Aspects Care Limited

Aspects Care Limited is a supported living service providing personal care to 31 people many of whom were living with learning disabilities and or autism at the time of the inspection.

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.

The service has 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 received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People received safe care. People were supported by staff who understood the action to take should they have any concerns about people’s safety. The risks associated with people’s care had been identified and plans put in place to minimise these. Staff had been recruited safely. People were supported to take their medicines safely.

People received effective care. People received support to eat and drink meals of their choosing and where required were supported to access appropriate healthcare. Staff had received training in people’s needs. 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.

People felt well supported and cared for by staff. People told us of the benefit a regular staff team had for them. People had been involved in developing a plan of care based on their preferences. Staff enjoyed supporting people and we were informed of examples of the positive impact the service had had on people’s care.

People received care that was responsive to their needs. People had been involved in reviewing their care to ensure it continued to meet their needs. People participated in activities of their choosing. People and relatives felt able to raise any concerns and be assured these would be investigated.

The service was well led. Systems were in place to monitor the quality and safety of the service. People and staff were able to feedback their views of the service and had opportunities to suggest improvements. The registered manager was aware of their responsibilities for notifying the commission of specific events.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 5 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aspects Care Ltd is registered to provide personal care. They provide support to 46 people living in their own home. People required support from the agency because they had a learning disability, mental health needs or a sensory impairment. Some people had short care visits of approximately one hour and other people had the support of one or more members of staff throughout the day and night. We call this supported living.

The registered manager was present during our 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.

We spoke with one person who used this service. Some people who used this service had support needs that meant they were unable to give us any direct feedback about the care they received.

The relatives of people using this service told us that staff were aware of the need to keep people safe and follow the risk assessments in place. Staff knew how to report allegations or suspicions of poor practice. Our discussions with people and looking at the staff rota showed us that there were enough staff employed to ensure the care and support was reliable. Staff had been recruited appropriately and safely.

Some people needed the support of staff to administer and manage their medicines. We found that medicines were well managed. The staff had received training and competency checks to ensure they were able to handle and administer medicines safely.

The majority of staff we spoke with told us they had received adequate and relevant training to meet the specific needs of people they supported. Records showed that the registered manager was aware of which staff continued to require training or updates. Staff told us that they had received competency checks to ensure they were safe to undertake some aspects of their work.

Care staff demonstrated how to promote choice and maintain people’s independence. The authorising body had been consulted and agreed restrictions on people’s liberty. It was positive that work to explore other possible restrictions had commenced. This would ensure people’s human and civil rights were fully protected.

People were supported to maintain a healthy lifestyle, and to see health professionals when required. When people required assistance to plan and prepare meals and drinks staff prompted people to make healthy choices based on their preferences and nutritional needs.

Relatives described the staff who supported their loved ones as being kind and compassionate. Staff who worked for this service understood the needs of the people who they supported. Staff supported people to make choices and decisions about the care they received through a variety of communication styles. People were supported by staff who respected their dignity and privacy.

The care plans reflected the individual needs and wishes of each person. They were in place to enable staff to provide care in the way that people preferred.

Some people required staff to help them plan and undertake activities. We found the majority of people enjoyed a range of activities that met their needs and preferences. Specialist support had been requested for people with complex needs, who found accessing many activities difficult.

The registered manager had ensured that the service continued to meet people’s needs and to comply with the requirements of the law. There were audits and monitoring systems in place that helped the registered manager and registered provider understand the strengths and challenges of the service, and where to target their improvements. People, relatives and staff we spoke with were happy about the quality of the service that was provided by the consistent team of staff employed.

In December 2013 we inspected the agency and at that time found that they were not meeting three of the essential regulations. This meant people using the service could not be certain their care and welfare needs would be met, that they would safe from abuse or the risk of being abused and that the systems in place to check on quality and safety were working effectively. We made compliance actions to ensure these areas were addressed and to ensure the service improved for people using the agency. We conducted this inspection to follow up on the issues of concern and see what progress had been made. Generally we found that many improvements had been made although the agency had not yet achieved full compliance in all of the regulations we assessed.

Aspects Care service is registered to provide personal care. This means that staff employed by the agency provide care and support to people living in their own home. Some people have short calls of 30 minutes to enable them to maintain their independence at home. Other people require more staff support and at the time of our visit some people were receiving 24 hour care from a team of carers. Below is a summary of what we found. The inspection findings are based on our observations during the inspection, reading records and discussions with people. We spoke with five people who used the service, three people's relatives, seven of the staff that supported people and talked with five health and social care professionals.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff we spoke with understood their role in safeguarding the people they supported and they had access to the agency's own safeguarding procedure. Staff demonstrated no tolerance for abusive practice.

