Archived: Affinity Trust - Domiciliary Care Agency - Norfolk

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.

This announced inspection took place on 17 and 22 November and 19 December 2016.

At the time of the inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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. However they were not available during the inspection.

CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People told us they felt safe. Risk assessments were in place and staff confirmed they followed them. Staff had an understanding of how to protect people from harm and knew what action they should take if they had any concerns.

Staffing levels ensured that people received the support they required at the times they needed it. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the service. People using the service were involved in the recruitment procedures, with only the most appropriate staff being selected for a job.

Staff were kind when working with people. They knew people well and were aware of their preferences, likes and dislikes. People’s privacy and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, administered and disposed of safely. People were supported to maintain good health as staff had the knowledge and skills to support them and there was prompt and reliable access to healthcare services when needed. People were provided with a choice of food and drink that they enjoyed.

Support plans were in place detailing how people wished to be supported and had been produced in conjunction with people using the service. People had agreed what care and support they needed and were fully involved in making decisions about their support. People participated in a activities at their home or in the community and received the support they needed to help them to do this. People were able to choose how they spent their time and what activities they participated with.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager if they needed to. The complaints procedure was available in different formats so that it was accessible for everyone.

People had confidence in the management team and the way the service was run. The provider ensured the service was well supported and there were opportunities for people and staff to provide feedback about any improvements that could be made, and these were listened to and acted on.

Is the service safe?

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

Staff had an understanding of their roles and responsibilities in making sure people were protected from the risk of abuse and correct procedures had been followed. People who used the service told us that they felt safe and they felt confident to report any concerns.

People were cared for by suitably qualified, skilled and experienced staff.

Appropriate checks were undertaken before staff began work.

The provider was taking appropriate action to ensure that people's rights were protected by appropriate consideration and use of the Mental Capacity Act (2005).

Is the service effective?

We saw that members of staff had a thorough knowledge of people's individual health and wellbeing needs. People had a positive relationship with the staff who supported them.

The care and support plans were personal to each individual and were reviewed on a regular basis. Assessments of any potential risks to people had been carried out and measures put in place to reduce risks.

Staff told us they received a very good level of training and felt well equipped to undertake their role at the service.

Is the service caring?

We saw how members of staff supported people and this was done well and in a respectful way. We saw that staff were friendly and encouraged people to be independent and engage in meaningful activities. Staff demonstrated a thorough knowledge and sensitive understanding of the needs of the people they supported.

Staff ensured they gained consent from people before they offered them care and support. One person said, 'Staff always ask my consent.'

Is the service responsive?

We saw that people's individual physical, emotional, psychological and social care and support needs were assessed and met. This included people's individual choices and preferences as to how they liked to spend their day.

People's needs and care plans were regularly reviewed by the staff. Support plans included information on people's likes and dislikes and their preferences to ensure that care and support was delivered taking into account their preferences. Staff promoted the independence of people who used the service.

Is the service well led?

The service had a registered manager in place.

Staff told us they felt very well supported by the management of the service. They felt well trained to safely do their job. They told us they enjoyed working for the service provider. One member of staff said, 'It's great, it's a very good company to work for. I feel very well looked after and I have received lots of good training.'

There was a clear complaints procedure in place. People told us they were confident to raise any concerns or complaints they had with staff and managers.

The provider had effective quality assurance and audit systems in place to monitor the service and ensure improvements were made where necessary.

Professionals involved with the individual people cooperated with Affinity Trust staff. This ensured the care and support was appropriate and that people received the correct care and support required.

We looked at records and spoke to staff who told us that the training and support offered to them was suitable. They told us the skills required to meet individual people's needs would be offered in training and support. This enabled them to do the job required safely and appropriately.

There were comprehensive methods used by this service to ensure quality was monitored. People who required individual support were given methods such as picture formats or translations into another language to ensure they could participate in assessing the quality of the care provided.

People who were unhappy with any aspect of their care and support were listened to and action was taken to address the concerns/complaints.