Royal Mencap Society - Domiciliary Care Services - North London

About the service

Royal Mencap Society - Domiciliary Care Services - North London is a supported living service providing personal care to people with a learning disability and autistic people. This service provides care and support to twenty-seven people living in eight '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. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Right support:

There were some risks for people with dysphagia (swallowing difficulties) as staff were not consistently following expert guidelines on supporting some people with eating and drinking. When we raised this concern the provider responded by requesting new assessments for the people concerned to ensure they were supported safely.

The service worked well with health and care professionals to meet people's care needs. Medicines were generally managed safely but we identified a few areas for improvement.

The care two people needed at night time was not written clearly so there was a risk they may have unmet needs during the night.

People were given choice and control in a supported way. Staff supported people to follow their individual interests and to develop their independence. The service provided a clear and positive ethos to guide staff in how to support people to maximise their choices and independence. Staff supported people with accessing the health services they needed to achieve the best health outcomes.

People had support to follow their own chosen lifestyles and daily routines. Staff supported them with their personal care needs and their independence.

Staff were trained to meet the needs of the people they were supporting. We observed staff interacting with people. People were comfortable around staff and staff were aware of people’s individual personalities and preferences. People were treated with respect and dignity and supported to be involved in meaningful activities.

Right care:

There were some safety concerns where two people had not been protected from the risk of avoidable harm. In both cases people had been at risk of harm from a person they lived with.

People’s relatives were satisfied that people received good care and were happy with how the service supported people to lead fulfilling lives. 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.

There was a strong commitment to delivering person-centred care and in practice people led individual lifestyles where staff respected their individuality and rights to dignity and privacy. Staff had good knowledge of people’s individual communication needs and treated people with kindness and respect while providing care.

Right culture:

Staff formed relationships with people they supported and encouraged them to make decisions for themselves. The provider had implemented new initiatives to improve the culture within services. This had not yet been implemented in this service but staff were preparing for it. Systems were in place to promote continuous improvement. People’s families were involved in their care and support and people benefitted from a stable staff team who were committed to providing them with the best care.

The provider had a quality assurance system in place to check that the service was running safely and meeting people’s needs. The registered manager was committed to continuous learning, aware of improvements needing to be made and had planned to ensure these improvements were made. There was an open culture in the service where staff enjoyed working and relatives generally felt involved.

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 17/07/2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risk and safeguarding people from abuse. This inspection examined those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led key question sections of this full report.

The provider has taken some action to mitigate the risks.

Enforcement and recommendations

We have identified breaches in relation to keeping people safe, safeguarding people from risk of abuse and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about regular monitoring of people’s weight to help monitor their health.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Royal Mencap Society – Domiciliary Care Services – North London is a domiciliary care service that provides care and support to people living in supported living schemes with learning disabilities and complex healthcare needs in and around North London. At the time of our inspection the service was supporting 37 people.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Each person’s individualised risk was identified and assessed to ensure people’s safety. Risk assessments were comprehensive and gave guidance on how to reduce or mitigate people’s risks.

The service continued to ensure that people received a safe service. Safeguarding policies and procedures were in place, understood and followed by all staff.

Medicines were managed and administered safely. Policies and processes in place ensured people received their medicines safely and as prescribed.

The provider ensured robust recruitment procedures were followed to ensure the recruitment of staff assessed as safe to work with vulnerable adults.

Care staff were supported through regular training, supervisions and annual appraisals.

A comprehensive pre-admission assessment was completed to ensure that the service was able to meet the assessed needs of the person.

People chose what they wanted eat and planned their own menus for the week. People decided the level of their own involvement with the preparation of their meal and where they required support. People had access to a variety of healthcare professionals and were supported by care staff where needed.

We observed caring and positive interactions between people and support workers that supported them. Relationships had been formed based on trust and mutual respect.

The provider and service demonstrated responsive practices on how people were supported in their daily lives which was highly responsive to their needs, choices and wishes. Staff that had been trained to deliver positive behaviour support which supported people emotionally and practically looked at triggers and previously known behaviours and then worked with people in response to their needs to so that they were supported within any possible environment in the least restrictive way.

Care plans were person centred, comprehensive and detailed how people wished to be supported in order to meet their desired outcomes.

Care staff spoke with people with respect and promoted their independence. People were involved in all aspects of the care and support that they received especially through regular review meetings.

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.

Complaints received were recorded and investigated according to the provider's complaints policy. People and relatives knew who to complain to if they had any concerns to raise.

A clear management structure was in place which allowed oversight and monitoring of service provision at each of the supported living schemes where people were supported with the regulated activity of personal care. A number of systems were in use to ensure that continuous monitoring, learning and improvement of services was implemented.

Further information is in the detailed findings below.

The focus of the inspection was to answer the five key questions : is the service safe, effective, caring, responsive and well-led?

Is the service safe?

The service was safe because safeguarding issues were dealt with appropriately and referrals and notifications were made where necessary. For example, we were told staff who were investigated and found to be working unsafely were no longer able to work in the organisation and a Disclosure and Barring Service (DBS) referral was made.

When we spoke with people who received support, they all felt the service was keeping them safe. Relatives of people receiving support also felt their family members were safe.

Staff had received safeguarding training and there was a focus on regular discussion of any safeguarding issues at team meetings.

Is the service effective?

The service was effective because people receiving support felt they were receiving a very good quality of support.

The service had high quality support plans and risk assessments in place which helped to ensure people's care and welfare needs were being met.

Relatives gave very good feedback on the quality of support being provided for their family members by staff.

Is the service caring?

The service was caring because people receiving support felt they were respected and involved in their support. There was a need, however, to ensure people receiving support were always involved in recruiting new staff to work with them as this had happened less consistently recently than in the past.

The service had taken time to understand and plan to meet people's needs and was focused upon ensuring they were treated well at all times.

Is the service responsive?

The service was responsive because it dealt with complaints quickly and effectively.

The service was also responsive because it responded quickly when safeguarding concerns were raised and it acted swiftly to ensure any vulnerable individuals were immediately protected from any potential further harm once the concern was known about.

Is the service well-led?

The service was well-led because quality systems were in place ensuring effective quality monitoring took place to make sure services delivered were of a high standard at all times.

Managers appeared to be proactive, person-centred and committed to working with all parties to ensure people who received support got a consistently high quality service.

We found that the manager had co-operated with other services she liaised with, such as social services and healthcare professionals.This meant that people using the service were assisted to obtain appropriate health and social care support.

The provider had a safeguarding policy in place. All five staff we spoke with were fully aware of the policy, and what signs might suggest someone was being abused or being neglected.

We reviewed staff training records and this confirmed staff were up to-date with mandatory training. People we spoke with rated staff highly. One person said, "they help me every day with all my emotional stuff."

The provider recently issued surveys to people to check on the quality of their service. Responses were all positive about the service. We saw that the service was monitoring the quality of the care regularly.

People that use the service and staff told us that people were involved in making decisions about their care.

The people we spoke with knew how to raise concerns. People said they felt safe.

Staff told us and training records showed that staff had up to date training and felt supported. There was a system in place for checking the quality of care delivered.