East Living - Domiciliary Care Service

East Living provides a supported living service and a domiciliary care service to adults who have a learning disability, autistic people, and people with mental health needs. The supported living service consists of 3 houses/supported living schemes that can accommodate a total of 7 people. Each person has their own bedroom and shared communal areas.

The domiciliary care service supports up to 16 people in their own self-contained flats. Not everyone who used the service received personal care. The Care Quality Commission 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. At the time of the inspection the agency was supporting a total of 10 people with personal care.

People’s experience of the service and what we found:

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service implemented innovative ways to ensure people received the care and support they required to meet their needs. For example, staff were highly effective at implementing assistive technology when caring for people that helped them with promoting their independence and to have real choice and control over their life.

The service ensured risks to people's safety and welfare were appropriately assessed and mitigated effectively. We saw that staff promoted positive risk taking and involved and supported people to set their own goals and to find solutions to mitigating risks, so they were empowered to improve their own independence and felt valued. People were supported to manage their medicines safely, and as independently as possible.

The provider had robust governance systems and processes to ensure all aspects of care and support and its delivery were monitored and checked for quality, and improvements. The service had many fantastic examples of excellent outcomes for people’s where expectations had been exceeded. The provider worked closely in partnership with other key organisations and had excellent examples of positive partnership working. People and relatives were involved in staff recruitment to help ensure that staff had the right skills and values to deliver excellent care.

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

We saw that the delivery of people's care was flexible and delivered in a person-centred way and led by the individual’s needs and wishes. The staff team valued feedback and involvement from everyone that used the service and health and care professionals, which helped ensure people’s care and support was consistent and tailored to the individual.

People’s care outcomes were outstanding, as people were supported to achieve positive results and barriers were broken down to ensure people could achieve their goals.

People were supported to be involved with the local community and led meaningful lives. The provider was awarded a government grant to help set up new opportunities to help prevent people from becoming isolated and lonely. Staff worked with and followed healthcare professionals’ advice and guidance to help support people to manage their health needs, such as epilepsy and diabetes.

The provider’s demonstrated a clear commitment to implement the CQC’s guidance ‘Right Support, Right Care, Right Culture’ into their services. This was included in the staff induction programme, so they were familiar with the principles which underlined Right Support, Right Care, Right Culture. People and relatives told us, they received good quality care, support, because staff had the right training and knowledge to meet people’s needs and wishes.

Right Culture

The leadership team and staff aimed for high standards of care and support. The provider’s values helped to promote an open culture which was inclusive and empowering. Staff we spoke with praised the management team for their support and guidance they provided to help staff give the best care possible.

People received support by staff who understood best practice in relation to the wide range of needs people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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 Outstanding (published 12 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 5 and 12 December 2017 and was announced. The provider was given at least 48 hours' notice because the location provides a supported living service for people who are often out during the day. At the previous inspection in October 2016, the service was rated as Requires Improvement with no breaches. At the last inspection the service was providing personal care support to 77 people in supported living schemes for adults with learning disabilities and extra-care and sheltered housing schemes for older adults. Since the last inspection the service had changed its model of care and now was providing support to nine people living in supported living schemes for adults with learning disabilities.

There were two registered managers at this service. 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 who used the service, relatives and health professionals were complimentary about the standard of support provided. The locality manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests. Relatives and professionals were very positive about the service people received. The service specialised in supporting adults with behavioural problems.

Positive risk taking was driven through the safe use of innovative and pioneering technology in order to support people to live fulfilling lives. The registered managers and staff had an excellent understanding of managing risks and supported people that had previously challenged services to reach their full potential. The service was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential. Over a period of time we saw that people were supported to progress and their support plans and environment adapted and developed to promote their independence.

The service had developed and sustained effective links with professionals and this helped them have a multidisciplinary approach in supporting people. Their success in achieving positive outcomes for people and their ability to develop best practice led to them being asked to share their ideas with other organisations that supported people with learning disabilities. This meant the service was being an excellent role model for other services.

People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans were in place to monitor and reduce risks. People had access to relevant health professionals when they needed them. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. Medicines were stored and administered safely.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA). MCA is legislation protecting people who are unable to make decisions for themselves. We saw people were able to choose what they ate and drank.

People had access to a wide variety of activities within the community. People’s cultural and religious needs were respected when planning and delivering care. Discussions with staff members showed that they respected people’s sexual orientation so that lesbian, gay, bisexual, and transgender people could feel accepted and welcomed in the service.

The service had a complaints procedure in place and we found that complaints were investigated and where possible resolved to the satisfaction of the complainant.

