23 July 2015
During a routine inspection
This was an announced inspection carried out on the 23 July 2015.
Living Ambitions supports citizens (people living in the community), who have a range of disabilities, including autism, mental and physical needs and learning disabilities. The service provides care and support to people living in their own homes or in a supported living environment. The office premises are situated in Salford, they are accessible by public transport and there is car parking spaces available. The office is spacious with facilities for meetings, training and interviewing.
There was a registered manager in place. 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.
At the last inspection carried out in April 2013, we did not identify any concerns with the care and support provided to people by the service.
People who used the service told us they felt safe and trusted their support staff. Without exception, people who used the service and their relatives spoke positively about the staff who supported them. One person who used the service told us; “Staff listen to us and we do feel safe living here.”
During our inspection, we checked to see how the service protected vulnerable people against abuse. We found suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. Safeguarding training was also provided as part of an initial induction to the service for new staff, which included recognising signs of abuse, the response and ‘whistleblowing.’
We found people were protected against the risks of abuse, because the service had robust recruitment procedures in place.
We found that risk assessments were compiled in consultation with people who used the service, families and professionals. They provided guidance to staff as to what action to take and were regularly reviewed by the service.
We looked at how the service managed people's medicines and found that suitable arrangements were in place to ensure the service was safe. Medication plans included body maps for the application of creams and protocols for administering ‘when required’ (PRN) medicines, such as pain relief.
All staff underwent a comprehensive induction programme, which involved the successful completion of a foundation training workbook within a 10 week period. This was then followed by a period of six months’ probation. Staff underwent mandatory annual training, which we verified by looking at personnel records and was managed by way of a training matrix. Training included health and safety, fire safety, emergency first aid, infection control, mental capacity act, medication and behavioural communication.
Regular supervision and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner. Both managers and staff confirmed they received regular supervision and appraisals, which we verified by looking at staff personnel records.
We were told by the registered manager that the service currently had three communication co-ordinators within Salford. Their role was to support staff and teams in devising bespoke communication tools to help people communicate in their preferred method, which had proved invaluable.
One local authority learning disability manager told us that the service had a really productive relationship with the local authority. They were described as being full of ideas and very proactive in meeting people's changing needs. They were always prepared to suggest doing things differently in order to achieve better outcomes for people.
We saw care staff interacting with people with compassion and humour. People were relaxed and were activity encouraged to undertake house hold chores such as cleaning, sweeping and making drinks. We saw smiling and heard laughter with appropriate touching to reassure people.
People and relatives told us they were actively involved in making decisions about their care and were listened to by the service. They told us they had been involved in determining the care they needed and were regularly consulted and involved in reviews of care.
Both people and relatives described staff as being very dedicated and doing little extras or as being thoughtful about things that made a big difference to the quality experience of people. We found the service was tailored and responsive to people's individual needs.
We looked at a sample of nine care files to understand how the service delivered personalised care that was responsive to people’s needs. The structure of the care plans was clear and easy to access information, which provided staff with clear guidance on people’s individual support needs.
Regular reviews of support needs were undertaken, which were person centred and involved people who used the service, social health care professionals, relatives and interested parties. A local authority learning disability manager told us they were thoroughly impressed with the service who were marked out for their person centred care, their ability to advocate for people and to support people to build independent lives.
People and relatives were actively encouraged to provide feedback about the service in relation to any concerns they had. Regular questionnaires were circulated to gage what the service was doing well and not so well and where improvements could be made.
Staff told us that the service promoted an open and transparent culture and always looked to learn in order to improve the service for people who used the service. Staff told us they felt valued and supported by management.
The service had devised a ‘project planning tool’ as part of a joined-up approach to planning and preparing a safe effective transition for a person when moving into their new home. This information enabled the service to ‘match staff’ and ensure suitable risk assessments and support plans were in place. This meant that staff skills and interests were matched with needs and interests of the person being referred, or to facilitate the recruitment of new staff with particular skills and interests.
We found that the service actively engaged with and listened to people, families, social care professionals and the local community to improve the way they delivered services. The service had a well established project group called 'Making it Real.' Completed questionnaires from people were reviewed by a ‘Making it Real Task Group’ twice yearly, which consisted of stake holders, such as social care professionals, relatives, people who used the service and staff in an effort to identify what was working well and what was not working for people. The group then identify the three top priorities for the service in the coming year. These priorities formed part of the service’s local business plan with action plans that were then published on a community web site where people could monitor progress made against the priorities.
The service produced an informative ‘newsletter’ for people and staff and included articles of activities and community engagement such as gardening events, BBQ and trips. People were encouraged to actively support the newsletter with the inclusion of an ‘ideas corner.’ Both new people and staff received a welcome to the service.
The newsletter also published details of the employee of the month. This was a scheme, which allowed people who used the service and staff to nominate an employee of the month based on their commitment to their role. People who used the service were also recognised for any achievements they had made, an example we looked at highlighted a person being more independent and requiring less support.
The service was involved with other partners in providing courses such as self-management courses to empower people in their everyday lives. People were supported to learn new skills such as working in a charity shop. Parties and events were arranged in which recognition of achievements made by people who used the service were celebrated. These included ‘black tie events’, ‘Christmas party’ and ‘red nose day.’
The service undertook a comprehensive range of audits to monitor the quality service delivery. These included daily medication audits, health and safety checks and people's finance, which were undertaken by both staff and management.