Archived: Affinity Trust - Domiciliary Care Agency - South

Affinity Trust - Domiciliary Care Agency - South is a care agency, providing personal care to people living in supported accommodation and their own homes. At the time of the inspection the service was supporting 32 people living in six supported living settings. Five of the supported living settings were located in Surrey and one in Portsmouth. Five of the settings were single locations which supported between one and three people in a property. The provider supported a further two people living in their own homes.

The sixth setting had been commissioned by a local authority in two phases which had been set up over the last two years. The care and support supplied to people by the provider, was completely separate from the accommodation people rented. The sixth setting had been a former care home which had been closed and re-configured to create separate properties by the commissioning authority. This setting accommodated 21 people on one-site with between one and five people living in each property. The complex was larger than good practice guidance recommends. However, people’s properties were staffed separately and two on-site support managers managed the two phases separately.

The service has been developed 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 and what we found

Overall medicines had been safely managed. There had been issues with medicines errors at the sixth setting. The provider had taken extensive and robust actions to address this for people, but it will take further time for them to be able to demonstrate their full effectiveness.

The provider had processes and systems in place to protect people from abuse and to investigate any incidents at the appropriate management level and to take any relevant action required. Staff assessed individual risks to people and monitored their safety. The provider had ongoing concerns about the compatibility of people living in one property in the sixth setting which they had raised with commissioners.

There were sufficient numbers of suitable staff deployed. It had taken time in the sixth setting to establish a completely new, large workforce across the different properties with the required skills and knowledge. The provider had experienced issues with consistency of on-site management with the second phase of the sixth setting and had ensured throughout there was senior management cover in place, whilst a suitably experienced manager was appointed.

People’s needs were assessed and the delivery of their support was in accordance with legislation and guidance. Staff were provided with the required skills and knowledge for their role. Staff ensured people ate and drank enough to maintain a balanced diet. Staff worked with each other and across agencies to deliver effective care and to promote people’s health and welfare.

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.

Staff treated people with kindness, respect and compassion. People were involved by staff wherever possible in decisions about their care. Staff upheld people’s privacy and dignity during the provision of their care.

People received personalised care that was responsive to their needs. Staff were able to support people at the end of their lives.

The provider promoted a positive culture. People who used the service, their relatives and staff were engaged and involved with the settings. There were processes and systems in place to drive improvements. Staff used any concerns or issues raised as an opportunity to improve the service. The provider worked in partnership with other agencies, openly and honestly

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 opportunities to gain new skills and become more independent.

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 8 November 2017)

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 service had three operations managers’ to manage the service, two of whom were also registered managers for 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.

People felt safe from the risk of abuse and relevant processes, procedures and staff training were in place to protect people. The provider was transparent in their safeguarding reporting and ensured all potential safeguarding incidents were reported to ensure people’s safety.

People’s support plans and risk assessments identified potential risks to them and how these would be managed to reduce the likelihood of harm to them. Incidents were documented and relevant action taken to reduce the likelihood of repetition for people.

Some relatives reported there had been too high a use of agency staff at some locations. Although agency usage was high at some locations, people still received the care they needed safely. The provider was taking a proactive approach to recruit staff and in the interim had taken measures to ensure there were sufficient staff to deliver people’s care safely and that staffing was as consistent as possible for people. Safe recruitment processes were in place for all staff recruited since 2014. Further pre-employment information is required for some TUPE staff that transferred to the provider pre 2014 and the provider has requested this to ensure it is available.

People received their medicines from trained staff. Some aspects of people’s medicines management required improvement and the provider took action during the inspection to ensure people’s safety.

Overall, feedback about the effectiveness of the service was good. People were supported by staff who underwent a thorough induction and who had received on-going training. The provider was aware through their own monitoring that not all staff were receiving one to one supervisions at the frequency the provider required and actions were already in place to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had clear records of their dietary needs, preferences and any associated risks, which staff had read and understood. Where staff were responsible for preparing people’s meals, records indicated they had been provided with a suitable, varied and balanced diet.

Staff supported people where required to see a range of health and social care professionals in order to ensure they maintained good health.

Overall people and relatives reported staff were caring and kind. We saw people were relaxed in the company of staff and familiar with them. People’s records documented their needs in relation to communication and staff understood how people communicated. The provider had ensured information for people was provided in an accessible format. Staff supported people to make choices about their care and to be independent where possible. Staff provided people’s care in a manner that promoted their privacy and dignity.

People were involved in planning their care where possible and had comprehensive care plans, which staff including agency staff had read and used to familiarise themselves with people's care needs and preferences.

People received individualised care that reflected their needs and interests. Staff supported people to have a presence in their local community and to participate in a range of activities. It was not always possible to roster a driver at all locations at all times; however, we found no evidence at the locations sampled of people not being able to go out regularly due to a lack of driver provision.

There was an effective process in place to enable people or others to raise issues if required. The provider had responded to any complaints received appropriately.

Staff upheld the provider’s values when they provided people’s care. People were involved in decisions about the service where possible. The provider listened to staff’s views and actions had been taken in response when they had raised concerns.

There was a clearly defined operational structure, management had a good understanding of the issues facing the service and were proactively taking action to make improvements to the service where required. At all levels of management there were regular visits to locations to meet with people and staff.

Processes were in place to monitor, audit and analyse the quality of the service people received. This information was used to improve the service for people.