Support for Living Domiciliary Care Agency

Support for Living Domiciliary Care Agency provides personal care and support to people living in supported living accommodation in North West London. The service is part of Certitude, a London based, not for profit, social care provider for people with learning disabilities, autism, mental health needs or multiple needs.

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, 125 people were receiving support with personal care across 25 different supported living houses.

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

In some of the schemes we found improvements were needed to safety, infection control and medicines management. We discussed this with the provider, and they addressed these issues and developed an action plan to make improvements.

People experienced personalised care which met their needs and reflected their preferences. The provider was committed to reducing restrictive practices and staff understood this and worked with individual people to enable them to take risks and develop their independence. People's care was planned to meet their individual needs, with staff working alongside healthcare professionals to make sure people received the right support.

The staff were well trained, supported and knowledgeable. They demonstrated a good understanding of the people they were caring for and were able to use a variety of communication methods to allow people to make choices and have control over their lives. The staff were able to access the training and support they needed and felt valued.

The provider had effective systems for addressing concerns and making improvements to the service. They undertook quality checks and responded appropriately when things went wrong. People using the service, their families and staff felt managers were approachable, open, and listened to them.

There were local and provider level strategies to promote human rights and improve the quality of people's experiences. For example, the provider had improved the way they supported staff and people using the service with protected characteristics to feel included, safe and respected.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: People were supported to live within settings that met their individual needs. There was a robust assessment process which included involving people, their families and other stakeholders to make sure care was personalised and maximised people's choice while meeting their needs. People were supported to learn independent living skills and take risks to enhance their quality of life.

Right care: Care was provided in a person-centred way which promoted people's dignity and rights. Their lifestyle choices, religion, sexuality, culture and disabilities were respected and they were given the right care and support to live their lives to the full.

Right culture: There was a positive culture where staff were committed to caring for people. They knew people well and wanted to support them in a personalised way. They felt a sense of pride in people's achievements and happiness. The leadership created positives values and behaviours which were embedded and echoed throughout the service and in the day to day support of people being cared for.

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 rating at the last inspection was outstanding (Published 5 April 2018). Whilst we found the service still had some outstanding qualities, we judged that these were not enough to rate the service outstanding in any key questions or overall. We also identified improvements were needed to ensure the safety of people using the service at all times. The provider addressed these concerns when we discussed them with the registered manager and nominated individual.

Why we inspected

The inspection was prompted in part by information about a number of incidents where people had been harmed. We carried out an inspection to assess whether standards of safety and quality were being met. Whilst we identified potential risk of harm in some areas, we were satisfied people were receiving a good service and the provider had responded appropriately to these concerns.

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.

The provider for Support for Living Domiciliary Care Agency is Certitude and is often referred to as either Support for Living Limited or Certitude. During this inspection report we will refer to the provider as Certitude.

Support for Living Domiciliary Care Agency provides personal care to people with learning and physical disabilities and mental health needs living in their own houses and flats in the community and specialist housing.

This 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 our inspection there were one hundred and six people being offered a service in twenty four supported living schemes across four local authorities.

At the last inspection, the service was rated Good. At this inspection, we found the service had continued to make improvements and had introduced innovative practices and ideas in many aspects of the service to further enhance the experiences of people using it. We have therefore rated the service as Outstanding. There was 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.

People and relatives said that staff were kind, thoughtful and helpful. Staff were enthusiastic and passionate about their work, speaking very positively about people and wanting the best outcomes for them.

It was a strength of the service that staff had been trained in the use of different methods of communication to ensure people were understood. People were well supported to express their views in a variety of ways that were tailored to their individual needs.

The provider had an internal intensive support team and there was good use of speech and language therapist’s and other healthcare professionals to support staff to reach the best outcomes for people. Staff were innovative in their use of technology to support people to express their views and to live more independent lives.

