Archived: Affinity Trust - Domiciliary Care Agency - South

This service supports people with learning disabilities, including autism, sensory impairment and physical or mental health needs, in the counties of Berkshire, Surrey and Hampshire. People were supported with personal and domiciliary care in their own homes. This included supported living housing locations. These are self contained homes in shared tenancy housing, and sometimes include 24 hour care support. At the time of our inspection 55 people were supported with personal care.

Within this report we sometimes refer to staff. This is used to describe all staff roles, including support workers, team leaders and support managers. Each supported living location was managed on a day to day basis by a team leader and/ or support manager. Support managers oversaw several supported living locations for day to day needs, and reported to the registered manager.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 were protected from potential harm, because staff were trained to recognise and deal with possible abuse. People felt safe with the staff who supported them.

Risks affecting people’s health and wellbeing had been identified. People were supported to manage risks safely without affecting their chosen activities and lifestyle.

There were sufficient staff deployed to support people’s needs safely. Recruitment checks and roster reviews provided assurance that people’s commissioned care was fully met by support workers of suitable conduct.

People were supported to take their prescribed medicines. Support workers were trained and assessed to ensure they administered people’s medicines safely. Records demonstrated that support workers followed the provider’s training and guidance to protect people from potential medicine administration errors.

People were supported by staff who completed and regularly refreshed their training. This ensured they had the skills required to meet people’s needs effectively. Staff had regular supervisory meetings that provided opportunities for skills and development review, as well as discussion of issues. Support workers and their managers were effectively supported to resolve any concerns identified.

People were supported to make decisions about their care and support. Staff understood and implemented the principles of the Mental Capacity Act (MCA) 2005. People’s relatives confirmed that they were involved in best interest decisions where people were assessed as lacking the understanding to make an informed or complex decision. The registered manager understood the requirements of the Deprivation of Liberty Safeguards (DoLS) and had applied to the Court of Protection for these when necessary. DoLS ensure that where people’s liberty is restricted, this is only to protect them from identified potential harm, is as least restrictive as possible, and is applied in accordance with the MCA 2005.

People were supported to maintain a healthy diet. People’s dietary and health needs were managed effectively, because support workers liaised with and followed health professionals’ guidance.

Support workers treated people with compassion and care. They provided reassurance and comfort when this was needed, and took pride in people’s developing independence. They understood people’s wishes and preferences. People’s cultural, religious and gender preferences were recognised and respected. People were able to seek privacy when they wished, and staff treated them in a dignified manner.

People and those important to them were involved in agreeing and reviewing their plan of care. Changes were identified promptly to ensure people’s support plans remained current, and met their needs and wishes.

Feedback was welcomed, and used to influence changes in the service. Complaints were managed and resolved in accordance with the provider’s policy. The registered manager liaised with families to ensure concerns were addressed to their satisfaction.

Staff understood and demonstrated the provider’s values of inclusiveness and empowering people’s independence as far as possible. Despite some concerns regarding changes to people’s commissioned care regarding the change from residential care to supported living, support workers took pride in the quality of care they provided.

Staff spoke positively of the leadership provided by the registered manager and divisional director. People’s relatives told us communication was improving, and they had no concerns about the quality of care people experienced.

The provider’s quality audit framework ensured issues were identified and addressed. Progress towards resolution of issues was monitored by the divisional director to ensure changes were embedded into practice. Learning was shared in management meetings to drive improvements to the service. The service was well-led.

The location did not have a registered manager at the time of our inspection. This is a requirement for registration with the Care Quality Commission (CQC). The person managing the service told us they had started the application process to become a registered manager with the CQC.

We looked at documents including six people's support plans and service management reports. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; is the service caring, responsive, safe, effective and well led?

This is a summary of what we found.

Is the service caring?

The service was caring. We observed people sought the company of staff, and appeared to enjoy their company. Staff treated people with kindness, and ensured they were included in conversations. A relative told us their loved one was 'Thriving' in the care of staff. They told us staff genuinely cared for people.

Staff understood people's diverse communication methods, including facial expressions and gestures used. They took care to promote people's independence and offer choice. A care worker told us 'I love my job. I want to do it well'.

Is the service responsive?

The service was responsive. Staff told us that support plans were reviewed and updated regularly, and reflected people's current needs. Staff liaised with health professionals to ensure identified health issues had been addressed.

People and staff told us they felt supported and listened to. Relatives said staff were responsive to their concerns, and informed them promptly of any issues affecting their loved one.

Is the service safe?

The service was safe. A relative told us 'They do things properly, safely. I am content that X is well looked after'. A care worker told us 'We spend time engaging with people, we ensure they are comfortable with staff'. This meant that people were encouraged to talk about their wishes, issues and concerns.

Risks affecting staff and people had been identified, and actions had been implemented to reduce the risk of harm. These had been reviewed to ensure people and others remained safe.

Staff understood the principles and importance of safeguarding, and had attended training to ensure they protected people from the risk of abuse.

Is the service effective?

The service was effective. People's support plans documented how actions had been taken to promote people's health and wellbeing. For example, one person identified at risk of weight loss had achieved and maintained their ideal weight for the previous six months. People told us they were happy with the care provided, they liked the staff, and could not think of any issues that concerned them.

A team leader told us that comments from staff were welcomed. They said 'This is encouraged in team meetings. Everyone's input is valued and respected. There are always new things we can try. Otherwise we would never learn'.

Staff had been trained to ensure they supported people effectively. In addition to essential training, care workers attended training to understand the specific needs of people they supported, such as dealing with behaviour that challenges, and awareness of dementia and autism.

Is the service well led?

The service was well led. A relative told us 'There is an ethos and passion that cascades from the top. This service has far exceeded my expectations'. One care worker said 'This company is about quality, not quantity'.

Care workers told us they felt supported and appreciated. One care worker told us managers 'Value my experience. We always have back up and someone available'.

Audits demonstrated that the provider's policies and procedures had been followed. Internal systems ensured that learning occurred from incidents and complaints to drive improvements to the service. For example, monthly operations meetings had identified an improvement required to produce more person-centred reviews of people's support needs. The support plans we saw were person-centred.