Shared Lives

Not everyone using Shared Lives (Bromley) receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help or prompting 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.

At our last inspection we rated the service good overall. At this inspection we found the service had made further progress in some areas and the evidence continued to support the rating of good in most key questions. However, we found some improvement was needed in the key question safe, to the way some risks were recorded to ensure that relevant information was available to SLCs and staff. We have also made a recommendation in relation to the management of medicines. The registered manager started to take action to address these areas during the inspection.

The service remains rated good overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they were safe and enjoyed living with their SLCs. The SLCs and staff working on the scheme had a good understanding of the signs of possible abuse and how to report it. Most risks to people were identified, assessed and plans put in place to reduce the likelihood of the risk occurring. The provider regularly updated and monitored these to ensure people were safe. SLCs understood the importance of infection control and the need to reduce any possible risks. The registered manager and team were proactive in identifying any learning from incidents or safeguarding to make improvements to the service.

Robust recruitment processes were operated for staff and the SLCs to ensure only applicants suitable for the role were approved. There were enough staff and SLC’s to ensure people’s needs were met at all times and there were effective arrangements in place for emergencies.

SLCs received a range of training to provide them with the skills and knowledge to care for people effectively. SLCs spoke very positively about the training and support they received from the staff who worked on the scheme.

People were encouraged to eat healthily and their nutritional needs were identified and met. People had access to a range of health professional advice when needed.

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.

Some people had lived with their SLCs for a number of years. People spoke very highly of the care and support they received from the SLCs. They said they were consulted about their care, that they felt part of the family and encouraged to do things independently where possible; in line with registering the right support.

People’s needs were assessed before they joined the service and they had individualised care and support plans that addressed their needs. People’s diverse needs were recognised and met and information was available in a range of formats if needed. They received highly personalised care and told us about changes and improvements they felt they had made since being part of the scheme. It was evident the scheme had improved outcomes for people.

In line with registering the right support guidance people were encouraged to be as independent as possible and to be part of their local community. SLCs were positive about the work they did and the support they received from the scheme. People were aware of how to make a complaint if they needed to.

Everyone we spoke with was complimentary about the way the scheme was managed and the leadership of the registered manager. The service had developed since the last inspection and made several improvements to the way they monitored the service and sought feedback. There was a culture of continuous improvement. The scheme worked in partnership with other professionals and agencies and looked to learn from best practice. Feedback from people and SLCs was sought to consider how to make any improvements.

SLCs told us there was a positive and open culture about the way the service was managed and we confirmed this from our findings.The service worked to deliver personalised care in a sensitive and supportive manner.

Shared Lives recruits, trains and supports carers who provide placements for adults within their own family homes in the community. Most people using the service have learning disabilities. There were twenty nine people using the service on the day of the inspection.

The service had a registered manager in place at the time of the inspection. 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 told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of the types of abuse to look out for and how to raise safeguarding concerns.

We saw that risk were managed effectively. Comprehensive risk assessments were in place for people that included steps to take to minimise any risks identified. Risk assessments were personalised and were individual to the person. People were encouraged to take positive risks.

Medicines were managed safely and effectively and regular audits took place at monthly monitoring meetings.

People were supported with sufficient staff with the right skills and knowledge to meet their individual needs and promote person centred care. When the carer whom the person lived with went on holidays, people would normally be offered a placement with a carer within the scheme that provided respite care.

We observed positive and caring interactions between carers and people who use the service and they were treated with kindness and compassion. Carers understood what privacy and dignity meant when assisting people and the importance of ensuring people had choice.

Care plans were person centred and reflected what was important to the person. Care needs were regularly reviewed and updated to meet the changing needs of people who use the service.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff were also safely recruited with necessary pre-employment checks carried out. Staff received regular supervisions and annual appraisals.

Staff had received training on the Mental Capacity Act (2005) and understood what to do if they had concerns with regards to people’s mental capacity. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff regularly met with people and their carers to ensure the service was meeting their needs and they were providing a good service.

People’s care records showed relevant health and social care professionals were involved with people’s care and arrangements were in place for them to have regular visits to the GP, dentist and opticians.

The service used the local authority complaints policy and one complaint had been logged in the past 12 months. We saw that complaints were addressed appropriately and concerns and complaints were used as an opportunity for learning or improvement.

The service was well run and the approach adopted by the registered manager and shared lives staff was positive and transparent.

Quality assurance systems were in place to monitor the quality of service being delivered. We saw surveys that had been completed by people that use the service in October 2015 and all of those completed were very positive.

The registered manager was committed to improving the service and identified areas for improvement.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke with two people who used the service during our inspection who told us they felt safe. The service had appropriate safeguarding procedures in place and the carers we spoke with had an understanding of safeguarding and had received safeguarding training. The service was in regular contact with the local safeguarding team. Systems were in place to ensure the service learnt from events such as accidents, incidents and safeguarding investigations. This reduced the risks to people.

Recruitment and personnel records showed that the service carried out appropriate checks to ensure the carers that were recruited were appropriate people to work in care. We saw that DBS (Disclosure Baring Service) checks and two written references were obtained before placements were made with carers. We saw that the qualifications, skills and experience required for carers was looked at before placements were made.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt the service met their needs. One of the people we spoke with said 'My Carers X & X are great, they help me do what I want to do.' When people were referred to the service details of their care needs, medical history, allergies and likes and dislikes were detailed in the referral forms. The service carried out an assessment of people's care needs and involved the person. The care plans we saw met the needs identified in referral forms and during assessments. This meant the service was meeting the identified needs of people who used the service.

Is the service caring?

People were supported by kind and attentive carers. The people we spoke with said they were happy living with their carers. They told us that their homes had 'a family' atmosphere. We read customer feedback forms that were sent to the service from the relatives of people who used the service. The forms were positive about the service. People said their relatives were looked after by 'warm and friendly' carers.

Is the service responsive?

There was a complaints procedure in place. People knew how to make a complaint if they were unhappy. We saw that the service had a system in place to respond to complaints. The people we spoke with told us the service had asked them about their lives and what they liked to do. The records we read showed that people were supported to access activities that were important to them. We saw that people were supported to go to college, attend day centres and to visit people that were important to them. We also saw that regular checks were made to ensure people had not changed their minds about what they liked to do.

Is the service well-led?

The service had regular panel meetings to discuss the appropriateness of placements and to review existing arrangements. The service worked well with other agencies to ensure people received their care in a joined up way. The carers we spoke with were aware of the aims and objectives i.e. to provide a 'caring' and 'responsive' service that meets the needs of people. We saw that the service regularly asked people for their views and acted upon what they found. We saw that external organisations were asked to quality review the service and acted upon recommendations they made.

We also gathered evidence of people's experiences of the service by reviewing client satisfaction surveys. Each person in a long term placement completed the survey once a year, away from their carer's home and with the support of a member of the Shared Lives team. We looked at 15 surveys completed in the autumn of 2012 and saw, for example, that people felt their carer listened to them and helped them learn new things; that they got to make their own choices; that friends and family could visit them when they wanted to; and that they had support for health appointments.

We found care was planned to meet the individual's needs and to keep them safe, and that people were protected from abuse. Arrangements were in place for obtaining people's consent to care and for acting in people's best interests. Recruitment procedures ensured people were supported by suitably qualified, skilled and experienced carers; and the provider had systems in place to monitor the quality of the service people received.