Archived: Dover and Deal Independent Living Scheme

The Dover and Deal Independent Living Service is registered to provide personal care to people with learning disabilities, living in their own homes. The scheme can provide support to people living in one bedroom flats and to others in shared accommodation, such as two/three bedroom houses, where they share communal areas with other people. Each person had a tenancy agreement and rents their accommodation. The Care Quality Commission inspects the care and support the service provides to people but does not inspect the accommodation they live in. People received support in line with their assessed personal care needs. The support hours varied from a few hours per day/week to 24 hour support. With this support people were able to live in their own homes in the community as independently as possible. At the time of the inspection the service was supporting three people who lived in shared accommodation.

There was 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.

Staff were trained in how to protect people from abuse and harm. They were aware of the procedures to follow in case of abuse, or suspicion of abuse, and whistleblowing.

The service had effective procedures for ensuring that any risks about a person’s safety within their home and community were appropriately reported. People were being supported and enabled to remain safe as any risks were appropriately assessed, managed, monitored and reviewed. The assessments reflected each person’s specific risks, including risks associated with daily living, such as facilitating trips, shopping and travelling on public transport. Accidents and incidents were recorded and monitored to identify any possible risks so that measures could be implemented to reduce similar occurrences in the future.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff were recruited safely and had been through a selection process that ensured they were suitable to support people in the community. There was an ongoing training programme for established staff and systems were in place to ensure that new staff received an induction, to ensure that they had the skills and knowledge required to meet people’s needs. Staff received regular one to one meetings with their line manager, including observational supervision sessions, to ensure they had the competencies to fulfil their role. They also received an annual appraisal to discuss their performance, and training and development needs.

Staff could access management support and guidance at any time, as there was an out of office number to call during evenings and at weekends if they had concerns about people. There were contingency plans in place so that the service could continue to run in the event of an emergency, such as technical failures with the computer programme.

People were supported to maintain good health. They received their medicines safely and were supported to attend health care appointments as required. Staff knew each person well and understood how to meet their needs. Care plans were personalised in places, but further details were required to ensure that people’s personal histories, preferences and choices were fully recorded. The registered manager had identified this shortfall and told us that a new format of care planning was being introduced to show in detail what people’s likes and preferences were, together with information about each person’s personal history. This was an area for improvement. The care plans had been regularly reviewed and updated to ensure that staff were aware of people’s current care and support needs.

Staff had received mental capacity training to ensure that they had understood the current guidance to support people to make decisions, and consent to the care and support they received. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

Deprivation of Liberty Safeguards (DoLs) provides a process by which a person can be deprived of their liberty, in a care home or hospital, when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. However in domiciliary care these safeguards are only available through the Court of Protection. At the time of the inspection no one was subject to an order of the Court of Protection. People were supported to make their own decisions and they told us their consent was gained at each visit. People had also signed and agreed with the care to be provided, as part of their care plan.

People were being supported to choose their food and staff helped them in the preparation of their meals. Staff supported people when they planned their individual menus, and ensured people made informed choices that promoted their health.

People felt staff were kind and caring. They were satisfied with how their support was delivered. Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people's needs.

Staff treated people in a dignified manner, promoted their independence and respected their choices. Staff were very knowledgeable about people they were supporting, and were able to talk about what was important to them.

Feedback about the service had been sought from people, relatives, staff and outside professionals to promote and drive improvements in the service.

There were comprehensive systems in place to monitor the safety and quality of the service being provided. The service was open and transparent, with an emphasis of learning and development to continuously improve the service.

People told us that the communication had been very good at the agency. They were kept informed about who would be visiting and were updated when this changed.

People spoken with confirmed that they had given consent to their care and felt in control of the care received. Overall people spoken with had no concerns with regard to the quality of care and were complimentary about the staff and the support offered. People told us they felt safe receiving a service from the agency.

One relative said 'The staff are very good, very caring. They help my daughter to attend day centre and support her to lead a normal life'. Another relative was very happy with the staff and the support they gave his brother. He explained how they helped him to do daily tasks for which he could not do himself. One person spoken to had great delight in explaining to us her action packed weekly programme of activities and how she was supported by staff.

However mental health assessments under the Mental Capacity Act 2005 were not in place or made reference to (These assess the capacity that a person as to make decisions and ensure that any decisions made on people's behalf did not compromise their human rights and rights of choice).

Detailed guidance for staff was not clear within care planning documentation so that they supported people consistently with actions that achieved the desired goal. Some support was identified but no guidance on how.