Archived: Living Options Outreach - Domiciliary Care

Living Options Outreach – Domiciliary Care can provide personal care and support for up to 3 people with a range of disabilities. At the time of our inspection there were 2 people using the service. Both people received 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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: People were not always supported to have maximum choice and control of their lives. People chose how they wanted to spend their days and were supported by staff to follow their interests. However, if staff were not available, people could not always go out when they wanted, even though they were allocated additional funding for one-to-one support.

Right Care: Care was personalised to meet people’s needs. People were cared for by staff who knew them well. People's preferences, likes and dislikes had been documented in their care plans which staff followed.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services were able to lead confident, inclusive and empowered lives. Lack of oversight at the service had resulted in people being harmed. Concerns raised were not always listened to or acted upon by the provider.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (report published 11 May 2019).

Why we inspected

The inspection was prompted in part by notification of incidents of alleged abuse affecting people who used the service. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risks. This inspection examined those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 well led section of this report. You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living Options Outreach – Domiciliary Care on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the governance and management oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Living Options Outreach – Domiciliary Care provide personal care for people with complex physical health needs and additional conditions. Personal care and support is delivered from a detached bungalow in a residential part of Worthing, where each person has their own room and ensuite wet room.

People’s experience of using this service:

• People told us they received safe care. They were supported by consistent and suitably trained staff. People received support to take their medicines safely and as prescribed. Risks to people's well-being and environmental safety were recorded and updated when circumstances changed. Lessons were learnt where appropriate to improve the service further.

• People's rights to make their own decisions were respected. They were supported to access health services if needed. People's dietary needs were assessed and where required people were supported with their meals.

• People received caring and compassionate support from the staff. The management team led by example and staff referred to people in a caring way. People were complimentary about staff and about positive, caring relationships they were able to form with the staff. Staff respected people's privacy and dignity and people were supported to be as independent as possible.

• The service was committed to assisting people to pursue their interests which created a sense of belonging and purpose. A range of activities were on offer to ensure a variety of opportunities which reflected people's wishes and interests. The manager was passionate about providing person centred care and this was reflected in every aspect of the service. People were empowered to help run and improve the service. People knew how to complain and told us where they raised concerns the management acted promptly to address these.

• The manager had a clear vision on the quality they wanted to provide at the service. There was a clear staffing structure and staff were aware of their roles and responsibilities. The provider had a number of quality assurance systems in place and there was a focus on further development. The service worked well with other partners and organisations.

Rating at last inspection:

At the last inspection the service was rated Good (report published 07 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Living Options Outreach – Domiciliary Care is registered to provide personal care for people with complex physical health needs, including cerebral palsy, and additional health conditions. The service model is based on supported living with people receiving personal care and support from staff employed by the provider. People have their own service user/tenancy agreements and the property is owned and managed by Leonard Cheshire Disability. Personal care and support is delivered, not from the registered address, but from a detached bungalow in a residential part of Worthing, where each person has their own room and en-suite wet room. Three people resided in the property and received personal care there.

A registered manager was in post. 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 were protected from potential abuse and harm by trained staff. Risks to people had been identified and assessed and were managed appropriately. Management of medicines was satisfactory, although we asked for the overstock of one particular medicine to be returned to the pharmacy.

Staffing levels were sufficient to meet people’s needs, with at least one member of care staff on duty at all times. However, maintaining staffing levels on some weekends with consistent staff had proved a challenge. Gaps to staffing were filled through the use of regular agency staff. New staff were recruited safely. New staff followed the Care Certificate, a universally recognised qualification and the provider’s induction programme. Essential training to staff was delivered in a range of areas, with updates as needed according to the training plan. Staff received regular supervisions with the registered manager and team meetings were held, usually every other month.

People receiving a service had all been assessed as having capacity to make decisions, with support if needed. Staff had been trained on the Mental Capacity Act (2005). People had sufficient to eat and drink and were involved in shopping and menu planning. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were treated with dignity and respect and were encouraged to be involved in all aspects relating to decisions about their care and support. Care plans provided detailed and comprehensive information and guidance to staff about people’s life histories, likes, dislikes and preferences. People were encouraged to be involved in activities relating to their interests and were supported to access the community. People knew how to make a complaint and these were managed in line with the provider’s policy.

The provider organised a national survey to obtain people’s feedback about the service. House meetings were also held at which people could express their views and be involved in the development of the service. In the Provider Information Return (PIR), the registered manager stated, ‘The whole service is being restructured and residents will direct their support even more by removing the core element of cost and have them decide how (for example, assistive technology) they want that to be spent’. A range of systems were in place to audit the service provided and to identify any improvements needed.

The people who lived in the house did not want us to visit them during this inspection. One of the people who lived there came to talk to us at the office of the organisation. We met with the manager and senior personal assistant and spoke with four staff members and three relatives on the telephone.

The person we spoke with told us the house was "a very special place" to live and they were "very happy" there. Relatives told us they were happy with the care and support their relative received with one person saying their needs were "well catered for."

We found people were having their health and welfare needs met by the staff and were being supported in the way they chose. The person we met with told us they made their own decisions about how to be assisted.

Systems for safe management of medicines were in place and people were supported to be independent with their medicines if they wished.

People who used the service were involved in the recruitment of staff. The required information regarding new staff was obtained prior to them starting work. Staff told us they felt supported by the manager.

Systems were in place for informal feedback from the people who used the service. Some systems to monitor the quality of the service were in place.

During our visit to the Living Options Outreach offices we were invited to the home by one of the people, so we were able to speak one of the people who used the service, however due to the nature of their disability we were unable to gather to their views on the outcomes. However, one person did tell us that staff do help them a lot and that they liked the staff. The person was relaxed with staff and looked happy.

We also spoke to three members of staff including the manager. We looked also looked at records which included care files of people who used the service, personnel files of employees and information the provider used to assess and monitor the quality of the service.