This comprehensive inspection took place on 18 September 2018 and was announced. This was the first inspection since the provider registered with the Care Quality Commission (CQC) in September 2017.
This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults and younger disabled adults and is the first provider in the UK specifically for the LGBTQI+ (Lesbian, Gay, Bisexual, Transgender and other ways that people can define themselves, for example Q (Questioning) and I (Intersex)) community.
At the time of the inspection they were supporting three people in the London Boroughs of Lambeth and Camden. Not everyone using Alternative Care Services Limited receives 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.
All three people had been receiving personal care for less than three months. This meant that although we were able to carry out an inspection we did not find enough information and evidence about parts of the key questions we ask about services, or the experiences of people using the service, to provide a rating for each of the five questions and an overall rating for the service. We were therefore not able to rate the service against the characteristics for inadequate, requires improvement, good and outstanding ratings at this inspection.
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.
People who were supported with their medicines did not always have the full up-to-date information recorded in their care records. We had to seek clarification after the inspection to confirm the level of support that was being provided.
There were inconsistencies between the three care records we reviewed. Records did not always contain sufficient and detailed information about the care and support people received.
Risk assessments covered a range of factors that people were at risk of, including environmental assessments to ensure people’s homes were safe. However, not all risks were fully addressed with sufficient information available for staff to follow to keep people safe.
Staff were aware of their safeguarding responsibilities and were confident the registered manager would take the appropriate action if they had any concerns. We could not confirm if safer recruitment procedures had been followed as some documents were not available at the time of the inspection. We requested them to be sent after the inspection and we were still waiting for confirmation of them at the time of writing this report.
Staff had received training around the Mental Capacity Act 2005 (MCA) and there was evidence people had consented to their care. However, two care records did not fully reflect how consent had been sought in line with best practice.
An induction and mandatory training programme was in place when new staff started to support them in their role. Care workers spoke positively about the specific training they received about supporting people in the LGBTQI+ community.
Care records highlighted if people were supported with their nutritional needs and if they had any dietary preferences. However, for one person’s care record more information was required to provide a more accurate summary of the support that was given.
People and their relatives had been actively involved in decisions about their agreed care and support. We received positive comments about the kind and caring nature of care workers and how positive relationships had been developed at the start of the care package.
People were provided with information on how to make a complaint. Relatives told us they would feel comfortable getting in touch with the provider if they had any concerns.
The service promoted an open and honest culture. We received positive feedback about the management team and staff felt well supported. Staff were confident they could raise any concerns or issues, knowing they would be listened to and acted upon.
Staff spoke positively about the values of the provider and the direction the organisation was going in. The registered manager was passionate about the rights of people who needed support from the LGBTQI+ community. He had been involved in campaigning for people’s rights at workshops and national conferences.
There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvements. Due to the size of the service, formal records of quality monitoring had not been completed.
We had further contact with the management team after the inspection and gave feedback about the shortfalls we had identified. We asked the registered manager to send us an action plan about the improvements they planned to make.
We will be in contact with the provider as the service develops and will aim to return within six months to carry out the next inspection and provide a rating for the service.