Expect Limited

Expect Limited provides personal care and support to people in their own homes in the Sefton area of Merseyside.

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.

People’s experience of using this service:

There was not always clear guidance for staff to follow with regards to consuming food and drink whilst supporting people in their homes. We have made a recommendation about this. Some information in care files was not always easy to find and differed in their presentation. The registered manager explained there was a new system in place which would re format people’s care plans, so they were clearer. Recent audits had been used to evidence the need for this change. Audits took place across all areas of service provision, and detailed action plans were drawn up as a result of the findings.

People told us they felt safe receiving care from Expect. Our observations showed that people’s homes were secure, clean, and kept to a nice standard. Staff were deployed in suitable numbers, and staff had time to spend with people and were not rushed. Medication needs were assessed, and medication was only given by staff who were trained to do so. Staff were recruited safely, and incident and accidents were analysed for patterns and trends. Risks to people were assessed safely.

Staff had the correct skills to support people and their training was up to date and recorded in a training matrix. Staff were required to engage in supervision and had an annual appraisal. People were supported to eat and drink in accordance with their needs. Decisions and consent to care and treatment were sought in line with the Mental Capacity Act 2005.

We received positive comments about the staff in relation to the support they provided. Everyone said staff were kind and caring. Staff were able to describe how they ensured people’s dignity was respected. People were involved in their care plans.

We observed, heard and read examples of how people’s routines and choices were listened to and respected. There was a complaints procedure in place.

Rating at last inspection: rated good, report published November 2017.

Why we inspected: This inspection brought forward following some concerns we received which may put people at risk of harm.

Follow up: ongoing monitoring.

Our last inspection of Bowersdale Resource Centre took place in October 2016. During this inspection we found the service was in breach of regulations relating to person centred care, safe care and treatment and the governance of service. The service was rated as Requires Improvement. Following our inspection in October 2016, the provider sent us an action plan detailing what steps they were going to take to ensure the breach was met. We checked this during this inspection and found that the service had made the required changes.

Bowersdale Resource Centre provides personal care and support to people in their own homes and in supported living in the Sefton and Liverpool areas of Merseyside. At the time of our inspection 96 people received Outreach support and 56 people were living in 24 hour support living settings.

During our last inspection in October 2016 we found the service in breach of regulations relating to person centred care. This was because people’s care was not planned so it was personalised to reflect their current and on-going needs and was not regularly reviewed. We checked this during this inspection and saw that the registered manager and acting manager had Implemented new care planning documentation which contained personalised care plans.

Also at the last inspection in October 2016 we found the service in breach of regulations relating to safe care and treatment. This was because Medication Administration records (MAR) were not always completed in line with the service’s policies and good practice guidance and staff were not checked to ensure they were competent to administer medicines. We checked this during this inspection and saw that the provider had introduced an improved MAR and appraised staff of the new requirements. We looked at the new process and found it promoted safe administration of medication. The service was also found to be in breach because risk assessments were not always in place to minimise risk .We checked this during this inspection and saw that the provider had introduced new care planning documentation which included risk assessments, which meant individual risk assessments were completed.

At the last inspection in October 2016 we found the service in breach of regulations relating to governance. This was because we found key areas of quality and safety required further development so that people being supported were not exposed to potential risk. We checked this during this inspection and saw that the provider had formulated a new checking and auditing system which helped ensure people received support which met their needs and kept them safe. A new checking and auditing system helped assure managers that staff had administered medication; regular reviewing of people’s support now took place and care records were regularly checked to ensure support plans and risk assessments were completed. The service was no longer in breach of these regulations.

The service has two registered managers in post. A registered manager oversees the Outreach service and another oversees the supported living service. The role of the registered manager for the Outreach service was being covered for the period of maternity leave by another manager in the service. 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.’

Some people received staff support with their medicines. They told us they received it at the right time. Staff administered medicines safely.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs.

Staff spoken with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

The provider had robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. Staff received an induction when starting their employment.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

Staff were trained to ensure that they had the appropriate skills and knowledge to meet people’s needs. They were well supported by the registered manager.

People told us the staff had a good understanding of their care needs and people’s individual needs and preferences were respected by staff.

People at the home told us they were listened to and their views were taken into account when deciding how to spend their day.

Care plans provided information to inform staff about people's support needs, routines and preferences.

An electronic system was used to allocate staff to calls and informed of staff unavailability because of holiday leave, days off or sickness. The system showed when staff had arrived at a call. People in the main received the same staff to support them.

People told us staff were kind and polite. We observed positive interaction between the staff and people they supported.

A process for managing complaints was in place. People we spoke with knew how to raise a concern or make a complaint. However the service had not received any complaints since the last inspection.

People receiving the service and relatives told us they were able to share their views and were able to provide feedback about the service. Feedback we received was mainly complimentary regarding the service.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service.

This was an announced inspection which took place over two days on 10 and 11 October 2016. The inspection was carried out by an adult social care inspector.

The service had 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.

We found medicines were being administered safely to people but there needed to be some improvements to ensure safe standards were maintained. These included monitoring of staff to ensure competency with administration of medicines, ensuring quantities of medicines received were recorded and medication standards were regularly audited.

We found that risks to care provision had not been assessed appropriately and there was a lack of plans in place to help ensure people were kept safe. Arrangements were not in place for regular assessment and checking of people’s living environment environments to ensure they were safe.

With regard to overall management and governance, we found key areas of quality and safety required to be developed so that people being supported were not exposed to potential risk.

Only a small number of people had an up to date care plan to plan and evaluate their on-going care needs. This meant there were no agreed aims and objectives to the care and communication. The lack of information was confusing regarding the focus of staff support and input.

You can see what action we told the provider to take at the back of the full version of the report.

Health care professionals told us people were getting health care reviews when needed. People’s care documents were unclear and did not record details about people’s on-going medical and health care needs.

We made a recommendation to improve this.

There were systems in place to gather feedback from people so that people felt they were listened to; these needed to be more inclusive.

We made a recommendation in the report.

People we spoke with said they felt safe when receiving staff support from the agency. People told us that if any issues arose they were addressed by the managers.

There was sufficient staff available to support people. We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found that appropriate checks had been carried out and recruitment was robust.

The staff we spoke with described how they recognised abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report through any concerns they had. This helped ensure people were kept safe and their rights upheld.

We saw that people’s consent to care was recorded. The service worked in accordance with the Mental Capacity Act 2005.

Feedback from people we spoke with and their relatives informed us that staff seemed well trained and competent.

Staff were supported by on-going training, supervision, appraisal and staff meetings. Formal qualifications in care were offered to staff as part of their development.

We had positive feedback regarding how staff approached care and respected people’s rights to privacy and to be treated with dignity.

All relatives and people spoken with felt confident to express concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised.

We found managers open to feedback and discussion. This was evidenced throughout all of the feedback and interviews conducted.