Archived: JRHT- Independent Living Services

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

There was a registered manager in post. People and staff spoke positively about the management and leadership of the service.

There were safe systems in place to ensure people received their medicines as prescribed. Risks to people were assessed and action taken to reduce them. Staff were aware of different types of abuse and the action they should take if they had any concerns. Safeguarding referrals had been made appropriately.

There were sufficient, suitably trained staff to meet people’s needs. Appropriate recruitment checks were undertaken before staff started their employment, to ensure they were suitable to work with vulnerable people. Staff received support and supervision to give them the skills and knowledge they needed to care for people effectively.

People received support with their nutritional needs and people were satisfied with the assistance they received to prepare meals. Where people were at risk in terms of their nutrition or hydration, staff monitored their food and fluid intake. Staff supported people to access a range of healthcare professionals where required, and people received an annual health check.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect. Staff promoted people’s independence and supported them to be actively involved in the running of their own home and daily living tasks, such as cooking and cleaning. We observed caring interactions between staff and people who used the service. People’s diverse needs were catered for. Staff understood people's individual communication needs and made appropriate adjustments to aid effective communication.

There were regularly reviewed care plans in place, to give staff the information they needed to support people in line with their preferences and needs. People took part in a range of activities of their choosing in the community. The provider had a procedure in place for responding to any concerns and complaints. People told us they would feel comfortable reporting any concerns and were confident these would be addressed.

There was a quality assurance system in place to monitor the quality of the service provided. Feedback from staff indicated there was a positive, person-centred culture within the service.

Further information is in the detailed findings below.

Joseph Rowntree Trust Independent Living Service provides care and support to people in six properties across York and the surrounding areas. People hold their own tenancy agreements and there was a mix of individual and shared accommodation across the scheme. The service is registered to provide personal care for people with a range of varying needs including, learning disabilities or autistic spectrum disorder, older people, sensory impairment and younger people who live in their own homes. At the time of our inspection, 19 people received a personal care service. The service provides community based care and support services from the registered office location, on the outskirts of York.

The registered provider is required to have a registered manager in post and on the day of this inspection, there was a registered manager registered with the Care Quality Commission (CQC). 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 who used the service told us they felt safe and we found that care workers had received training in safeguarding people from abuse and knew how to protect people from avoidable harm. Care files contained up to date risk assessments that helped promote people to maintain their independence in a safe way. Risk management plans were in place and they were regularly reviewed and updated in line with the person’s needs.

People’s care files were thorough and focused on the person. Care plans included an easy read version and a section, 'What's Important to Me'. This recorded personal history, personal preferences, interests and aspirations of people. We saw this helped care workers to deliver personalised care for all areas of a person’s life.

We saw that accidents and incidents were recorded. These were logged monthly onto a quality assurance system where they were investigated and analysed by the health and safety officer. Because of these investigations, the registered provider had implemented risk assessments and had updated support plans.

The registered provider undertook a variety of recruitment checks to help ensure care workers recruited were considered suitable to work with vulnerable people. We saw care workers underwent an induction programme to gain a fundamental understanding of providing care for people that included areas of mandatory training. Care workers received training in privacy, dignity and confidentiality during their induction. We saw that the registered provider undertook documented observations on care workers whilst they delivered care and support to people to ensure they upheld the basic values of care. The induction was followed by a period of shadowing experienced care workers until the care worker was signed as competent to provide care and support on their own.

People and care workers raised concerns around the use of agency staff. The registered manager told us they had an action plan in place to recruit permanent care workers and appropriate checks were carried out when agency staff were used. The registered provider recognised the importance of building relationships between people and the carers and told us they had involved people in the recruitment process.

The registered provider had a medication policy and procedure in place and this followed guidance provided by 'The National Institute for Health and Care Excellence' (NICE). We saw this was reviewed and updated at least annually. There was clear guidance for people who were prescribed ‘as and when needed’ (P.R.N) medication and appropriate guidance by way of pictorial body maps was documented for the application of patches, creams and emollients. Appropriate risk assessments were completed and training provided to care workers to help them to ensure that they followed the agencies policies and procedures.

Care workers had received training and understood the requirements of The Mental Capacity Act 2005.

The registered manager showed us maintenance certificates for the premises, which included the electrical wiring certificate, gas safety certificate and portable appliance checks. These were up to date and helped to ensure the safety of the premises. We saw regular maintenance programmes in place. This meant the environment was safe for people and others.

We saw people were kept safe from the risk of emergencies in their home. People had a risk assessment in their care files for the environment and a personal emergency evacuation plan (PEEP). PEEPs are documents, which advise of the support people need to leave the home in the event of an evacuation taking place.

People were supported to maintain good health. Care plans contained detailed information to ensure people were not at risk of malnutrition. We saw the use of ‘Malnutrition Universal Screening Tool’ (‘MUST’). These were completed monthly and where risks were identified, we saw the person’s care and support plan had been updated.

We saw peoples dietary requirements noted in their care plans that included details of food likes, including any religious dietary requirements and information on supporting people with good nutrition and hydration. The support people received varied dependent on their individual circumstances. Appropriate professional advice was identified where necessary to ensure people’s health needs were supported.

Care workers told us they felt well supported and we saw good communication and relationships between care workers, management, people who used the service and outside agencies such as the local authority and health workers.

We received positive feedback about the leadership and there was a high degree of confidence in how the service was run. Care workers we spoke with told us the registered manager was approachable open and honest. Management understood how to meet the conditions of their registration with the Care Quality Commission (CQC).