Staff supported people to remain healthy both physically and mentally, there was an emphasis on supporting people’s emotional well- being. Community health care professionals visited people and staff supported people to attend routine appointments and hospital clinics. When people found hospital visits difficult staff worked alongside with health professionals to support them to attend.

People had person centred care plans that gave very good background information about them. Often there were photos of childhood and earlier adult life that showed the person in the context of their life. Care plans reflected their wishes and preferences.

Care plans described people’s circle of support and informed staff how people wanted their care and support provided. Staff supported people to attend a variety of meaningful activities of their choice. Staff explored new activities with people to widen their life experiences this included trips to see sporting events and holidays abroad. Staff demonstrated they believed in making people’s lives as full as possible seeing opportunities rather than the limitations.

People had end of life plans, some of which contained specific information with regard to their end of life care. We saw some excellent work had been undertaken in one service when supporting a person who chose to have their home as their final place of treatment.

The registered manager and the provider Certitude encouraged feedback from people and relatives in a number of ways such as regular listening events, visiting the schemes and sending out questionnaires to ensure people and relatives could give feedback. As such, they were open and approachable. Staff told us they felt a part of an open and empowering culture where they were respected as individuals. We saw that staff’s skills and knowledge were recognised and utilised throughout the service and that staff felt valued and part of a wider team. Exceptional staff work was recognised and celebrated.

The registered manager had developed robust systems to ensure that all records were reviewed regularly and to make sure these contained up to date and relevant information about people. People using the service were involved in the quality assurance processes, to ensure their perspectives on quality were taken into account when deciding whether the provider was providing a good enough service for people. The provider’s quality assurance team analysed the monthly audits produced by the managers of the individual schemes to ensure there was a consistently high standard of provision of care and support across the service.

The provider shared their aims and values of the service and communicated with people, relatives, and staff through newsletters, blogs, and events. People were encouraged to be part of national debates with regard to learning disability issues and were empowered by the provider to voice their views. The registered manager looked for ways to continually improve the quality of the service and to raise the profile of issues in relation to learning disability by working with other voluntary organisations and campaign groups.

The registered manager supported people and relatives to complain and the provider investigated complaints thoroughly and responded appropriately to the complainants and to address the concerns.

The provider had ensured that there were robust systems in place to support staff and managers to identify and report safeguarding adult concerns. Managers investigated concerns and lessons were learnt and shared within the whole service to help prevent similar mistakes from arising again.

People had person centred risk assessments that identified measures to mitigate the risks of harm. Managers had undertaken positive risk assessments to promote individuals’ independence and to give them freedom of movement whenever possible. Managers had fully involved people in drawing up the positive risk assessments. Health and social care professionals had contributed to the plans that were reviewed on a regular basis.

The provider recruited staff on an ongoing basis and undertook recruitment checks to ensure staff were safe to work with people. Most schemes had consistent staff groups who were familiar with people living in these schemes. The provider’s bank of care workers were familiar with people and helped to cover any staff absence.

Staff had received training to administer medicines in an appropriate manner and managers undertook checks to ensure medicines records were completed appropriately and people received their medicines as prescribed.

Staff told us they felt well supported and had received a thorough induction prior to commencing their role and had ongoing refresher training. Specialist training had been provided when required and this had included positive behavioural approaches to behaviour that challenged the service.

The registered manager had ensured managers and staff had a thorough understanding of the Mental Capacity Act 2005 and people’s care plans described how they made decisions and what support they required to make a decision. The provider had liaised with the local authority when people required Court of Protection decisions with regard to their care and treatment.

All the people we spoke with were positive about the care and support they received. People who were able to tell us said that staff treated them with consideration, respect and dignity. They told us they were supported to develop independent living skills. We observed people being supported to engage in activities in the community.

People told us they were involved in developing and reviewing their care plans and risk assessments.

People had their needs met by other healthcare professionals that were involved in their care and support.

There were adequate numbers of staff to meet people's needs.

There was an effective complaints management system in place and people told us that they were able to raise their concerns with staff.