People using the agency told us they felt safe and their comments included, 'My staff never hurt me. I'd complain if they did. I would phone up the on-call' and 'I always feel safe. I really don't think anyone from here would hurt me.'

We looked at the recruitment of new staff. Staff recruitment records showed that all required recruitment checks were being undertaken. This was a way of ensuring people were supported by staff suitable to work in care.

Is the service effective?

People's health and care needs had been assessed. Some of the risks relating to people's challenging behaviours had been identified and planned for. However records showed that some of the risks had not been well planned for and one health professional we spoke with said,' Sometimes staff don't recognise risk as well as they should do.' Care plans had not all been updated when people's needs had changed. The care plans were therefore not all able to support staff to meet people's needs in a consistent way.

The management team undertook a number of checks and audits to establish how the service was running. These had been mainly effective at identifying the areas that needed to change or improve but had not been so effective at ensuring that the changes were made or that the changes made had been maintained. This meant that improvements made were not being monitored and were at risk of not being consistently sustained.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of the service provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers were patient and kind. People's comments included;' I'm really happy, couldn't be happier' and 'I have a moan from time to time but would I change it? No, not really.' One member of staff we spoke with about adult abuse told us they had never witnessed any abusive practice and commented that, 'In fact most staff go out of their way to help people.'

Is the service responsive?

During this inspection we identified a number of issues about which the provider took immediate action to rectify or improve the situation and to ensure people's care and support needs were being met.

We observed in daily records that staff had been quick to identify changes in peoples' well-being and to seek support from the person's own doctor or staff at the agency.

Is the service well-led?

The leadership team of the agency had recently changed following the recruitment of new care co-ordinators and a deputy manager. During our inspection we had both positive and negative feedback about the management of the agency and the confidence people had to raise issues of concerns. Positive comments from staff included, 'The support from management is very good. There is someone available all the time, even out of hours.' Some staff commented on the lack of support or response from the agency to issues of concern or suggested improvements. This mixed feedback indicated that arrangements in place for staff to raise concerns and for the views of staff to be obtained about issues of quality and improvement were not robust and needed to be improved.

We looked at the opportunities people had to comment on the service they were receiving. We found that surveys were sent out and the results compiled into a report that was presented in a style that was easy to understand. People told us they were now receiving regular visits from their care co-ordinator and were being asked weekly for feedback about the service. People told us, 'My care co-ordinator comes out to see me every week. She asks me if everything is Okay.'

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having mechanisms in place to seek out and use the views of staff in respect of safety and quality issues.

We looked at the care and support records for three people. The care plans and risk assessments available were not adequate to ensure that people would get the care and support they would need to maintain their hygiene, health and wellbeing or to manage their home.

We looked at the systems in place to ensure people were not subject to abuse. We found that staff had been trained in safeguarding and that this was renewed to keep their knowledge up to date. However we found that although staff identified neglect and acts of omission that caused harm or risk of harm to people this was not followed up by these staff or managers.

The systems in place to monitor the quality of the service were not effective. The systems were not providing the registered manager with adequate or accurate information to assess and monitor the quality of the service being provided. This had placed people at risk of receiving unsafe care and support.

Following our inspection we received assurances from the registered manager that swift and robust action had been planned and taken to improve the situation for people using the service.

We looked at four care plans and saw that each person had a dedicated medicine folder. These folders were up-to-date with evidence of regular medication audits. People were supported to receive their medication as prescribed to maintain their health.

We spoke with three members of staff. They told us that they had sufficient time between visits to ensure they could provide support to people at the agreed times. One staff member told us: "We always know where we are meant to be as we get a copy of our schedule a month in advance. I feel very supported by management."

We viewed the records of three staff which included evidence of appropriate training. However, only one of the three staff members had also completed training in respect of the mental capacity act.

We saw a policy in place for three of the people using the service that specified excessive phone calls from them would not be answered. In respect of one person this policy had been agreed with the person's social worker but there were no similar agreements in place in respect of the other two people.

People told us that they felt safe with the staff that were supporting them and that they had got to know them well. A person using the service told us 'I feel that I know my staff very well. They are my friends.'

People using the service had opportunities to express their views about the service they received from the agency. They told us that they were involved in the planning of their care and support needs. This was so that they could maintain their preferred daily routines and be actively involved in setting and working towards their life goals. A person using the service told us 'I like to do most things for myself, such as cooking. The staff encourage me and make sure I am safe to do this.'

People told us that they were confident that they could raise concerns if they were not happy with the care and support they received. People told us that actions had been taken in response to any concerns they had raised. A person using the service told us 'I talk to the staff or come in the office if I'm worried about anything.'

During our inspection, we asked local authority staff involved in monitoring the service about the quality of care provided. They told us that they did not have any new information to share with us at this time.