Archived: Independence Homes Domiciliary Care Agency

Independence Homes Domiciliary Care Agency is part of Active Care Group, a large national provider had taken over the ownership of Independence Homes. The service provides support for adults with learning disabilities, physical disabilities or mental health needs. At the time of this inspection, the service was providing support within the regulated activity of personal care to 35 people across four ‘supported living’ settings. Support ranged from a few hours per day to 24-hour care. CQC does not regulate the premises used for supported living; this inspection only looked at people’s personal care and support.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The management team had continued to develop and improve the quality of support against their own action plan since taking over the running of the service. The outcomes for people at each setting that provided a regulated activity now better reflected the principles of this guidance. As such, people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Comprehensive assessments and care plans were now the basis of personalised care and ensure that staff supported people in a way that maximised their choice and control, and independence. Staff had a better understanding of people’s needs and were committed to supporting them to live the lives they chose.

Right care:

• Care was more person-centred and promoted people’s dignity, privacy and human rights. People’s individual needs were recognised, and diversity celebrated. Managers had introduced ways of encouraging staff and people to explore each other’s cultures, beliefs and religions in an inclusive way.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff enabled people using services lead confident, inclusive and empowered lives. The management team had worked hard to develop an open and transparent culture which promoted learning and not blame.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 6 February 2020).

Why we inspected

We carried out an unannounced comprehensive inspection of this service in November 2019 where the service was rated requires improvement for the second consecutive time. Following that inspection, the provider completed an action plan to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm the areas which previously required improvement had been addressed. This report only covers our findings in relation to the Responsive and Well-led key questions.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Independence Homes Domiciliary Care Agency on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Independence Homes Domiciliary Care Agency (Independence Homes) provides support for adults with epilepsy and other neurological conditions. Some people may also have physical and learning disabilities or mental health needs. At the time of this inspection, the service was providing support within the regulated activity of personal care to 37 people across five ‘supported living’ settings. Support ranged from a few hours per day to 24-hour care. CQC does not regulate the premises used for supported living; this inspection only looked at people’s personal care and support.

People’s experience of using this service and what we found

Since the last comprehensive inspection, Active Care Group, a large national provider had taken over the ownership of Independence Homes. As such, there was a new management team leading the operational running of the service.

The new management team had taken on board the findings of the focused inspection in March 2019 and was working through a comprehensive improvement plan to address the shortfalls. The provider had initially focused on improving Woodland Court. The outcomes for people at that setting now better reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The systems and learning trialled at Woodland Court were now being rolled out across the rest of the service.

Recent months had been a period of significant change at the service and resulted in a large turnover of staff. The ongoing recruitment of new staff coupled with the high use of temporary staff had impacted on the quality of support people received. Managers and staff were working hard to address the issues and embed new training and care planning systems which would enable people to receive a more consistent and personalised service.

The new leadership team had secured a cultural shift across the service and people now benefitted from a more open and honest approach to support. People and their representatives were slowly gaining more confidence in the both the staff and systems in place. Feedback was being listened to and people’s voices were now being heard.

Comprehensive assessments and care plans were beginning to provide the basis of personalised care and ensure that staff supported people safely and in accordance with their needs and preferences. Risks to people were now identified and managed in a way that balanced their safety with their right to freedom, choice and independence.

People were encouraged and supported to lead active and healthy lifestyles. Staff were working better to facilitate opportunities for people to engage in a range of meaningful activities and work towards goals and learn new skills that were personal to them.

Those staff who had remained with the service, had done so out of loyalty to people and demonstrated great compassion and commitment to supporting people.

A new quality assurance framework which put outcomes for people at the centre had recently been introduced and a variety of feedback systems were

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 16 May 2019). The service remains rated requires improvement. The last inspection was a focused inspection where we found five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Whilst this is the second consecutive inspection in which we have rated the service requires improvement, we found significant improvements to the safety and quality of care that people received and the provider demonstrated a commitment to ensuring the necessary improvements would continue to be made.

Why we inspected

This was a planned comprehensive inspection which was brought forward based on the change to the rating at our last focused inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Whilst there were no significant concerns raised about the services provided at eight of the supported living settings, the people living at Woodland Court were not receiving appropriate care and support. Ongoing failure to address the issues at Woodland Court have therefore impacted on the service as a whole.

The lack of skilled and experienced staff deployed at Woodland Court placed people at risk of harm. Staff were unable to meet people’s complex needs and this had a significant impact on people’s physical and emotional well-being.

People and their representatives were angry that their views were not being listened to and their experience was further impacted by the low staff morale. Relationships with other health and social care professionals had broken down as practitioners expressed frustration at the lack of coordination of people’s care.

Despite receiving continuous feedback about the decline of quality at Woodland Court, the provider had failed to have effective oversight and monitoring of the service.

Rating at last inspection: Outstanding (Published September 2017). The rating has therefore dropped since the last inspection.

Why we inspected: This inspection was carried out in response to multiple concerns that we had received regarding the service being provided at Woodland Court. These concerns were raised by a range of stakeholders and indicated significant issues about the way Woodland Court was being staffed and managed.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will be seeking an action plan from the provider and continuing to monitor the service.

The inspection took place over three days. The service was given 36 hours’ notice of the inspection in order to arrange visits to three locations and make staff available to speak with. This also enabled us to obtain contact lists of family members and advocates to faciliate real-time feedback.

The service had a registered manager. 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.

Independence Homes provided a bespoke service to a high standard. People living with epilepsy benefitted from the provision of services delivered by highly trained staff. Staff had an excellent understanding of people’s needs and how to support them safely and effectively. Staff knew the importance of respecting people’s choices and advocated on their behalf.

Strong leadership across the service fostered a culture of high support and high challenge. The provider was focussed on continual development and evolution in line with industry best practice.

Staff were highly motivated and proud to work for the organisation and were committed to the future of the service and making it the best it could be.

There were good recruitment procedures in place that helped ensure that people received their support from staff of suitable character. Staff enjoyed their work and felt well supported in their roles. They had access to a wide range of training which equipped them to deliver their roles effectively. Staff were proud to work for Independence Homes and felt valued and empowered to deliver high quality care.

Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly. Learning was shared from within and outside the organisation and community contacts were well established. National best practice legislation and local policies were referenced to set and measure standards of care.

The service celebrated its successes as a way of motivating staff, but was never complacent and always striving to continually improve. People were regularly asked to provide feedback on the service. Where people made suggestions or raised issues, they were listened to and resulted in change.

The service had excellent systems in place to ensure that staff worked effectively together as a team to meet people’s holistic needs. The medical team provided a bespoke service that bridged the gap between support staff and the health profession. Medicines were managed safely and where possible, people were supported to become independent in this area.

The service had good systems in place to ensure that people’s needs were properly assessed at the start and kept under ongoing review. Risks to the health, safety and well-being of people were addressed in an enabling and proportionate way to ensure that people were kept safe without being restricted from living their life as they wanted.

People received a personalised service that was planned proactively in partnership with them and which was responsive to their individual needs. People had control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. People had opportunities to learn new skills and develop their independence.

Staff used creative and innovative ways to support people with their dietary needs which both improved their physical health and respected their cultural preferences.

People had good relationships with the staff that supported them. People were clearly relaxed with staff and felt happy and confident in their company. Staff respected people’s privacy and took appropriate steps to ensure their dignity was upheld.