limited opportunities to observe staff providing support during the inspection. Where we did observe support we saw that staff demonstrated care, kindness and warmth in their interactions with people. People told us that they very were happy with the care and support provided.

We saw that staff knew the people that they supported well. When we spoke with them they described the person and their needs in detailed, positive terms. Staff told us that they enjoyed providing support to people and were able to explain how they involved people in making decisions about their day-to-day care and support.

We saw from care records that people were given choice over each aspect of their service. This choice included; staff, activities and times of support. The support plans that we saw used person-centred language and provided an appropriate level of detail to inform staff. It was clear that people had been actively involved in developing their care and support plans.

The provider encouraged people and their families to provide feedback through a range of formal and informal mechanisms. They issued annual surveys and sought feedback at each review. Information from surveys was shared with people and their families.

People were given a number of options if they chose to complain about the service. They could speak directly to staff or managers. They could also use the complaints procedure. The complaints procedure was shared with people as part of their introduction to the service.

The service had clearly been developed and was continuing to develop with input from people and their staff. A recent engagement event had identified a number of areas for improvement and associated actions.

The organisation had a clear set of visions and values which were displayed in brochures and other promotional materials. These visions and values were linked to organisational strategy and used as one of the criteria on which quality was assessed. Staff were able to explain the visions and values of the services and applied them in their practice.

The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with enthusiasm about the people that they supported and their job roles. Each of the staff was positive about the support and quality of care offered by the organisation.

The registered manager was clearly aware of the day to day culture and issues within the service. We saw that they knew the people using the service and their staff well. Notifications relating to people who used the service had been submitted to the Commission as required.

The registered manager was knowledgeable about their role and the organisation. They were able to provide evidence to support the inspection process in a timely manner and facilitated meetings with service users, family members and staff.

The registered manager and other senior managers had completed a series of quality and safety audits on a regular basis. Important information was captured electronically and used to produce reports. These reports were shared with senior managers throughout the organisation and used at a local level to monitor and drive improvement. The processes were mapped to the Care Quality Commission’s inspection methodology and scored services against qualitative and quantitive measures.

We did not announce our inspection prior to our visit. We set out to answer our five questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. We reached our judgements through speaking with people who used the service and their relatives, speaking with staff and the manager of the service and reviewing records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were appropriately managed.

Staff told us they felt appropriately trained and supported to meet the needs of the people they supported safely.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People were involved in regular reviews of their support.

Staff spoke about 'supporting' people and 'encouraging' people to use their independent living skills and to access the local community.

Is the service caring?

Staff told us they were clear about their roles and responsibilities in relation to promoting people's independence and respecting their privacy and dignity.

Practices were in place to ensure people were involved in decisions about their care and support.

Is the service responsive?

The service worked well with other professionals to make sure people received their care in a joined up way. People were referred to health and social care professionals as appropriate to their needs.

People had detailed support plans which described their needs and how to meet these. Checks were carried out on a regular basis to make sure people received the care and support they needed.

Is the service well-led?

Systems were in place for checking on the quality of the service and making any required improvements. These systems were well developed and effective.

The service was managed in a way that ensured people's health, safety and welfare were protected.

Staff reported feeling well supported and they had the opportunity to meet with their manager on a regular basis to review their work and discuss their development as workers.

"I can go out when I want."

"My relative is well supported."

"I can make an informed decision."

People who used the service and their relatives told us that they felt able to raise any

concerns with the staff. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us that they had accessed supervision training and line management support to carry out their job roles.

The provider had clear systems in place to monitor the quality of the service provided. Clear processes were in place to ensure the maintenance of appropriate standards of cleanliness and hygiene.