Affinity Trust - Domiciliary Care Agency South East, Bedford and Northamptonshire Also known as Affinity Trust

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 continued to receive a personalised service. Staff knew people well and care plans were comprehensive and detailed to guide staff in how to provide care in the way people preferred. People were leading full and active lives and were supported to express their views and to be involved in decisions and choices about their care.

Staff understood their responsibilities for safeguarding people from abuse. Alerts had been raised and investigated appropriately. Risks to people were assessed and managed. People were supported to take positive risks and were encouraged to remain as independent as possible. There were enough suitable staff to care for people safely. People were receiving their medicines in line with their prescription. Incidents and accidents were recorded and monitored to ensure that lessons were learned when things went wrong.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. 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.

Staff received the training and support they needed to be effective in their roles. New staff received a comprehensive induction. One new staff member described how this had helped them to feel confident in their new role. Staff described good communication and effective team work. Support from health care professionals was sought when needed and people were supported to have enough to eat and drink and to maintain a healthy diet.

People were supported and encouraged to express their views and to make decisions about their care and support. Information was provided to people in accessible formats depending upon their needs. Staff respected people and treated them with dignity and respect. Staff spoke with affection about the people they were caring for and knew people well. People were treated with kindness and staff promoted and supported their independence.

Complaints and concerns were recorded and responded to appropriately. People were supported to maintain relationships that were important to them. Care was responsive to people’s needs and preferences. People were supported to plan for end of life care.

The service was well led, there were effective systems in place to provide governance and oversight. Lessons were learned when things went wrong, changes were made to improve standards of care. There was a strong emphasis on engagement with people, their relatives and staff. It was evident that staff had developed positive links within the local community and that staff worked in partnership with other agencies.

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 2 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

Affinity Trust Domiciliary Care Agency West Kent provides care and support to people living in shared houses and individual flats called ‘supported living’ settings, so that they can live 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. Each person had their own bedroom and bathroom and some people shared kitchens, dining rooms and lounges and others had their own. The service supported 34 people living with learning and physical disabilities living across Kent.

CQC carried out an announced comprehensive inspection of this service on 20 July 2016. A breach of legal requirements was found relating to support plans. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. The breach of regulation was now met. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Affinity Trust - Domiciliary Care Agency West Kent on our website at www.cqc.org.uk

The service continued to be run by a registered manager. 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.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The registered manager had reviewed support plans with people so that they were detailed and gave guidance to staff about how to support people to achieve their goals and ambitions. There was now information about how to support people to develop and increase their skills to live more independently.

People were supported to take part in activities of their choosing including gaining employment. People’s wishes should they become ill were recorded in their support plans. Any concerns and complaints were investigated and responded to.

The service continued to be well led, the registered manager was skilled and experienced in leading the service. People were asked about their views of the service and these were acted on to improve the support people received. The registered manager met with people and observed the staff to make sure people continued to receive good support. The registered manager had notified CQC of incidents and events as required and displayed their rating as required.

Affinity Trust – Domiciliary Care Agency West Kent provides care and support to adults in their own homes. The service is provided to people who have a learning disability, some of whom live on their own and some share with other people using the service. At the time of this inspection there were 27 people receiving support with their personal care. The service provided one to one support hours to people, most people were supported 24 hours a day although during this time may share staff for a period of time with another person living in the same house, such as in the evening or at night. The service is delivered across Kent.

The service is run by a registered manager, who was registered in October 2015. 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.

People and relatives were involved in the initial assessment and the planning of their support. Support plans contained details of people’s wishes and preferences, but the level of detail was not always consistent. People’s independence was encouraged wherever possible, but this was not always supported by the support plan. Risks associated with people’s support had been identified and clear guidance was in place to keep people safe.

People had their needs met by sufficient numbers of staff. People received a service from a small team of staff, who were recruited specifically to match the people they supported. New staff underwent an induction programme, which included relevant training courses and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role, which was refreshed regularly to ensure staffs knowledge remained up to date. Some staff had gained qualifications in health and social care.

People were supported to maintain good health and attend appointments and check-ups. People’s medicines were handled safely.

People’s consent was gained for the support they received and they were supported to make their own their own decisions where possible, sometimes using pictures, photographs or objects of reference. Most people had an appointee to manage their finances. One person had Lasting Power of Attorney arrangements in place. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People and relatives felt staff were kind and caring. People were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect. Staff were kind and caring in their approach and knew people and their support needs.

People and relatives felt people were safe using the service. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People had opportunities to provide feedback about the service provided. Any negative feedback was used to drive improvements to the service. Audits and systems were in place to ensure the service ran effectively and people received a quality service.

The provider had a mission statement and staff followed this through into their practice.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We carried this inspection out over two days. This included a visit to the agency's offices on the first day; and a visit to a person receiving support on the second day. We talked with two staff as well as with the manager and the agency's Divisional Director.

