We carried out a review of the data available to us about Independent Living Alternatives on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Independent Living Alternatives, you can give feedback on this service.
At the time of this inspection Independent Living Alternatives employed 71 personal assistants and 8 volunteers who were providing support to 32 people in their own homes. The volunteers provided support in exchange for accommodation. In addition, Independent Living Alternatives facilitates the recruitment of personal assistants for people who employed their own personal assistants.
People using the services of this agency managed their own personal assistants and their own care. The ability to manage this was a prerequisite for using this agency. This inspection report covers all the services provided by Independent Living Alternatives.
We previously inspected the service on 12 December 2016. There had been a breach of regulation as the service was not following safe practices in recruiting staff. At this inspection we found the agency had improved their recruitment practice and staff were recruited safely to minimise the risk of unsuitable people being employed. A second breach of regulation at the previous inspection was due to the registered manager not notifying CQC of incidents which is a legal requirement. The registered manager told us they were now fully aware of what they needed to report to CQC. At this inspection we found all regulations were being met.
A registered manager was in post at the time of this inspection. 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.
Independent Living Alternatives is different to other domiciliary care agencies. The people using the service choose their own personal assistants from those recruited by the agency and people manage their own care including the training of their personal assistants.
Each person using the service had a risk assessment in order to keep them safe while respecting their right to take risks. Some people had a written care plan called a personal profile and others did not as they preferred to train and direct their personal assistants without a written plan. Each person had an annual review with the registered manger to seek their views of the service and see if their needs were being met.
Each person had between one and six personal assistants in their care team. The agency was able to supply extra staff in an emergency as they employed casual workers to cover sickness and holidays of personal assistants.
People were responsible for their own medicines management and they trained their personal assistants to help them with medicines and to use mobility and medical equipment.
Staff felt they had enough training and support to carry out their roles.
The service tried to match people to personal assistants who would relate to and respect their individual lifestyle. People told us they were happy with the service provided.
We saw concerns and complaints were dealt with appropriately by the provider.
There was a management committee made up of people using the service and the registered manager reported on how the service was running to the management committee. This was an effective way of monitoring the quality of the service and addressing any improvements needed.
We have made one recommendation regarding training in safe moving and handling.
At the time of the inspection Independent Living Alternatives was employing 77 personal assistants who were providing support to 35 people in their own homes. Independent Living Alternatives also provides volunteers who live with people who require support and assist them with a range of tasks, in exchange for accommodation. At the time of the inspection there were nine volunteers working for Independent Living Alternatives. In addition, Independent Living Alternatives facilitates the recruitment of personal assistance staff for people who require support due to a disability. These staff are then employed directly by the person using a personal budget. This inspection report covers all the services provided by Independent Living Alternatives.
We previously inspected the service on 13 August 2014 and the service was found to be in breach of the regulation which related to assessing and monitoring the quality of the service provided.
Independent Living Alternatives had a registered manager at the service. 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 ethos of this service was to encourage people who were using the service to be as independent as possible by employing a personal assistant (PA) staff member rather than care workers. Independent Living Alternatives requires that the people with a disability who request a PA are able to articulate their needs and manage their PA on a day to day basis. This means the service operates quite differently to many other care agencies as control for the day to day running of the service is passed to the person using the service.
Independent Living Alternatives carried out initial recruitment checks on PA staff, and people then interviewed prospective PAs for their suitability to work with them in their own home. People who used the service told us they felt safe with their PA and trusted them to ensure their safety and to ‘look out’ for them. The registered manager told us if a person felt a PA was not suitable in their role, Independent Living Alternatives would assist them finding a new PA.
Staff recruitment was not always safe. We found the provider was not always complying with their procedure to obtain two references prior to employment. The registered manager told us people using the service were made aware of when references were not available. They then chose whether to proceed to interview the specific PA to support them or not.
Care records had an individualised risk assessment document which included all potential risks specific to the person who used the service. We found most people did not have detailed care plans or communication books in their homes as people directed their PA and so told them what tasks they wanted undertaken and how the task should be carried out. There were some instances where a health and social care professional who commissioned the care, had drawn up a detailed care plan if a person had extremely complex needs. People using the service, PA’s and health and social care professionals told us this worked well.
People told us they had choice over the support they received and nothing was done without their consent. People told us they were very happy with the service provided by their PA as they wrote their own personal profile and only accepted PAs they felt would be suitable to work with them. Training took place both in the home by the person they were working for and more formally at the office. However we noted the provider did not have records to show that staff received an induction prior to starting work with people that covered key areas of vital information including policies on safeguarding adults, first aid or health and safety matters.
People were responsible for their own medicines management and administration. PA staff supported people where necessary with taking medicines or collecting prescriptions from the pharmacy. People used health and social care services either independently, or with the help of the PA or family or friends.
We saw complaints were dealt with appropriately by the provider.
People using the service spoke very highly of the service and of the skills of the registered manager in managing it. The staff spoke well of working for the organisation and there was a culture of openness. People using the service and staff told us the registered manager was good at communicating with them and was readily available and responsive when issues arose.
There were two breaches of regulations in relation to staff recruitment and the lack of notifications to CQC in relation to safeguarding concerns.
You can see what action we told the provider to take at the back of the full version of the report.
Our inspection team was made up of one inspector. As part of this inspection we spoke with five people who used the service, one relative, the registered manager and three care staff. We also reviewed records relating to the management of the home which included four placement guides and four staff files.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.
Is the service safe?
There were detailed placement guides and personal profiles for each person who used the service, three of which had been reviewed recently and included risk assessments. There was an out of hour's phone number in case of emergencies. Staff had emergency first aid training. Staff had received training in safeguarding vulnerable adults and the people we spoke with told us they felt safe with staff.
Is the service effective?
The service undertook assessments with the person who used the service or a relative to identify their needs. People who used the service had returned their profiles back to the service electronically by way of giving consent to support. The people we spoke with told us there needs were met by staff.
Is the service caring?
People who used the service or a relative had been involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. Staff told us, "We are told by the user what to do, sometimes I ask what they'd like for example; on a hot day I may ask if they'd like to go for a walk? If they say no I don't try and force them." A person who used the service told us, 'I'm in charge, I say what I want and it's done'
Is the service responsive?
People's individual needs had been assessed and staff were aware of their needs. People who used the service knew how to make a complaint; however the people we spoke with told us they had not made any.
Is the service well-led?
The service was using the skills and knowledge of staff members to provide the required service to meet people's needs. There were no records of staff meetings; however the staff we spoke with confirmed they felt able to make suggestions and voice concerns. We were shown two evaluations, which had been completed by people who used the service, which we were told were used to monitor and improve the quality of service. The feedback from the evaluations demonstrated people were happy with the service.