Archived: Independent Living Alliance - St Helens

Independent Living Alliance is registered to provide personal care to people with mental health issues, physical and learning disabilities. Support is provided either in 24 hour supported living accommodation or as a domiciliary care service where staff visit people in their own homes. At the time of the inspection there were nine people being supported with a regulated activity.

During the previous inspection in September and October 2016 we identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 because the registered provider had not always notified us of incidents as required. During this inspection we found improvements had been made and notifications had been sent as required by law.

During the previous inspection staff told us they did not always feel supported by the management team due to the on-call system not being very effective and they did not always feel their views were listened to. Since the previous inspection the registered provider has implemented a new on-call system for staff to contact managers in an emergency. Staff told us they felt more supported since the new registered manager and service manager had been in post and now felt their views were listened to.

The service has had a registered manager in post since September 2016. 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.

People using the service were unable to provide feedback about the support they received due to communication difficulties. Relatives spoke positively about the way the service was managed and the care and support provided to people.

People were assessed prior to receiving support from the service to ensure that person centred care and support was provided. Care records included detailed risk assessment and support plans to help staff appropriately manage people's needs and keep them safe from harm. Care and support plans had been developed with the involvement of family and were reviewed regularly to ensure effective support was being provided at all times.

Staff had received training in relation to safeguarding adults from abuse and understood what actions they should take when concerns are identified. Safeguarding policies were available for staff to access when needed.

The service continued to use safe recruitment processes to ensure that staff were suitable to work with vulnerable people. Staff had completed a detailed induction program and shadow shifts with experienced staff members before loan working. Staff completed mandatory training as well as additional training specific to people's individual needs. Staff were supported in their role through regular supervision and meetings to ensure they maintained the right skills and knowledge to carry out their role.

Medicines were stored and managed safely by staff who were suitably trained to administer medications to people receiving support. Staff consistently completed medicine administration records (MARs). The registered provider had policies and procedures in place for the safe management of medicines.

Consent was gained in accordance with the Mental Capacity Act 2005; the registered manager, service manager and support staff understood the need to obtain consent from people prior to offering support.

People were supported to access health and social care professionals; care records showed evidence of additional support from GPs, social workers, speech and language therapists and adult learning disability nurses.

Interactions between staff and people being supported were positive and staff showed a good knowledge of the people they supported. People were treated with dignity and respect and staff ensured privacy was maintained at all times. People were encouraged to be as independent as possible and provided choice and control over their day-to-day lives ensuring that the least restrictive support was given where appropriate.

The quality and safety of the service was assessed at monitored regularly and improvements made where required. The management team were open and inclusive and showed a desire to maintain and improve on the quality of the service being provided.

Independent Living Alliance is registered to provide personal care to people living with mental health issues, physical and learning disabilities. Support is provided either in 24 hour supported living accommodation or as a domiciliary care service where staff visit people in their own homes. At the time of the inspection there were 10 people being supported with a regulated activity.

The service had not had a registered manager in post since August 2016. The registered provider’s area manager had taken up the post of manager for the service and was in the process of registering with the CQC. 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.

The registered provider did not always send notifications to the CQC as required by law. After raising this with the manager we found this was being done. You can see what action we asked the registered provider to take at the back of the report.

Not all staff felt that they received the support they needed from the registered provider or manager. Staff told us that the on call system whereby staff can contact management for support in emergency situations did not work. They also commented that they did not feel their concerns were listened to, and were unaware of efforts being made by the manager to address these. The manager confirmed that a new on call system had been put in place following the inspection. We have made a recommendation about motivating staff and team building.

Staff had not recently undertaken training around supporting people with learning disabilities to manage their behavioural needs. This had impacted upon the ability of staff to effectively support people with managing their behaviour. We have made a recommendation relating to staff training in this area.

Staff had received training in other areas that enabled them to carry out their roles effectively. This included training in the Mental Capacity Act 2005, safeguarding vulnerable people, first aid and moving and handling. Staff had also been supported to complete nationally recognised qualifications.

Recruitment processes were robust and helped to ensure that staff were suitable to work with vulnerable adults. New staff had completed an induction which included a period of shadowing experienced members of staff, and completing training in core subjects such as moving and handling, safeguarding and the Mental Capacity Act 2005.

Staffing levels were consistent with the hours allocated to people by the local authority. Where the manager felt that people needed additional support they had referred to the local authority for a review.

Accidents and incidents were monitored and appropriate action had been taken to ensure people’s safety was maintained. These actions included referrals to health professionals and the local authority for support. Where staff were supporting people with complex behavioural needs they had been provided with an alarm which they used to call for help. Up-to-date risk assessments were in place which provided staff with information around how to keep people safe.

Care records contained detailed and personalised information around their care needs. This information was reviewed on a regular basis to ensure that it remained up-to-date. This meant that staff had access to relevant and accurate information on how they should support people.

Staff were kind and caring towards people. They had a good knowledge of people’s needs and how they liked to be supported. People’s family members commented positively on the support their relatives received from staff, telling us that staff were “kind”, “caring” and good at communicating.

The registered provider had a complaints policy in place. People’s relatives told us that they would feel confident making a complaint if they needed to. In one example we saw that one person had been helped to access support from the local advocacy service. An advocate ensures that people’s wishes and feelings are taken into account.

One person we spoke with told us they liked the staff and were being supported in a way which suited them. We saw they were able communicate their wishes with staff members and these were clearly understood. They said they were happy with the daily support they were receiving. People we spoke with told us they had regular support form staff who understood their individual needs. They told us they enjoyed taking part coming into the office for a regular chat and to take part in weekly activities. Comments included, 'We come here a lot. It's good for a chat with the staff or doing activities on a Wednesday'. Also, 'My carers are very good for me. Couldn't do without them'.

People told us they felt involved in their care and the planning and review of it. 'They tell me about any changes and ask me what I would like'.

Staff members we spoke with had knowledge and understanding of peoples care needs and support plans. A staff member told us, 'We work closely with people and support plans are person centred and worked through together.'

Practices in relation to staff recruitment and induction appeared to be safe and adequate.

People had the information they needed to raise a concern or complaint. Systems were in place to ensure complaints were managed effectively in the best interest of the person.

'It's brilliant'.

'I go out to different places'.

'I am happy and I feel safe'.

'Smashing'.

'I have a lot of confidence in the staff'.

'I get involved with what is going on'.