Background to this inspection
Updated
20 October 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care and supported living agency. It provides personal care to people living in their own houses and flats and supports people who need support to promote more independence. This service provides care and support to people living in 7 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Inspection activity started on 13 September and ended on 20 September 2023. We visited the location's office on 15 September 2023. We provided initial feedback about our inspection findings on 22 September 2023.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission (CQC) to
manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post. However, when we undertook our site visit they were on leave, so we held a virtual meeting with them on 20 September 2023.
Notice of inspection
This inspection was announced. We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.
What we did before the inspection
We reviewed information we had received about the service since the previous inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers
are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 4 people who used the service and 5 people's relatives by telephone. We visited 3 people in their homes. Not everyone using the service was able to speak with us. We used staff to help with their communications. We received feedback from a social worker, 2 healthcare professionals, and the local safeguarding authority. We also spoke with 12 members of staff including the regional director, the registered manager, the deputy manager, a project lead, 2 team leaders and care staff.
We reviewed a range of records, this included 5 people's care records. We looked at 3 people's medicines' records and 3 staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed, including incident records, compliments, complaints, quality assurance processes, audits, policies and procedures.
Updated
20 October 2023
Westminster Homecare Limited (Independent Living Network) is a domiciliary care agency and supported living service. At the time of our inspection 73 people were being supported in their own home, 16 of whom were supported with personal care. The service provides support to people, living with dementia, with a learning disability or autistic spectrum disorder, with a physical disability and people with a mental health condition.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.
'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people, and providers must have regard to it.
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.
People's experience of using this service and what we found
Based on our review of is the service safe, effective, caring, responsive and well-led questions, the service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care and right culture.
Some risks to people had not been documented and some quality assurance processes were not as effective as they could have been. This meant there was a risk of missing opportunities to make improvements and prevent any incidents reoccurring. No person had been harmed but this put people at risk of harm.
The regional director and deputy manager addressed these matters promptly, but until we highlighted these, actions had not been taken. Staff however were clear on how to safely support people with eating and drinking safely, and how time specific medicines had been correctly administered.
Right support
Staff complied with measures designed to reduce the risk of infections spreading, and focused on people's strengths and promoted what they could do, enabling the opportunity for people to lead fulfilling and meaningful lives. A person told us how careful staff were to always use the correct personal protective equipment (PPE), washing their hands and safely disposing of PPE.
Staff supported people with equipment to keep them safe by using an appropriate number of suitably skilled staff. A staff member said, "I see [person] being able to live at home with reasonable adjustments and the right equipment. It means a lot to them having more independence."
Staff received effective training in the use of restraint and were confident in their ability to deploy this training should it ever be needed. At the time of our inspection, where people needed restraint, such as with medicines, this was appropriately authorised, and only used in an emergency situation, as a last resort, and for the shortest time possible.
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.
Right Care
Staff focused on and promoted people's equality and diversity, supporting, and responding well to their individual needs. This changed people's lives for the better. A person said, “I feel safe when out [in the community], as staff are very good to me. I take all my [medicines] morning and night and staff watch me to make sure I haven't dropped any.” A relative told us how much more their family member could now do and how well staff understood their communications in ensuring the person was given equal opportunities.
People or their legal representative helped create and review their care plans when they chose to, and as such were a reflection of the support they needed and what people could do independently. Staff had training on how to recognise and report abuse and had the skills to help protect people from poor care and abuse, or the risk of this happening.
The service had enough appropriately skilled staff to meet people's needs and keep them safe. All those we spoke with felt people were safe and had enough support to do this. People were supported to communicate in their preferred way including a few words and visual prompts.
People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. A relative told us the service always strove to improve the quality of people's lives and said, “[Staff] have transformed my [family member’s] life. Now they live in their own home. This has given them the confidence to keep growing with independence.”
Right Culture
People were supported by staff who understood best practice in relation to people's strengths, impairments, or sensitivities for people with a learning disability and/or autistic people may have. A relative told us the service had made a huge difference to their family member saying that although their family member needed a lot of support around their needs, staff were quick to make healthcare referrals for support when needed, meaning the person was eating more healthily.
Staff put people's wishes, needs and rights at the heart of everything they did. People, relatives, staff, and health professionals had a say in how the service was run. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 19 October 2017).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westminster Homecare Limited (Independent Living Network)
We have found evidence that the provider needs to make some improvements. Please see the safe and well-led section of this full report. The overall rating for the service has changed to requires improvement. This is based on the findings at this inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.