Staff told us the service had an open and inclusive atmosphere and the registered managers were approachable and open. The service had various quality assurance and monitoring mechanisms in place so the voices of staff, people and their relatives were heard and acted on to shape the service.

East Living Domiciliary Care Service provides care to people in their own homes. This takes the form of supported living schemes for adults with learning disabilities and extra-care and sheltered housing schemes for older adults. At the time of the inspection 77 people were receiving personal care.

The service had a registered manager in post. 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.

The service had robust measures in place to ensure that people were protected from avoidable harm and abuse. Staff were knowledgeable about safeguarding adults from harm and were familiar with the provider’s policy on safeguarding. Records showed that concerns about abuse were escalated appropriately. People told us they felt safe.

The quality of measures in place to reduce and mitigate risks faced by people receiving a service varied across the schemes. Some schemes followed best practice, particularly regarding risks associated with behaviour which challenges services. However, in other schemes risks had been identified but the measures in place to mitigate them had not been captured. We have made a recommendation about risk assessments.

People were supported to take their medicines by staff. In most cases medicines were managed in a safe way, with detailed plans in place to inform staff about how to support people to take their medicines and regular audits to ensure the service was managing medicines safely. However, practice was inconsistent across the services and audits and plans were not always in place. We have made a recommendation about medicines management.

Staff were recruited in a safe way which ensured they were suitable to work in a care setting. New staff received a comprehensive induction including a period of shadowing more experienced colleagues. Staff spoke highly of the training opportunities and support available to them. This included access to specialist external training.

Care files contained records showing that people had consented to their care. Where people lacked capacity to consent to their care best interests processes were recorded. Where people had legally appointed decision makers records were less clear and it was not always possible to tell who had the legal right to consent to aspects of care and treatment. We have made a recommendation regarding records of legally appointed decision makers.

Care files contained details of people’s health needs and how they liked to be supported to have their health needs met. Where appropriate people had health action plans and health passports in place to facilitate communication with health professionals. Health information was recorded in different places in people’s files and it was not always easy to locate the most up to date information or records of health appointments. We have made a recommendation about recording health information.

People told us they thought staff cared about them. Staff told us they had time to develop caring relationships with people they supported. Care plans were highly personalised and contained details of people’s choices, preferences, cultural and religious needs. Plans contained details of people's dietary preferences and where it was within the remit of the service there were details of how to support people with activities of their choices. The level of detail regarding support to meet people’s personal care preferences varied across the services and care plan documentation was not used consistently across the services. We have made a recommendation about care plan documentation.

The provider had developed a dignity charter with involvement of people who received services. Each service had a dignity champion within the staff team and staff and residents meetings showed the dignity charter had been discussed. The provider had completed themed supervisions with staff and a dignity survey with people who received a service. Dignity in care was embedded in care plans viewed.

The provider had a robust complaints policy and records showed that people who complained were satisfied with how their complaints were resolved. Records showed that complaints made at services were not always escalated to the central complaints process. The provider was aware of this and was taking action to address this.

The provider conducted various initiatives to ensure the mission and values of the organisation were embedded across the service. This included the use of a ‘theme of the month’ which included events for people who used services, training and workshops for both staff and people, themed supervisions and resource packs. The provider had staff recognition awards for staff who demonstrated the values of the organisation in their work. Staff told us they felt part of the provider organisation and supported in their roles.

The registered manager and scheme managers completed regular quality assurance audits of the schemes and these led to reports to the board of the provider to ensure high level oversight of the services. Records showed the audit process had led to improvements in services that had been performing poorly. However, the audits had not addressed the inconsistencies in risk assessments, medicines management and care planning identified on inspection. We have made a recommendation about using quality assurance to achieve consistency across different services.

We saw that people were treated with respect and dignity. We noted that care plans had been written using pictorial aids and that the provider had taken steps that ensured people had been able to input into their respective care support plans.

People told us the care they received was good; they told us they were happy with their care support workers. Comments included that staff were "wonderful" and "I feel I have the best care ever.' Care was provided took into account people's welfare and safety.

People who used the service seemed happy with the care provided. Staff who we spoke with were knowledgeable with regard to the forms of abuse that could occur in people's homes and knew how to escalate any concern. This ensured people were kept safe.

Staff were appropriately supported and trained before they commenced employment. Training records confirmed that the provider ensured that staff received regular supervision and support.

The provider had a robust complaints policy and procedure that staff and people who used this service were aware of.

Care plans were detailed and holistic and evidenced the involvement of people that used the service in the planning and review of their own care.

Most services provided through the domiciliary care agency were to people living in extra care housing or within a supported living scheme. Each scheme had an allocated manager, who was based on site and was responsible for co-ordinating each person's care and managing their own staff team.

Recruitment processes were robust and records were fit for purpose.