Archived: The Halow Care Agency

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 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. The values of the service were embedded into practice and were designed to ensure people received a highly personalised service which focussed on their specific needs and aspirations.

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.

People had developed positive relationships with staff and told us they felt safe. Risks to people’s safety were managed whilst ensuring people were able to develop their independence. Where people required support with their medicines this was provided in line with their prescriptions. People were supported to access healthcare professionals and to monitor their healthcare needs.

Staff were supported to develop skills and received the training they required to meet people’s individual needs. There were sufficient staff to meet each person’s support hours and staff were recruited safely. Staff told us they felt supported in their roles.

People were supported by staff who were caring and knew them well. Each person had a personalised support plan in place which highlighted their needs and goals for the future. People and their relatives spoke positively about what the support they received and how they were progressing towards independence.

People, relatives and staff were positive about the service and the approach of the registered manager. There were systems in place to check the quality of the service and the service worked in partnership with healthcare professionals and community resources. There was a strong emphasis on continually developing the service and people and staff were fully involved in this process.

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 Requires Improvement (published 2 January 2019). One breach of regulations was identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a planned inspection based on our inspection schedule.

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.

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. At the time of the inspection there were 12 people using the service in supported living and 45 people using the buddy service although not everyone received the regulated activity personal care in their own homes.

People using the service had a learning disability or autism. The support service has been developed and designed in line with the values that underpin the Commission’s Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The Halow Care Agency is a not for profit social enterprise, one of a number of services provided by a charity the Halow Care Community Interest Project. People using the Halow Care Agency have access to other project services that focus on social activities, employment preparation and life skills services providing wider opportunities and support for young people with learning disabilities and autism. CQC does not regulate these other related services but only the Halow Care Agency when personal care is provided.

At our last inspection in October 2016 we rated the service Good overall but found a breach of regulation in Well Led as there was a lack of effective systems to monitor the quality and safety of the service.

At this announced inspection on 8 and 9 November 2018 we found a breach of regulation in respect of training provided as buddies were not always provided with the specific training needed to meet people’s needs.

You can see what action we told the provider to take at the back of the full version of the report.

There had been some improvements made to the quality assurance and governance and a system for quality monitoring had been put in place. However, there were some aspects of the quality monitoring that needed improvement to ensure they were effective.

At this inspection there was not a registered manager in place as the previous registered manager had left the service at the end of May 2018.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. A new manager had been appointed who already worked within the project. They had previous experience of being a registered manager and had applied to CQC to register as the registered manager and their application was in progress at the time of the inspection.

Medicines were safely stored and administered. The medicines policy was out of date and did not reflect some aspects of medicines management. This was updated following the inspection.

We have recommended that the provider consults appropriate and up to date guidance on the management of medicines.

People told us they felt safe and were supported to be safe in the community. Staff received safeguarding training and showed an understanding of how to protect people from abuse or harm.

Risks to people were assessed and guidance provided to staff to reduce risk. There were processes in place to identify and share learning from accidents and incidents. Staff understood how to reduce the risk of infections

There were enough buddies to meet people’s support needs. Buddies received supervision and support to fulfil their roles and responsibilities in a number of areas.

The service worked in an inclusive way and prior to joining the service people's needs were carefully assessed in partnership with service users, their families and health and social care professionals where relevant.

Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff told us and we saw we saw they sought the consent of people before they delivered care and support.

People were encouraged and supported to meet their dietary and nutritional needs. The service worked with health and social care services and professionals to maintain the health and well-being of people they supported. The service supported people when they moved between services through effective communication to ensure their care and support were coordinated well.

People told us their buddies were kind and caring. People’s care was personalised and they were empowered to be as independent as possible. The ethos and values of the service supported this. Buddies promoted peoples’ right to choose and treated people with dignity and respect. People had individual support plans that were personalised. People were supported to socialise, build on skills, and maintain relationships. People and their relatives knew how to complain about the service should they need to. Information was available to them in a range of formats.

People and their relatives’ views were sought about the service through regular surveys. Relatives, staff and professionals gave positive feedback about the management of the service and said their views were listened to. There was a clear ethos of working to provide person centred care at the service.

At our last inspection in March 2014 the provider met the regulations we inspected.

The Halow Care Agency supports young people and adults aged 16 to 35 years of age who have a learning disability and are living within the county of Surrey. Services provided include shared supported living houses and staff known as buddies proving domiciliary care and support to young people to access the community, develop life skills and achieve their goals. There were approximately 42 young people using the service and support or personal care was not being provided to anyone under the age of 18 at the time of our inspection.

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.

Throughout this report people who use the service are referred to as young people and the staff who provide support are referred to as buddies.

Young people using the service told us they felt safe and that buddies treated them with dignity and respect. They were happy with the support provided which met their individual needs.

The service empowered young people to take control of their own care and support. People were supported to plan and achieve their personal goals including building their independent living skills. Buddies said, and we saw that, the service was focused on putting young people at the centre, and in control, of their support.

People were supported by buddies who were trained and well supported in their job roles. Each buddy had been safely recruited, had access to regular training and supervision and felt well supported by the management team. The staff said they felt valued by the organisation.

Medicines were administered in a safe way. Buddies received training and a new competency framework was in place to make sure they understood and followed safe procedures for administering medicines.

Buddies and other staff had received training in the Mental Capacity Act (MCA) and understood the importance of gaining people's consent before assisting them.

The systems in place to monitor the quality of the service required improvement. Quality assurance processes were not fully embedded and consistent. The provider organisation did not have the necessary systems and governance in place to ensure full oversight of the service and drive improvement where required.

We saw that the registered manager or an appropriate member of staff had reviewed the support plan of the majority of people who used the service. For some people who had been away at residential educational establishments or had not been reviewed for other reasons, that reason had been recorded and a review planned.

We saw that the details of all of the people involved in the reviews had been recorded and that a review matrix document had been drawn up. This document provided details of the original review date, the most recent review and the projected date for the next review.

Although the service mainly offered social support, there was the possibility that personal care would be delivered to people who used the service. We found that the plans of care maintained for each person who used the service were detailed.

The provider had made suitable arrangements to ensure that people who used the service were protected from abuse. The relative of one person who used the service said "I feel 100% certain that X is safe when with their buddy from Halow."

The provider had ensured that all staff, and volunteers employed by the service had been subject to the checks as described in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff were supported to deliver care and support through a programme of regular supervision and appraisal as well as through the provision of relevant initial and refresher training.

The Halow Care Agency had in place suitable arrangements which allowed the registered manager to monitor the quality of the service provided to people who used the service.

We found that, although records were securely and safely stored there was no evidence that people's support plans had been subsequently reviewed. One person's relative told us "I don't really have a lot of contact with Halow unless there is something I want to bring up."

We found evidence that the service was run in the best interests of the young people and that it provided a flexible reliable service. Relatives told us that they found the support provided to be positive and that it met the needs of their member of family. Evidence showed that the emphasis of the service was to enable and empower each young person to maximise their potential and to make decisions and choices about their lives and future.

Records viewed showed that support plans covered all aspects of the young person's individual circumstances. Satisfaction questionnaires were very positive and suggested that people were happy with the service and that they liked the 'buddies' who provided day-to-day-support.

Further improvements were required to ensure that staff received up to date training and opportunities for regular supervision and an annual appraisal.