Archived: Brighton and Hove City Council - Shared Lives Team

The Brighton and Hove City Council - Shared Lives Team is registered to provide personal care for children sixteen years and above, adults and older people living in Brighton and Hove. People with either a learning disability or autistic spectrum disorder, mental health issues, dementia, a physical disability or sensory impairment. The care service has 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 learning disabilities and autism using the service can live as ordinary a life as any citizen.

In shared lives, people who need support and or accommodation become a regular visitor to, or move in with, an approved shared lives carer. Together, they share family and community life and in many cases the individual becomes part of a supportive family. Shared lives carers and people they care for are matched for compatibility and can develop real relationships. The shared lives carer acts as ‘extended family’, so that someone can live at the heart of their community in a supportive family setting. Care and support was offered for long-term and short-term respite placements. A ‘day share’ facility was also available where people can go to a shared lives carers home for the day who provide care, support and activities. Approximately 65 people, of which 26 received the regulated activity personal care, were supported by 37 approved shared lives carers in the scheme. Not all the shared lives carers provided the regulated activity of personal care at the time of the inspection. But were supporting people with developing access into their local neighbourhood and helping develop people’s life skills towards improved independence. Shared lives carers were supported and managed by shared lives staff employed by the scheme.

As part of the scheme staff were working on a pilot project to support care leavers from the age of 16 years plus within Brighton and Hove. Shared lives staff had been collaboratively working with another scheme also in the pilot. They were working with Shared Live Plus, the UK network for shared lives schemes on the policy and procedures to be followed. Staff were in the process of being recruited and trained. The pilot was not up and running at the time of the inspection so was not looked at on this occasion.

At our last inspection on 25 February 2016 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.

At the last inspection on 25 February 2016 risk assessments did not reflect the level of knowledge held by staff members, and lacked sufficient guidance. Where changes had been made these had not always been used to inform and update the information. At this inspection we found improvements had been made.

Outstanding responsive care had been provided. We were given numerous examples of where care had been outstanding in its outcomes for people. Observations, staff and a visiting health and social care professional consistently told us how the service was exceptionally personalised to meet people's individual needs. Staff spoke with pride and passion about the way people were cared for. Management and staff continuously looked-for ways to improve people's care so they received positive experiences and led fulfilling lives at the service.

The culture of the service was open and inclusive and encouraged staff to see beyond each person's support needs. The provider had clear values which the registered manager and staff promoted. The registered manager showed outstanding drive and passion, ensuring the service was continually improving and striving to be outstanding, with people at the heart of the service.

Systems had been maintained to keep people safe. One person told us, “Yes its nice. Thumbs up. Yes, I feel safe. I get help with medication.” People’s care and support plans and risk assessments continued to be developed and reviewed regularly. A shared lives carer told us, “He likes shared living. He lives with a jolly family. He likes the hustle and bustle. I’m given a care package plan with his needs and risk factors.” People remained protected from the risk of abuse because staff understood how to identify and report it. Infection control procedures were in place.

People told us they had continued to feel involved and listened to. The culture of the service remained open and inclusive and encouraged staff to see beyond each person's support needs.

The care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence.

New shared lives carers continued to undergo rigorous assessment and checks before being ‘matched’ with people who needed support. People’s equality and diversity needs had been considered when they were matched with potential carers. People told us how they liked their accommodation and enjoyed living with their shared lives carers.

Staff continued to have the knowledge and skills to provide the care and support that people needed. One person told us, “They do understand what I need and they know me very well.” Staff told us they had received supervision and appraisal’s. They had been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively.

People continued to be supported by kind and caring staff who treated them with respect and dignity. They were spoken with and supported in a sensitive, respectful and professional manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. One person told us, “Twenty-six years I’ve lived with this family. I do very much so feel safe. It is beneficial towards me. It’s company for me and I live with other people and I’m independent and I am very happy here and well settled. I do medication myself.” Shared lives staff continued to have a good understanding of consent. People spoke of continued good support to access a range of educational, work and social activities.

