LDN London Domiciliary Care Service

This service provides care and support to people living in 18 ‘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. The Care Quality Commission (CQC) does not regulate premises used for supported living. This inspection looked at people’s personal care and support. This service also provides domiciliary care services. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults with learning disabilities, autism spectrum disorder and mental health issues.

At the time of the inspection the service was supporting 101 people in the City of Westminster, the Royal Borough of Kensington and Chelsea and Camden. Not everyone using Westminster Society Domiciliary Care Services for Adults receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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 were registered managers in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The service had six registered managers and one nominated individual who were responsible for all services under this registration.

The service was exceptionally caring. People using the service and their relatives spoke extremely positively about the caring and compassionate nature of the staff and felt that staff went above and beyond their expectations of care to meet their needs.

Staff ensured that people’s emotional needs were supported at sensitive moments in their life and had worked closely with them, their relatives and health care professionals, especially when managing bereavement.

People were supported to have access to advocates if the provider felt they needed support to have their voice heard. Staff had also supported people when they were unable to or found it difficult to express their choices and wishes.

People using the service and their relatives were confident they would be listened to and felt the management team were approachable and felt comfortable getting in touch. The provider gave people the opportunity to discuss the issues they faced and supported them to have their voices heard in the wider community.

People were supported to follow their interests and maintain relationships with relatives and friends that mattered to them. The provider had been creative in overcoming barriers to providing support to people and created opportunities for people to carry out a wide range of activities and events with friends with a shared interest. There was evidence that cultural requirements were considered and positive work had been done to raise staff awareness for people who identified as LGBT+ (Lesbian, Gay, Bisexual, Transgender and other ways that people can define themselves, for example Q (Questioning) and I (Intersex)).

Care was personalised to meet people’s individual needs and the provider ensured people were fully involved in discussions about how they wanted their care and support. An initial needs assessment was completed from which care plans and risk assessments were developed.

The management team understood the legal requirements of the Mental Capacity Act 2005 (MCA) and staff took the necessary action if they had concerns about people’s capacity. We observed that staff respected people’s decisions and gained their consent before they offered support.

People’s nutritional needs were recorded in their care plans and staff were aware of the level of support required, with further guidance available for people who needed extra support. People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, psychiatrists and the community learning disability team.

Risks to people were identified during an initial assessment with detailed guidance and control measures in place to ensure their freedom was respected and staff supported them safely. Advice and guidance was sought from health and social care professionals to support staff to manage a range of complex behaviours that challenged the service

New staff received a comprehensive induction training programme to support them in meeting people’s needs effectively. They shadowed more experienced staff in supported living services before they started to work independently with people. Staff received regular supervision and told us they felt supported by their staff teams and line managers.

People using the service and their relatives told us they felt safe using the service and staff had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

People who required support with their medicines received them safely and all staff had completed training in the safe administration of medicines, which included observations and competency assessments. Appropriate checks were in place to minimise errors and action was taken if errors were reported.

Staff spoke positively about the culture of the service and felt valued as part of the organisation. People and staff were fully involved in the development of the service and staff had opportunities to progress within the organisation.

There was a range of effective quality assurance systems in place to monitor the quality of the service provided, identify any concerns and understand the experiences of people who used the service. The management team were open to feedback to help make improvements within the service.

Westminster Society Domiciliary Care Service for Adults provides personal care and support to people living within supported housing and in their own homes. It also supports people registered with their LDN short breaks, LDN Connect, LDN Living and LDN 4U services. At the time of our visit the service was providing support to 109 people across the London Boroughs of Westminster, Camden and Kensington and Chelsea.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service had six registered managers and one nominated individual who were responsible for all the activities registered under the service. At the time of the inspection one other service manager was in the process of submitting a registered manager’s application to us.

People and their relatives told us they felt safe using the service and support workers had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

People’s risks were managed effectively and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. Support workers were assigned to work with people in specific schemes and were aware of the needs of each person they supported. The service had a robust recruitment process where applicants were assessed against the organisation’s core values and were observed how they interacted with people using the service. Staff had the necessary checks to ensure they were suitable to work with people using the service.

People who required support with their medicines received them safely and all staff had completed in-depth training in the safe handling and administration of medicines, which was refreshed annually. Staff completed appropriate records when they administered medicines and these were checked on the same day to minimise medicines errors.

