Luton Council Respite and Shared Lives Service

Luton Council Respite and Shared Lives Service provides care and support for people with a learning disability or autistic spectrum disorder. It consists of 2 services; a care home that provides respite care and a shared lives service. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 9 people and the respite service supports 65 people on a rotational basis. At the time of the inspection, 6 people were being supported by the service.

The shared lives scheme provides people with long-term placements, short breaks and respite care, within shared lives carers (SLC) own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, the service was supporting 6 people with personal care. Some of the people who were supported by the shared lives scheme, also accessed the respite service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were at risk of harm because risks were not always fully assessed, and care plans contained inconsistent information. Risks in relation to people’s behaviour needs, health and nutrition needs, equipment and medicines were not always managed safely. 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; however, the policies and systems in the service did not always support this practice.

Right Care: The provider did not always ensure staffing deployment for the respite service was planned effectively. Staff understood how to protect people from poor care and abuse. We observed positive interactions between people and staff and people told us they felt safe. The provider worked in partnership with other professionals.

Right Culture: Audits and checks were not always effective to ensure the quality of care plans and risk assessments. Feedback was gathered through surveys and meetings; however enough action was not always taken in response to staff feedback.

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 good (published 11 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Luton Council Respite and Shared Lives Service on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to risk management, medicines and governance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made recommendations about recording consent and people’s involvement in care planning and ensuring people’s needs are thoroughly assessed and accurately recorded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The home was very clean and well ventilated. Key areas were cleaned several times a day. People had their own bathrooms.

¿ The registered manager had adapted the home’s admission processes to prevent the spread of potential infections. There were plans in place if people developed COVD-19 symptoms during their stay.

¿ We observed staff wearing personal protective equipment (PPE) correctly. Staff received training in relation to PPE. People had been supported (where possible) to understand the importance of staff wearing this equipment.

¿ The registered manager was monitoring key aspects of infection protection control (IPC) to promote people’s safety. The home had not had any cases of COVID-19 so far during the pandemic.

Luton Council Respite and Shared Lives Service runs a ‘care home’ to provide respite care to people with learning disabilities and autistic spectrum conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 9 people and the service supports 41 people on a rotational basis. At the time of the inspection, three people were being supported by the service.

The service also operates a ‘shared lives’ scheme. This is a service which supports people who need care to move in and live with their approved carer. At the time of the inspection, 10 people were living with and being supported by eight approved carers.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was no registered manager in post. A new manager who had been in post for a few months was in the process of registering with the Care Quality Commission. 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 were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or harm. There were safe staff recruitment processes in place and there were sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. People had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services when required.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet their individual needs in a person-centred way. The provider had an effective system to handle complaints and concerns. People were supported to pursue their hobbies and interests. Further work was necessary to ensure that people’s wishes about the kind of care they would like at the end of their lives were recorded in their care records.

The provider’s quality monitoring processes had been used effectively to drive improvements. People, relatives and staff we spoke with were happy with the quality of the service.