Archived: Office

Your Choice agency provides care and support services to people with a learning disability living in their own homes. The agency had moved location and is now based at the manager’s home.

There was no registered manager in post. This was because the agency was registered to one person who is the provider and therefore the agency does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for the agency. The provider was at the agency office every day and there was a manager in post who gave support with the day to day running of the agency. The registered provider and manager also provided care and support to people.

The majority of the people who used the agency lived with their relatives. The agency provided 13 self-employed P.As (personal assistants) to support people with their personal care and their social activities. (Because the people who worked at the agency were self-employed they were referred to as personal assistants and not staff). The agency also provided support and respite for relatives throughout the week. The support hours varied from 24 hours a day to an hour or more.

Since the last inspection the agency had moved the location of their office and this was now based at the manager’s home. The provider had failed to notify the Care Quality Commission (CQC) of the change of the agencies office address. The provider is required by law to notify us when they move location or if there is any changes to your contact details. Therefore the agency was carrying out a regulated activity from an unregistered location which it is an offence under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider has since notified the CQC of the changes. As the breach of regulations was retrospective and the offence was no longer being committed we decided to take no action.

People received support in line with their assessed personal care needs. Systems were in place to manage risks to people. In some cases further detail was needed in the risk assessments so that P.As had full written guidance of how to keep risks to a minimum. P.As were able to explain what action they would take if an incident did occur.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The agency was supporting people to make decisions about their health and wellbeing. Staff had knowledge about the MCA and how to implement it on a daily basis. However, mental capacity assessments had not been formally completed to demonstrate when people could make decisions for themselves and when they may need support.

The registered manager regularly carried out checks to identify any shortfalls and ensure consistent, high quality, personalised care. However, checks had not been recorded. People and their relatives had been surveyed to ask their opinions on the service, but staff and other stakeholders such as people's G.Ps had not been asked.

Some people required two P.As at each visit. For some people the routine was that the P.As would go into their homes in the morning to assist and support them with their personal care and get them ready for the day. P.As would them take them out to participate in activities in the community. On other days relatives/parents gave all the support. Each package of care was tailored to meet the personal needs of each person. The agency worked to give people the care and support they wanted and needed to remain at home and to be as independent as possible

Safeguarding procedures were in place to keep people safe from harm. People felt safe using the service; and if they had any concerns, they were confident these would be addressed quickly by the provider. The P.As had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures.

Relatives told us that they were very happy with the service the agency provided. PAs knew people’s individual needs and how to meet them. People and their relatives were fully involved in the assessment and planning of their care. The details in the care plans contained the information needed to support people in the way they preferred and suited them best.

People’s care plans had been reviewed by senior P.As and any relevant changes were made when required. P.As said the communication between them and the office made sure that they were up to date with people’s changing needs.

People received their medicines safely and when they needed them. They were monitored for any side effects. The agency made appropriate referrals and worked jointly with health care professionals, such as community nurses, doctors and specialist services to ensure that people received the support they needed.

P.As supported people to prepare meals to make sure they had a range of nutritious food and drink.

There were sufficient numbers of P.As available to make sure people’s needs were met. They had permanent regular schedules of calls so that people received care from a consistent team who knew people’s routines well.

People were protected by robust recruitment procedures and new PAs had induction training which included shadowing experienced P.As, until they were competent to work on their own. P.As received an induction, core training and specialist training, so they had the skills and knowledge to meet people’s needs. They fully understood their roles and responsibilities as well as the values of the agency.

P.As were caring and treated people with dignity and respect. They were kind, compassionate and polite. Relatives told us that the P.As arrived on time and stayed for the duration of their call. P,As often took people out during the day to attend various activities in the local community. The activities varied depending on what the person liked and enjoyed.

People and P.As were supported by an out of hours on call system. They told us that the provider and manager were always responsive and any queries raised were sorted out promptly.

People felt confident in complaining, but did not have any concerns. People had opportunities to provide feedback about the agency informally and formally. The feedback received had been positive.

The culture within the agency was transparent, personalised and open. People said they felt comfortable talking to the provider about their concerns and ideas for improvements. The agency looked at new ways of working to continuously improve the service.