Archived: Affinity Trust - Domiciliary Care Agency - South

Updated 14 November 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 completed by an inspector.

This service provides care and support to people living in six ‘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 be sure that the provider or registered manager would be in the office to support the inspection. We also needed to check as some people using the service potentially could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this, which was completed.

Inspection activity started on 14 October 2019 and ended on 15 October 2019. We visited the sixth setting on 14 October 2019 and the office location on 15 October 2019.

What we did before the inspection

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 also reviewed information we held about the service from statutory notifications, which are events the provider is required to inform us of. We spoke with two health care professionals who had been involved with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service about their experience of the care provided. Not everyone could share their experiences with us of the care provided, so we visited people living in three properties in the sixth setting and observed their interactions with staff to help us understand their experience. We spoke with ten members of staff including the divisional director, the registered manager, two support managers, the quality improvement manager, a team leader and four support workers.

We reviewed a range of records. This included three people’s care records and medication records. We looked at three 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 spoke with six people’s relatives across four of the settings about their loved one’s care. We received feedback on the service from a third health care professional and continued to seek clarification from the provider to validate evidence found.

Updated 14 November 2019

About the service

Affinity Trust - Domiciliary Care Agency - South is a care agency, providing personal care to people living in supported accommodation and their own homes. At the time of the inspection the service was supporting 32 people living in six supported living settings. Five of the supported living settings were located in Surrey and one in Portsmouth. Five of the settings were single locations which supported between one and three people in a property. The provider supported a further two people living in their own homes.

The sixth setting had been commissioned by a local authority in two phases which had been set up over the last two years. The care and support supplied to people by the provider, was completely separate from the accommodation people rented. The sixth setting had been a former care home which had been closed and re-configured to create separate properties by the commissioning authority. This setting accommodated 21 people on one-site with between one and five people living in each property. The complex was larger than good practice guidance recommends. However, people’s properties were staffed separately and two on-site support managers managed the two phases separately.

The service has been developed 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

Overall medicines had been safely managed. There had been issues with medicines errors at the sixth setting. The provider had taken extensive and robust actions to address this for people, but it will take further time for them to be able to demonstrate their full effectiveness.

The provider had processes and systems in place to protect people from abuse and to investigate any incidents at the appropriate management level and to take any relevant action required. Staff assessed individual risks to people and monitored their safety. The provider had ongoing concerns about the compatibility of people living in one property in the sixth setting which they had raised with commissioners.

There were sufficient numbers of suitable staff deployed. It had taken time in the sixth setting to establish a completely new, large workforce across the different properties with the required skills and knowledge. The provider had experienced issues with consistency of on-site management with the second phase of the sixth setting and had ensured throughout there was senior management cover in place, whilst a suitably experienced manager was appointed.

People’s needs were assessed and the delivery of their support was in accordance with legislation and guidance. Staff were provided with the required skills and knowledge for their role. Staff ensured people ate and drank enough to maintain a balanced diet. Staff worked with each other and across agencies to deliver effective care and to promote people’s health and welfare.

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.

Staff treated people with kindness, respect and compassion. People were involved by staff wherever possible in decisions about their care. Staff upheld people’s privacy and dignity during the provision of their care.

People received personalised care that was responsive to their needs. Staff were able to support people at the end of their lives.

The provider promoted a positive culture. People who used the service, their relatives and staff were engaged and involved with the settings. There were processes and systems in place to drive improvements. Staff used any concerns or issues raised as an opportunity to improve the service. The provider worked in partnership with other agencies, openly and honestly

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 opportunities 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

The last rating for this service was good (published 8 November 2017)

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.