4 March 2020
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Two inspectors carried out this inspection.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection the service was supporting 12 people, five people were receiving support with personal care.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this and ensure there was a member of staff available to assist in the inspection process.
Inspection activity started on 6 February 2020 and ended on 12 February 2020. We visited the office location on 11 February 2020.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. This included correspondence we had received, and notifications submitted by the service. A notification must be sent to the Care Quality Commission every time a significant incident has taken place. We sought feedback from the local authority and health and social care professionals who work with the service. We used this information to plan our inspection.
During the inspection
We spoke and visited one person who used the service about their experience of the care provided. We spoke with seven members of staff including the registered manager.
We reviewed a range of records. This included three people’s care records. We looked at three staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service.
After the inspection
We spoke with two relatives about their experience of the service.
4 March 2020
About the service
Leaf Complex Care is a community-based service providing a rapid response support service to people with learning disabilities, autism, brain acquired injury and or mental health. They supported people in their own homes or with transitions from a hospital to a community setting. The service was registered to provide personal care. They were supporting twelve people of which five were receiving personal care.
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. Where they do we also consider any wider social care provided. At the time of the inspection five people were receiving support with personal care.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People were supported by a small team of staff that knew them well. Staff knew what to do if they were concerned about the safety of the person or an allegation of abuse had been made. Staff were trained, supervised and supported in their roles. This included supporting people with learning disabilities, mental health and positive behaviour support.
People’s needs were assessed, and a package of care was put in place to help them in a crisis. This was done working closely with commissioners and health and social care professionals. Feedback was good about the care and support that was in place for people. Although it was noted that improvements were needed to keep professionals better informed. This was being addressed by the senior management team. Additional office staff and a new manager had been employed to help with improving the communication.
People had a care plan in place that described the support they needed. This was kept under review as they got to know the person. There were plans to implement an electronic care plan system so that office staff could access information in real time. Care plans could be more person centred but it was clear that staff knew the person they were supporting and what they liked and did not like.
People were supported to maintain relationships with family and friends and take part in activities of their choosing. Staff supported people to attend health care appointments where needed. The support people needed with medicines and eating, and drinking was assessed and a care plan in place giving staff guidance on to help the person. Other professionals were involved in the care and support of people. Staff followed their guidance and advice.
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. Restraint was only used as a last resort and positive behaviour plans and the consistent approach of staff had seen a reduction of restraint where before it had used frequently by other providers. The registered manager had won an award for their commitment to reduce the use of restrictive practices.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
The registered manager was keen to continually improve and develop the service. Systems were in place to monitor quality and performance and actions were taken when shortfalls were identified.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 25 January 2019 and this is the first inspection.
Why we inspected
This was a planned inspection based on the registration for the service.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Leaf Complex Care on our website at www.cqc.org.uk.