The inspection took place on 05 December 2014, and was an announced inspection. The manager was given 48 hours notice of the inspection as we needed to be sure that the office was open and staff would be available to speak with us.
Kent Shared Lives provides a service for adults who need support and who want to live as part of a family or household. It is an alternative to residential care for people who want to live or stay in a homely environment, but cannot manage on their own. It provides services for people with learning, physical or sensory disabilities, and people with mental health problems. The service provides long term placements and respite care. It is responsible for co-ordination between the people who use the service and the carers with whom people live.
Kent Shared Lives staff liaise with social workers, who oversee the processes and care management of the people who need support. The staff are responsible for recruiting carers who will provide the care and support that people need within the carers’ own families or households. For the purposes of this report we will refer to those who provide support as ‘carers’. At the time of our inspection, the service had 123 carers, and was providing support to 164 people, of whom 142 were receiving long term care, and others were receiving respite care. 58 of these were receiving personal care as well as other support. Our inspection process included the recruitment of carers to support people, how they were matched to people needing support, how well they were trained and supported themselves; and how people who were being supported felt about their placements. We obtained people’s views about their placements.
The service is run by a registered manager, who was present throughout the day of the inspection visit. 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 and associated Regulations about how the service is run.
The service ensured that staff and carers were trained in safeguarding people, and in how to recognise and report different forms of abuse. Staff and carers were confident that they could raise any matters of concern with the registered manager or directly with the local authority safeguarding team. People who received support told us that they felt safe now that they were living with a family, and could raise any concerns with their carers.
An assessment of different risks was carried out before placements were agreed, and these were updated on an on-going basis. Risk assessments included checking that carers’ houses had sufficient space to take people for placements, and a suitable single bedroom, and met health and safety requirements. These included comprehensive risk assessments for the property such as gas, electrical and fire safety; and checks that the property was safe for any equipment used such as wheelchairs. The assessments explored if the carers’ homes were suitable for any necessary adaptations, such as ramps, and if the person needing support could use steps and stairs. Other assessments checked that carers had a stable home life; that family members agreed with taking people into their home; the carers’ financial stability; and if they were in good health.
People receiving support had individual risk assessments, such as if they were safe to access the community on their own; if they could safely use public transport; if they smoked; if they needed support with their finances; and if they had health needs where they might require support, such as epilepsy.
The service carried out thorough recruitment procedures for their own staff and for recruiting carers. These included Disclosure and Barring Service (DBS) checks; checks for personal identity; and written references. The staff had specific areas of responsibility, and had their own caseloads. This enabled them to develop an on-going knowledge of the carers’ needs and abilities. They supported the carers through monitoring visits, and worked with social workers in regards to changes in the circumstances of the people they were supporting. The staff said that the size of their caseloads enabled them to have sufficient time to carry out effective monitoring.
Staff ensured that carers had received relevant training so that they could support people with all of their needs, such as support with taking any medicines. Training in assisting people with their medicines was given to all carers; and additional training was put in place for people with specific health needs where carers may need to support them, such as insulin for people with diabetes, or medicines to give to people with epilepsy in the event of seizures. There were clear procedures for assisting people with medicines in accordance with the Mental Capacity Act 2005, where people may not be able to make decisions about whether or not to take their medicines.
The manager ensured that staff kept up to date with training requirements and were able to develop their knowledge and pursue career development. The staff ensured that carers were trained in all required areas to support the people in their care. Staff and carers received regular monitoring, individual supervision, and yearly appraisals. Staff followed detailed processes to match people needing support with the right carers, so that they could be quickly accepted into family life, and become a part of each carer's household.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. In ‘Shared Lives’ services the process involves the court of protection. However, there was no-one receiving support who needed to be deprived of their liberty, and so no applications for the court of protection had been made.
Carers assisted people needing support with all aspects of their day to day living, including their nutrition, personal hygiene care, health needs, education and employment, travelling, social lifestyle, and keeping in touch with friends and family. They supported people in making decisions about their own care and lifestyles, and promoted their independence as much as possible. Feedback from people receiving support showed that they felt they were given choices in what they did and where they went.
Carers and people receiving support were given comprehensive information to help them to discuss situations and make decisions. The information was provided in different formats such as easy-read format, or with photographs for people receiving support, if this aided their understanding. Advocacy services were sourced and made available if needed, including Independent Mental Capacity Advocates (IMCAs), if people who lacked mental capacity needed support to make complex decisions about their care.
Carers and people receiving support were informed about how to raise concerns or complaints, and who would help them through these processes.
Kent Shared Lives staff showed they had a clear understanding of the service’s vision and values, and worked together to provide opportunities for on-going improvements and expansion of the service. There had been a recent inclusion in the service for giving advice and support for people living with dementia. One of the staff was specifically allocated to this area of support; and was also arranging the commencement of using telecare in this capacity. (Telecare is a system of using equipment such as pendant alarms and pressure mats to alert carers that their support is needed).
The manager was creative in developing the service, and took projects on board which studied ways to make the service even better, and expand the knowledge of Shared Lives’ services nationally. She was exploring the possibility of starting day care service provision, as well as expanding the service for people who needed long term care and people needing respite care.
Health and social care professionals told us that this was a very professional service, which was constantly seeking ways to meet people’s needs in a way that was as normal for people as possible, entering into family life, and feeling accepted and supported. They said that the service had very high standards of recruitment and service provision.