Background to this inspection
Updated
3 October 2019
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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in 11 ‘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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to make arrangements to speak with people using the service and seek their consent to do so.
Inspection activity started on 2 September 2019 and ended on 10 September 2019. We visited the office location on 3 September 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and six relatives about their experience of the care provided. We spoke with 10 members of staff including the divisional director, registered manager, a support manager, and seven support workers. We also spoke with two health professionals who had worked with the service.
We reviewed a range of records. This included three people’s care records and their medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at additional records relating to the management of the service and spoke with the registered manager.
Updated
3 October 2019
About the service
Affinity Trust - Domiciliary Care Agency - Norfolk provides personal care to people living in
shared supported living premises. The service provides support to people living in 11 supported living premises. The number of people living in each premises varied. Where multiple people lived in the premises, there were communal facilities such as lounges, kitchens, and dining rooms, and gardens. Accommodation for staff to stay in overnight was also provided. 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. At the time of our inspection 26 people were receiving a regulated activity.
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 receive 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 were supported to stay safe. Risks were assessed, and mitigating actions taken in response. Adult safeguarding procedures were in place and effective in responding to any concerns identified. Staff took action to learn from and respond to incidents that occurred. People received support with their medicines as required. People and relatives told us staffing arrangements in the service were stable and people received support from consistent staff. The use of agency staff was managed so that people were familiar with the staff supporting them in advance.
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 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.
People were supported to have maximum choice and control of their lives and supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported by trained staff who followed best practice advice and guidance. People were supported to live healthy lives, this included ensuring they eat and drank well and could access external health care services.
Staff treated people kindly and respectfully. In many cases they knew the people they supported well and this helped to ensure people were listened to about their support needs. Their cultural and spiritual needs were considered. People were encouraged to identify goals they wanted to achieve, and staff supported people to achieve these.
The support provided was personalised to people’s needs and interests, this included supporting people to participate in activities of their choice. Staff had involved people in their care plans. These provided clear and detailed person centred information about each person’s needs. People’s communication needs were assessed and met. Concerns or complaints were investigated and responded to. Information on how to complain was available.
There was a positive inclusive culture and staff morale was good. The views of people, relatives, professionals, and staff were sought and listened to. Quality assurance systems and procedures were in place. The management team had a good understanding and oversight of the service provided. The management team was reflective and open to learning and improvement. They worked with other professionals to continue to learn and improve the quality of the service.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was good (published 8 February 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.