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Inspection carried out on 5 April 2017

During a routine inspection

The inspection took place on 5 April 2017, and was an announced inspection. The registered manager was given 48 hours’ notice of the inspection. At the previous inspection on 18 November 2014 no breaches were found and the service was rated as good.

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 this inspection there were two people receiving support with their personal care. The service provided one to one support hours to people who were supported 24 hours a day although during this time may share staff for a period of time with other people who lived in the same house. The service was delivered in New Romney.

The service is run by 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.

People and relatives were involved in the initial assessment and the planning of their care and support. Care plans contained details of people’s wishes and preferences. People’s independence was encouraged wherever possible and this was supported by the care plan. Risks associated with people’s care and support had been identified and clear guidance was in place to keep people safe.

People had their needs met by sufficient numbers of staff. People received a service from a small team of staff. New staff underwent an induction programme, which included relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role, which was refreshed regularly to ensure their knowledge remained up to date. The majority of staff had gained qualifications in health and social care.

People were supported to maintain good health and attend appointments and check-ups. People’s medicines were handled safely.

People’s consent was gained for the care and support they received and they were supported to make their own their own decisions where possible, sometimes using pictures. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager demonstrated they understood this process.

People and a relative felt staff were kind and caring. People were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect. Staff were kind and caring in their approach and knew people and their support needs well.

People and a relative felt people were safe using the service. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had opportunities to provide feedback about the service provided. Any negative feedback was used to drive improvements to the service. Audits and systems were in place to ensure the service ran effectively and people received a quality service. People saw the registered manager and director regularly, because they worked ‘hands on’ delivering some care and support. People felt confident in complaining, but did not have any concerns.

People felt the service was well-led and well organised. The provider had a set of objectives in place and staff followed these through into their practice.

Inspection carried out on 18 November 2014

During a routine inspection

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.

Inspection carried out on 25 November 2013

During an inspection to make sure that the improvements required had been made

On 7 July 2013 we inspected Reflective Care Ltd and found non-compliance in the area of requirements relating to workers. This was a follow up inspection to check compliance against that area. We spoke with the registered manager.

At the time of the inspection the service was only supporting one person who required assistance with their personal care.

We did not speak with people that used the service. Previously people had told us that the service recruited the right calibre of staff and no new staff had been recruited since that time. We found recruitment records had been reviewed and met with the regulations.

Inspection carried out on 9 July 2013

During a routine inspection

We visited the office and spoke with the manager who was in the process of registering with the Care Quality Commission. We visited a person who used the service and spoke with them and a staff member. We later telephoned a relative.

The person who was using the service was happy with the care and support they received. They gave their consent to care and support by talking through their personal hygiene choices each day with staff. They told us, “it’s good (the care and support)”. They talked about their care plan and showed us photographs of themselves and things they did, which it contained. They said they had an annual review meeting where they discussed their aspirations and any concerns. The individual told us they felt safe when they were supported by staff. The person said that they felt all the staff the service employed were “good” and some you could have a joke with and were “funny”. However we found shortfalls in the recruitment procedures. The individual said they had regular meetings where they could talk about any concerns and voice their views on the service provided.

Inspection carried out on 6 November 2012

During an inspection to make sure that the improvements required had been made

We did not speak to people who used the service on this occasion. All of the people spoken with on our previous inspection of 3 October 2012 were entirely satisfied with their care and support.

Inspection carried out on 3 October 2012

During a routine inspection

Reflective Care Ltd is a small service providing support to people living in supported living housing. It was first registered with the Care Quality Commission in July 2011. This was the first inspection of the service since registration.

People we spoke with told us how their care was personalised to their needs. They talked about the community activities they were involved in and how they could make their own decisions about what to do and when. People said they liked the meals, were able to choose what they had and were involved in the shopping and cooking.

People said they were happy living in supported living. People were aware of their care plan although could not always recall the detail. They confirmed that they had been involved in discussions about their care and said they had attended a review meeting. This was a meeting for them and people they wished to invite such as their social worker, family members and staff to discuss their care and support. People told us they felt safe living in supported living and if they had any concerns they would speak with a staff member or the manager. People spoke very positively about the staff.