There was a comprehensive induction based on the Care Certificate and a six month probation period for new staff. Staff members also took part in a training programme to support them in meeting people’s needs effectively and were always introduced to people before they started work with them. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received. People using the service were also involved in the recruitment and training of staff.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider had taken into consideration where people may have had restrictions placed upon them and notified the local authority responsible for assessment and application.

Support workers were aware of people’s dietary needs and food preferences. Support workers told us they contacted health care professionals if they had any concerns about people’s health and we saw evidence of this in people’s care plans. They could also contact service managers if they had concerns out of hours. People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and speech and language therapists.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. Support workers understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.

People were spoken to and treated in a respectful and kind way and staff respected their privacy and dignity and promoted their independence. People were also supported to access independent advocates where necessary.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care records were person centred and developed to meet people’s individual needs and reviewed if there were any significant changes. People and their relatives were actively encouraged to express their views and were involved in making decisions about their care and whether any changes could be made to it.

People were supported to follow their interests and maintain relationships with relatives and friends that mattered to them. With the resources from the LDN Connect service there were opportunities for people to take part in a range of activities, day trips and events. There was evidence that cultural requirements were considered when discussing this and making sure these needs were met.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. The provider listened to all complaints and made sure people were confident their complaints would be taken seriously. There were also surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

The service promoted an open and honest culture and the registered managers were transparent in their discussions with us. Staff spoke highly of their teams and felt well supported by their team leaders. Staff were confident they could raise any concerns or issues, knowing they would be listened to and acted on.

There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered managers followed a monthly, quarterly and annual cycle of quality assurance activities and learning took place from the result of the audits.

We spoke with nine people using the service (six in person), four relatives of people using the service (all on the phone), six staff, three registered managers and the nominated individual. We were able to visit some of the flats where people receiving care lived, accompanied by a registered manager and with people's permission. In addition we reviewed the 2014 survey of family and friends of people using the provider's adult services which was generally positive about the service provided (47 responses). The service provides care for people with a learning disability as well as a short breaks service to allow people caring for their relatives or friends a break of a few hours.

Is the service caring?

We spoke with people who used the service about the staff who support them. The feedback they gave us was positive, with one person saying their relationship was 'a kind of friendship'. Relatives we spoke with told us staff were caring for their family member well with a view that staff knew people well and were very helpful and informative.

Staff at all levels told us how they cared for the people who use the service with a strong understanding of working to meet the needs of people as individuals.

Is the service responsive?

People told us they knew how to make a complaint or raise an issue with staff and managers. Relatives knew how to contact the provider if they needed help or advice and said they were quick to respond and find solutions. We saw investigations were carried out if an incident occurred with action plans created and followed through.

Is the service safe?

People told us they felt safe with staff who were 'honest and trustworthy'. There were safeguarding policies and procedures and staff understood their responsibilities in this regard. People were treated with dignity and respect and their rights were respected. There was a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in planning their own care and support. Any specific needs were identified and noted in the care plan and training was provided so staff could meet individual needs.

People we spoke with were happy about the care they received. Relatives told us they felt their family members were supported appropriately by the service and they were happy to leave their family members in the care of staff. They were pleased people were encouraged to do activities they enjoyed.

Is the service well led?

The provider had good quality assurance systems in place with a Board of Trustees who understood their responsibilities and were involved in improving the Society's service provision. Records showed the Society had processes to identify problems, and procedures to act on concerns identified. There were varied ways for people who use the service to be involved in the management of the services they were receiving and these were planned and managed in a way they could understand and be fully involved in.

Staff told us they were supported in their job which helped to ensure people who use the service received a good standard of care and support. They felt they could raise issues or concerns with their managers and these would be acted upon. Managers encouraged challenge and consideration of working practices. As a reflective organisation staff told us how they planned to develop the service in the light of events and expert guidance and changes in the law.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We discussed this at the inspection. The registered manager has cancelled their registration and the CQC register will be updated.

Care and support was planned and delivered in a way that ensured people's safety and welfare. Each person had an up to date plan with risks assessed so that they could do the things they wanted to. Health needs were reviewed and managed with the involvement of other professionals. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

There were sufficient staff to meet the needs of people and they were well-supported by their managers. Safeguarding concerns were managed appropriately and staff had received relevant training could access advice and support. People were supported to raise any concerns or complaints.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. This will be corrected.