Archived: Freedom Care and Support Limited

Freedom Care and Support is registered to provide personal care to people in their own homes. The service specialises in providing support to people with a learning disability, autism and physical disability. Support is provided to both individuals in the family home and to people living in supported living tenancies. At the time of our inspection there were 25 people using the service within East Lancashire and Cheshire.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. The service ensured any incidents were recorded and investigated. Staff had been recruited safely and people were involved in recruiting their staff. Medicines were managed safely.

People's needs had been thoroughly assessed and care plans were detailed. staff knew the people extremely well and felt the care plans provided enough information to understand what support the person needed. Staff had received regular training and supervision to support them to meet people's needs. A comprehensive induction programme ensured new staff had a good understanding of their role and the values of the organisation. People were supported to maintain their health and wellbeing, through access to a range of health services.

The service was compliant with the Mental Capacity Act. People were supported to have maximum 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 promoted people's choices.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service 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.

People received person-centred care which was responsive to their needs. Care and support plans had been regularly reviewed to reflect any changes in the person’s needs and wishes. People had been referred for further input from professionals when required. People were encouraged to raise any concerns. No formal complaints had been received.

The registered manager was committed to providing high-quality, person-centred care. Staff spoke highly of the registered manager and the values they set. Roles and responsibilities were clear. Regular audits ensured care was provided effectively and records were accurately maintained.

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 6 July 2018) and there were multiple 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This service provides a combination of support as a domiciliary care agency and supported living service. It provides personal care to people living in their own houses in the community. The supported living service provides care and support to people living in 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported

living; this inspection looked at people's personal care and support. At the time of the inspection, a total of 24 people were receiving care and support from the service.

The service was managed 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.

At the last inspection, in January 2015 the service was rated as overall ‘Good’. At this inspection, the rating had deteriorated to ‘Requires improvement’. We found four breaches of the regulations in respect to safeguarding vulnerable adults, the failure to review risks to people’s health and safety, the implementation of the Mental Capacity Act 2005 and the failure to submit statutory notifications. You can see what action we told the provider to take at the back of the full version of the report.

Whilst there were safeguarding adults’ procedures in place and staff had received appropriate training, we found the provider had failed to report two incidents to the local authority under safeguarding procedures. This meant there was the potential for people to be exposed to further harm. Following the inspection, the registered manager confirmed they had reported all incidents to the local authority, as appropriate.

People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments had been carried out; however, the assessments had not always been reviewed in a timely manner and in line with people’s changing needs. Staff understood best practice for reducing the risk of infection. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home. Sufficient numbers of staff were deployed to provide people's care and support.

People were not always supported to have maximum choice and control of their lives and staff had not always supported them in the least restrictive way possible. Staff received appropriate training to meet people's needs. An induction and training programme was in place for all staff. Whilst the registered manager visited people and their families several times before they received a service and spent time sourcing a property, there were no records maintained during the assessment process. People were supported with their healthcare and nutritional needs as appropriate. However, it was unclear how people’s routine medical appointments were monitored.

Staff treated people with kindness and compassion in their day-to-day support. Staff knew people's needs well and people told us they valued and liked their support staff. People were aware of their individual care plans; however, there was no evidence people had been involved in the review process. Staff understood the importance of promoting people’s independence, however, there were no clear objectives or goals set for people’s future development. This meant it was unclear how people’s level of independence skills were monitored and developed.

People were supported to plan and participate in activities that were personalised and meaningful to them. We noted people participated in a wide range of activities and had an activity planner to help them structure their time.

People had access to a complaints procedure and were confident any concerns would be taken seriously. Whilst no written complaints had been received the registered manager had not maintained a record of verbal complaints and concerns. The registered manager agreed to make a record of any verbal complaints received in the future.

On looking at the incidents reports, we noted the provider had failed to submit the required statutory notifications without delay. We received all delayed notifications following our visit.

The registered manager monitored the quality of the service and sought feedback from people, their families and staff. However, we found a number of shortfalls during the inspection, which indicated the quality assurance systems needed improvement.

''The longer I have Freedom the more brilliant I think it is!''

''I am very happy with the service I get from Freedom. They listen to me.''

''I think it is a very good service.''

''I don't think there's anything I'd change because I'm happy with how things are going with Freedom. It works for me.''

''We can't believe how well it is going. We are very happy with the service.''

During this inspection we assessed standards relating to the care and welfare of people who use services and involvement. We also looked at the processes used by the provider to assess quality and manage complaints. The recruitment and selection of staff was also assessed. We did not find any concerns in any of the areas we inspected.