People continued to be supported with their food and drink and this was monitored regularly. People continued to be supported to maintain good health and access healthcare professionals when needed.

People, staff and a visiting health and social care professional told us the service continued to be well led. A shared lives carer told us, “It’s brilliant. Quite a lot of us have a wealth of experience. We all have different experience and skills.” Shared lives staff told us the registered manager was always approachable and had an open-door policy if they required some advice or needed to discuss something. The registered manager and shared lives officers had maintained a range of internal quality assurance audits to ensure the quality of the care and support provided. People and their relatives, and staff were regularly consulted about the care provided through reviews and by using quality assurance questionnaires.

Brighton and Hove Shared Lives Team provides long or short term personal care and support for adults in the Brighton and Hove area, who have a learning disability or a mental health need. In Shared Lives, an adult over 18 years of age who needs support and/or accommodation becomes a regular visitor to, or moves in with, a registered shared lives carer. Together, they share family and community life and in many cases the individual becomes part of a supportive family. Shared lives carers and people they care for are matched for compatibility and can develop real relationships. The shared lives carer acts as ‘extended family’, so that someone can live at the heart of their community in a supportive family setting. Approximately 53 people were supported by 34 registered shared lives carers in the scheme. Shared lives carers are supported and managed by staff employed by the service.

On the day of our inspection, there was a registered manager in post. 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.

Since our last inspection the service had amalgamated with another service in the city of Brighton and Hove. The service was going through a significant period of change and review, where the provider and local stakeholders were looking at the service provision, what care and support was needed in the city, and how the service would best be provided in the future.

Care and support provided was personalised and based on the identified needs of each individual. People were supported where possible to develop their life skills and increase their independence. People’s care and support plans were detailed and reviewed regularly. Detailed risk assessments were in place to ensure people were safe within their own home and when they should receive care and support. However, we found that details of the risks identified had not been consistently used to update the care and support plan to help ensure consistency of approach. Risk assessments did not reflect the level of knowledge held by staff members. This is an area in need of improvement.

People told us they felt safe in the service. People were supported by shared lives officers and cares who were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Consent was sought from people with regard to the care that was delivered. Shared lives officers and carers understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. Where people were unable to make decisions for themselves, staff had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests. Referrals had been made for Deprivation of Liberty Safeguards (DoLS) and we could see that staff understood how these were implemented.

People were supported to eat a healthy and nutritious diet. People had access to health care professionals and had been supported to have an annual healthcare check. All appointments with, or visits by, health care professionals were recorded in individual care plans. Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately.

New shared lives carers underwent rigorous assessment and checks before being ‘matched’ with people who needed support. People told us how they liked their accommodation and enjoyed living with their shared lives carers. Their cultural needs were taken into account when they were matched with potential carers. They felt able to express their views and were involved in decisions affecting them. People had contact with their relatives and were supported to stay in touch.

People were supported by kind caring staff. Shared lives officers and carers were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. They told us that communication throughout the service was good. The shared lives carers said they felt well supported by management and were positive and enthusiastic about their roles. One shared lives carer told us, “Someone is always at the end of the phone. They give you fantastic support.”

There was a detailed complaints procedure. The registered manager told us that they operated an 'open door policy' so people, their representatives or shared lives staff could discuss any concerns.

The registered manager, along with the shared lives officers provided good leadership and support to the shared lives carers. They were involved in day to day monitoring of the standards of care and support that was provided to people. One member of staff told us, “We are good at identifying what has gone well. We don’t hold it back we have a manager who is innovative.” Systems were in place to audit and quality assure the care provided. People were able to give their feedback or make suggestions on how to improve the service, through the reviews of their care, and they were asked to complete a satisfaction questionnaire to help identify any areas for improvement. There was evidence as to how any feedback was acted upon and improvements made to the service provided. Comments from members of staff about the service included, “Gives a rooted belonging feeling,” “Makes such a difference for that person,” and “To feel you belong – because long term and integrated in a family and a community service users get a feeling of belonging they could not get from another type of service. They build relationships with each other and become important to each other.”