The inspection took place on 18 November 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.
Reflective Care Limited is a domiciliary care agency that provides personal care to people with a learning disability who live in supported living accommodation. At the time of the inspection, the service supplied care and support to people living in two adjacent houses. One of these accommodated two people, and the other had six people. The houses were next door to the agency office, which provided people with easy access to the management. People receiving support had agreed to living in the houses with other people, and had their own bedrooms and shared communal areas.
The service was 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 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 supported living services the process involves the court of protection, and no applications had been necessary.
The agency had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the agency’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, the director, or the local authority safeguarding team.
The agency had suitable measures in place to protect people from risks to their safety. Each person had individual risk assessments highlighting specific concerns around their own needs, such as assessing the risks to them going out into the community on their own, or using public transport. Other risk assessments were in place in regards to their home environments, such as fire risks and use of shared equipment. These were tailored to each individual person. The environment was checked to ensure that it met people’s needs, and each person had tenancy agreements with the landlord.
The manager carried out checks on staffing numbers to ensure that people were provided with the correct number of support hours, in line with the agreements with the different Local Authorities. This included identifying if people had sufficient support hours provided to enable them to live their lives as they wished, and participate in community and social functions with support from staff where this was needed.
The agency had comprehensive recruitment procedures in place, ensuring that staff were suitable to work with the individual people concerned. For example, where someone wanted to take part in sports, the agency would recruit staff who had similar interests. Recruitment practices included stringent checks for any criminal records and to take up references. Staff were trained in essential subjects during their induction programme; and refresher training was provided throughout each year. Staff were encouraged to develop their knowledge and skills with formal qualifications; and to train in subjects which were relevant to individual people they were supporting.
People were assessed for their ability to manage their medicines and for the support that they needed to take them correctly. Staff were trained to assist people with their medicines, and to understand the importance of promoting safe storage, and disposal of any unused medicines.
Assessment processes included discussions about people’s dietary needs, and how to support them with making healthy choices and following any recommended diets for their health needs. People were supported to shop, prepare food, cook and eat food in line with their individual needs and preferences.
Staff supported people with their health needs, and reminded them of health appointments such as with their doctor or dentist. They accompanied people to appointments if they wished them to do so, or if they had been assessed as needing support in this area.
The environment was maintained in agreement with the landlord, and the provider ensured that the properties were suitably maintained for people’s safety, welfare and comfort. One person told us “I am enjoying it in my new home”; and another said “I like it here.”
It was evident that people felt relaxed with the staff, and they said they felt safe and well supported. Staff were friendly and kind, and chatted with people or left them alone depending on their wishes. They supported people with household chores and with going out in accordance with their individual development and agreed support. People knew who their specific key workers were, and said that if they had any concerns that they would talk with their key workers. As people shared houses, they knew all of the staff who provided support for the people living there.
Staff signed a confidentiality agreement as part of the induction procedures. They were careful to discuss people’s preferences and requirements in private. Monthly key worker meetings were always carried out in private and covered the range of people’s care planning and person centred care. Advocacy services were requested if people needed additional support with decision- making and did not want to involve family members or friends. A relative told us that their family member had increased in their independence over the last few months, and that staff had supported them in this.
Each person receiving support had a person-centred plan which had been prepared in a format or easy read style to promote their understanding and involvement. This was in addition to a written care plan. Individual communication books were used to record discussions and phone calls from family members or health or social care professionals, to ensure that a clear record was maintained, and nothing was missed which was relevant to people’s on-going support.
Staff helped people to identify their interests and hobbies, and supported them in finding suitable work placements, day centres or places of interest to visit. One person told us about their place of work, and another told us they were in the process of applying for a new job. Some people developed further skills and independence as a result of receiving agency support, and moved on to live on their own, or with less support in the future. Liaison between different services promoted a smooth transition for people as much as possible.
The manager and the provider took an active role in supporting people and acted as support workers on a regular basis. This enabled them to observe how people were progressing with their life skills, and helped people to relate to them in the event of any concerns. Staff said “We work really well as a staff team”; and “We can talk to the manager at any time if we want to ask anything.” Staff said that they were supported through individual supervision and through regular staff meetings. The agency had a culture of openness, where staff were invited to share their ideas and opinions.
The agency had robust quality assurance processes to obtain the views of people receiving support, staff, relatives and health and social care professionals. People’s responses were analysed and their comments were listened to. Changes were made in the way things were done in response to people’s views.