LDN London Domiciliary Care Service

Updated 30 August 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.

The inspection took place on 26, 28, 29 June and 2, 3 and 4 July 2018 and was announced. We gave the provider one weeks’ notice of our inspection as we needed to get permission to visit people in their own homes and so that the provider could give them notice, as we did not want to cause any distress or disruption to people’s routines.

Inspection site visit activity started on 26 June and ended on 10 July 2018. We visited the office location on 26, 28 June and 3 and 4 July 2018 to meet the registered managers and to review care records and policies and procedures. We visited 12 supported living services between 28 June and 4 July 2018 to speak with people and staff and review records related to the service. After the site visit was complete we contacted health and social care professionals, who were not present at the site visits.

The inspection was carried out by four inspectors. It also included an expert by experience who was responsible for contacting people and their relatives who used the domiciliary care service to find out about their experiences of using the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection we reviewed the information the Care Quality Commission (CQC) held about the service. This included notifications of significant incidents reported to the CQC and the previous inspection report. We also contacted local authority commissioning teams to support the planning of the inspection. In addition to this we reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spoke with 33 people and six relatives. We also spoke with 45 staff members. This included five registered managers, the director of services, nine team managers, four assistant team managers, 20 support workers, the learning and development manager, a workforce development manager, the buildings and properties manager, two activities coordinators and the chair of the operations and safeguarding committee. We looked at 32 people’s care plans, 10 staff recruitment and training files, staff supervision records and audits and records related to the management of the service.

Before, during and after the inspection we contacted eight health and social care professionals who worked with people using the service for their views and feedback and heard back from five of them.

Updated 30 August 2018

This comprehensive inspection took place on 26, 28, 29 June and 2, 3 and 4 July 2018 and was announced. At the last comprehensive inspection in March 2016 the service was rated as Good.

This service provides care and support to people living in 18 ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living. This inspection looked at people’s personal care and support. This service also provides domiciliary care services. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults with learning disabilities, autism spectrum disorder and mental health issues.

At the time of the inspection the service was supporting 101 people in the City of Westminster, the Royal Borough of Kensington and Chelsea and Camden. Not everyone using Westminster Society Domiciliary Care Services for Adults receives a 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.

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.

There were registered managers in post at the time of our inspection. 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 about how the service is run. The service had six registered managers and one nominated individual who were responsible for all services under this registration.

The service was exceptionally caring. People using the service and their relatives spoke extremely positively about the caring and compassionate nature of the staff and felt that staff went above and beyond their expectations of care to meet their needs.

Staff ensured that people’s emotional needs were supported at sensitive moments in their life and had worked closely with them, their relatives and health care professionals, especially when managing bereavement.

People were supported to have access to advocates if the provider felt they needed support to have their voice heard. Staff had also supported people when they were unable to or found it difficult to express their choices and wishes.

People using the service and their relatives were confident they would be listened to and felt the management team were approachable and felt comfortable getting in touch. The provider gave people the opportunity to discuss the issues they faced and supported them to have their voices heard in the wider community.

People were supported to follow their interests and maintain relationships with relatives and friends that mattered to them. The provider had been creative in overcoming barriers to providing support to people and created opportunities for people to carry out a wide range of activities and events with friends with a shared interest. There was evidence that cultural requirements were considered and positive work had been done to raise staff awareness for people who identified as LGBT+ (Lesbian, Gay, Bisexual, Transgender and other ways that people can define themselves, for example Q (Questioning) and I (Intersex)).

Care was personalised to meet people’s individual needs and the provider ensured people were fully involved in discussions about how they wanted their care and support. An initial needs assessment was completed from which care plans and risk assessments were developed.

The management team understood the legal requirements of the Mental Capacity Act 2005 (MCA) and staff took the necessary action if they had concerns about people’s capacity. We observed that staff respected people’s decisions and gained their consent before they offered support.

People’s nutritional needs were recorded in their care plans and staff were aware of the level of support required, with further guidance available for people who needed extra support. People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, psychiatrists and the community learning disability team.

Risks to people were identified during an initial assessment with detailed guidance and control measures in place to ensure their freedom was respected and staff supported them safely. Advice and guidance was sought from health and social care professionals to support staff to manage a range of complex behaviours that challenged the service

New staff received a comprehensive induction training programme to support them in meeting people’s needs effectively. They shadowed more experienced staff in supported living services before they started to work independently with people. Staff received regular supervision and told us they felt supported by their staff teams and line managers.

People using the service and their relatives told us they felt safe using the service and staff had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

People who required support with their medicines received them safely and all staff had completed training in the safe administration of medicines, which included observations and competency assessments. Appropriate checks were in place to minimise errors and action was taken if errors were reported.

Staff spoke positively about the culture of the service and felt valued as part of the organisation. People and staff were fully involved in the development of the service and staff had opportunities to progress within the organisation.

There was a range of effective quality assurance systems in place to monitor the quality of the service provided, identify any concerns and understand the experiences of people who used the service. The management team were open to feedback to help make improvements within the service.