Archived: Independent Living Home Care

Independent Living Home Care is a domiciliary care service providing personal care. The service was supporting five people at the time our inspection, including those living with dementia, older people and younger people.

Not everyone who used the service received personal care. The Care Quality Commission (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

People were at risk of avoidable harm because the provider lacked understanding of their responsibilities and regulatory requirements. They did not have robust systems in place to check safety and quality across the service including with staff training and people’s records. The provider had not acted on issues we identified at the last inspection of the service.

Despite the potential for risk, we found evidence of some improvements and the service achieved positive outcomes for people. The provider had a positive approach to risk management, this enabled people to remain independent living in their own homes. People were encouraged to manage their own medicines where possible. The provider was not always aware of best practice guidance for medicines.

People were satisfied with the effective care they received. Staff worked effectively with healthcare professionals, other care providers and relatives to ensure people’s care needs were met.

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 did not support this practice.

People were treated with dignity and respect. Staff ensured they were at the centre of decision-making about their care. The thoughtful, caring approach staff used improved people’s wellbeing and helped them to take pride in their appearance.

People received a personalised service reflecting their needs and preferences. The provider worked flexibly to provide support. People and their relatives were confident they could raise any issues with the provider and that these would be listened to.

We made recommendations about medicines, the Mental Capacity Act 2005 and end of life care planning.

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 requires improvement (published 27 July 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance of the service at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Independent Living Home Care is a small domiciliary care agency operating in Thirsk and Sowerby. It provides various services to people living in their own houses and flats. The service supports older adults, younger disabled adults and those living with dementia. Not everyone using the service received a 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. At the time of the inspection four people were receiving a regulated activity.

The service was run by a single provider in day to day control of the service. It was therefore not required to have 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations.

At the last inspection in August 2015, we rated the service 'Good'. At this inspection, we rated the service ‘Requires improvement’. This is the first time the service has been rated Requires Improvement.

We found breaches of two of the fundamental standards of The Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. These related to the systems and processes in place to monitor and improve the quality of the service and not following recruitment procedures to help recruit staff safe for working with vulnerable adults.

The provider had not understood when notifications should be submitted to the Care Quality Commission (CQC). This was a breach of the Care Quality Commission (Registration) Regulations 2009. We directed them to the guidance.

You can see what actions we told the provider to take at the back of the full version of the report.

Record keeping was not consistent and did not give staff clear instructions when people were supported with their medicines. We made a recommendation about the management of medicines.

The Mental Capacity Act (2005) was not consistently understood and applied to ensure people were empowered to make decisions for themselves and consider any risks affecting them. Despite this people told us they were involved in decisions about their care. There were enough staff to provide support and ensure people’s needs were met. People received care at their preferred times and knew which care worker would be visiting them.

Staff received training to give them the knowledge and skills needed for their roles. New members of staff received an induction which was adapted to reflect their levels of experience in working in care. Informal catch- ups and supervisions were arranged to help staff develop their confidence, skills and knowledge in their roles.

People were treated with dignity and respect. Staff knew how to support people in a way that promote their independence whilst recognising their limitations. People were supported to access health services. Emotional support was provided when required, including after hospital appointments, when people needed time to reflect on and come to terms with the information discussed.

People’s preferences and life histories were understood. People valued the attention to detail staff gave, understanding their specific requirements and enabling them to pursue their hobbies. People were supported to access the community, reducing their risk of social isolation.

Staff were flexible when providing care to people. When care needs changed or people declined care at a particular time adjustments were made to enable staff to support people.

The service had a clear focus on wanting to remain a small company. This was appreciated by people, relatives and staff alike. Staff understood their responsibilities and felt supported in their roles. This included having opportunities for professional development.