Affinity Trust Domiciliary Care Agency East

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good overall, with the responsive domain being rated as outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This comprehensive, announced inspection took place on 10, 16, and 22 May, and 20 July 2018.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were supported by staff who were aware of their responsibilities in reducing the risk of harm occurring. Processes were in place to protect people from harm or poor care. Staff used equipment and technology to help promote people’s independence safely. Staff were only employed after satisfactory pre-employment checks had been obtained. There were sufficient staff to ensure people’s needs were met safely. Medicines were managed safely by trained and competent staff. The provider had effective procedures in place to support the prevention and control of infections. The provider had robust systems in place to manage accidents and incidents and lessons learned were shared across the organisation.

People's assessed needs were met effectively by staff who had the right training, knowledge and skills. Staff encouraged people to use technology to help keep them safe and promote their independence. People were enabled to access healthcare services and to eat and drink a healthy balanced diet and lead healthy lives. 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 supported this practice.

People were supported and cared for with compassion, empathy and kindness. Staff treated people with dignity and respect. Staff empowered people to make their own choices about things that were important to them. Staff encouraged people to maintain and maximise their independence. People had access to information that was available in alternative formats to enable peoples’ understanding.

Staff supported people to maintain their links with the local community to promote and develop social inclusion. Staff used creative ways to help people maintain and develop their hobbies and interests. The registered manager and staff had an excellent understanding, and were very responsive to, each person's individual needs. Staff provided care that was person-centred and tailored to people’s individual needs. People's care arrangements took account of people's wishes and choices, including their likes and dislikes, what was important to them and any future goals. Staff were proactive in supporting people to develop and maintain relationships that were important to them.

People had access to the provider’s complaints policy and procedure that was provided in an appropriate format to support people’s communication needs. The provider had a process in place to receive and manage people's suggestions, concerns and/or compliments.

People had a say in how the service was run. People and their relatives were given opportunities to feedback on the quality of the service provided and felt listened to.

The registered manager provided good leadership. They and senior staff, made sure that the values of the service were embedded and promoted by staff. The provider’s governance, quality assurance systems and audits were effective in monitoring that the service complied with legislative requirements and promoted best practice. Staff worked in partnership with other professionals to ensure that people received joined-up care.

Further information is in the detailed findings below.

This comprehensive inspection took place on 10 May 2016 and was announced.

A registered manager was in post at the time of the inspection and had been registered since 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the agency. 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 were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were supported to take their medicines as prescribed.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access health care services and their individual health needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People’s mental capacity was assessed and care was provided in their best interest. Staff were trained and knowledgeable about the application of the MCA. Arrangements were in place for external agencies to assess people and make DoLS applications to the Court of Protection [CoP], if these were required. The outcome of these assessments was pending.

People were looked after by staff who were trained and supported to do their job.

People were treated by kind staff who they liked. They and their relatives were given opportunities to be involved in the review of people’s individual care plans.

People were supported to increase their integration into the community; they were helped to or take part in recreational and work-related activities that were important to them. Care was provided based on people’s individual needs. There was a process in place so that people’s concerns and complaints were listened to and these were acted upon.

The registered manager was supported by a team of management staff and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

We found that care records were current and reflected the needs of people who were supported by the service.

Staff we spoke with were clear about the procedure to follow if they had any concerns in relation to an allegation of abuse or concerns about the care and support being provided.

Staff we spoke with enjoyed their jobs and felt very well supported by their immediate teams and managers. One staff member told us: 'There is a great rapport in the team. We are really well supported. Training is great, and I feel staff are really listened to in this organisation'.

There was a system in place to check that people were satisfied with the service and an effective system to monitor and audit services provided to people who were supported by the provider.

Care and support was person centred and well coordinated. There were regular reviews to ensure that any changes to people's needs were being met. People were involved in the planning of their care and support.

Staff were trained in safeguarding people from harm and had access to policies and information about how to contact the local authority safeguarding team.

There were thorough recruitment procedures in place to ensure that only staff suitable to work with vulnerable people were employed to support people using the service.

The agency had an effective system to regularly assess and monitor the quality of the service that was provided to people.