We viewed a variety of documentation, which included two care plan files, risk assessments, staff training programmes, safeguarding protocols, and management of accidents and incidents.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

The manager and staff knew and understood their responsibilities to report any safeguarding concerns. The manager liaised appropriately with the local authority safeguarding team for any support or advice; and informed them of any suspicions of abuse. This was in accordance with the multi-agency safeguarding vulnerable adults' protocols and guidance for Kent and Medway. We saw confirmation that all of the staff had been trained in safeguarding vulnerable adults. We spoke to staff who gave clear explanations of the different types of abuse to be aware of, and who knew the action to take in the event of any suspicion of abuse.

Staff had been trained in regards to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). It had not been necessary to submit any DoLS applications.

We saw that the agency had implemented thorough risk assessments for individual people. These contained clear directions and guidance for staff, and explained how to take action to minimise the different risks identified.

We viewed medication policies and procedures, and saw that staff were appropriately trained prior to administering any medicines.

Is it effective?

We looked at two people's care plans in the agency's office, using an agency computer; and we then viewed one of these in the person's own home. We saw that people or their representatives were invited to be fully involved in their care planning and in decisions about their day to day activities.

We saw that people's support plans were put into formats which enabled them to engage with the processes about their care planning. These included the use of pictures, photographs and symbols, to encourage people to take an interest in them. We saw that people's preferences were recorded and were adhered to in regards to their individual care.

People's support plans were fully reviewed every six months, or more frequently if changes were implemented during that time. This ensured that staff were using up to date information.

Is it caring?

We saw that care plans identified people's own preferences, such as the name they preferred to be called by. The staff we spoke to were fully aware of the needs and wishes of the person they were supporting, and worked in accordance with the guidance in the care plan.

We saw that staff knew how to relate to the person in their care. We visited someone who had non-verbal communication, and staff recognised the signs that the person was making, and informed the inspector of their feelings and comments. Staff acted in a friendly and caring manner towards the person.

Is it responsive?

The care plans reflected different lifestyles and activities according to people's choices and wishes. The staff provided support with all aspects of people's needs, such as household tasks; personal care; going out into the community; making and keeping friends; hobbies and interests; and keeping the person safe from harm.

Staff that we spoke to demonstrated that they recognised when the people in their care had worries or concerns, as they saw changes in their behaviour which alerted them that something was not right. This enabled staff to inform senior staff and identify the cause of their changed behaviour, and provide appropriate support to individuals.

Is it well-led?

Staff said that they felt well-supported by the management, and could contact them at any time. Support staff were allocated to people who had similar interests or characters so that they could form suitable working relationships with the people in their care.

Staff had individual supervision with their line managers which enabled them to discuss any training needs or raise any issues. They were also supported through yearly appraisals and through team meetings. Each person receiving care had their own team of support staff, who met together at regular intervals to share changes and ideas about the things that worked well, or any areas of concern.

The manager was able to answer questions about the people being supported, showing his knowledge and understanding of the people receiving services. He provided documentation without any delay in response to our requests. We saw that the agency had systems in place to protect people's confidential information, using password protected computers. Staff were taught about the importance of maintaining people's confidentiality as part of the induction programme.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that staff understood safeguarding procedures, and how to safeguard the people they supported. There were systems in place to make sure that the staff learnt from events such as accidents and incidents, complaints, concerns, and investigations. Staff had been trained in regards to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) although it had not been necessary to submit any DoLS applications.

We saw that people felt secure with their allocated staff and looked to them for support.

The agency had suitable procedures in place to protect people's finances and pocket monies, and to protect them from financial abuse.

Is the service effective?

We saw that people were enabled to carry out their preferred choices of activities each day. The staff took a flexible approach so that people could change their minds or choose different activities on the day. We saw that people were relaxed with their support staff and felt secure in their company.

We found that the agency had provided staff with appropriate training and support, so that they could meet the needs of people they were supporting.

Is the service caring?

People spoke highly of the staff who supported them. One person said they had been crying in the morning, and the support staff had helped them to sort out the reason and they said "I feel better now". We saw from people's replies to recent surveys that people felt comfortable with their support staff, with remarks such as 'Staff listen to me'; 'I am happy where I live'; My support staff help me make decisions'; and, "Staff ask me all the time what I want to do and I have a full activity planner.'

We saw that documentation confirmed that people were supported wherever needed in developing their own lifestyles and independent living skills.

Is the service responsive?

The service operated a system to obtain the views of people receiving support, and their family members and staff. We saw evidence to show that appropriate action was taken in response to the things that people identified.

People knew how to raise a concern or complaint, and had their comments and complaints listened to and acted on.

Is the service well-led?

We saw that the management staff and support managers had a good rapport with support staff and people receiving care. The support staff said that there was an effective on-call system in place, and they never felt unsupported in any unexpected situations.

The service worked well with other services and health professionals to make sure that people received the care and treatment that they needed.