Archived: Your Life Your Way

Your Life Your Way provides care and support to adults and children living in their own homes. The service provides both domiciliary care support along with 24 hour packages in which specific teams of staff are employed to work. At the time of this inspection the service was supporting approximately 80 people.

People's experience of using this service:

Improvements had been made since the last inspection so that procedures for recording medicines were in place, identified risks to people were now fully recorded and care plans identified the intended outcomes for people and how their needs were to be met in a more person centred approach. Improvements had been made to the governance systems in place to ensure that the quality of the service was being monitored.

We have made a recommendation that a review of the roles of office based staff and management arrangements takes place to promote effective communication and service delivery

Systems for assessing and monitoring the quality and safety of the service were more effective in identifying areas for improvement within the service.

People’s needs were assessed and regularly reviewed. People received care and support from appropriately trained staff. People were supported to have a nutritious and balanced diet and were supported with their healthcare needs which were understood and met.

Systems were in place to gather people's views on the service they received. People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Risks to people and others were identified and measures put in place to minimise harm. Good infection control practices were followed to minimise the risk of the spread of infection.

Staff were knowledgeable about people's needs and how they were to be met. People told us they received care and support in line with their care plan. People and their family members knew how to raise a concern or make a complaint about the service. However, people had differing views on the effectiveness of the service’s complaints procedures.

People were treated with kindness and respect by staff who knew them well. People spoke positively about the staff who delivered their care and support. Procedures were in place to ensure that they received information in a manner that they understood.

Details are in the key questions below.

Rating at the last inspection: Required Improvement (report published on 8 January 2018).

Why we inspected: this was a planned inspection based on the rating of the last inspection. The rating for this service has improved to good overall.

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

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, people living with a learning disability and children. Not everyone using Your Life Your Way receives 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.

The service had three registered managers in post. One of the managers had been registered with the CQC since October 2015, and the other two had registered in May 2016. 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.

During the inspection we identified breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all people we spoke with were confident that either they or their relatives were adequately protected from harm. At the time of the inspection there were safeguarding investigations underway in relation to poor care planning and risk assessing for people with complex physical and behavioural needs. Some people did not have care records in place within their homes, or old care plans were being used whilst up-to-date ones were being developed. This meant that important information around risk management and people’s individual needs was not always available to staff. This placed people at risk of not receiving the care they required. In one example, a person was place placed at risk because their care record did not contain adequate information about monitoring their continence needs, whilst another person’s care record did not contain the correct information about the setting their ventilator needed to be on to aid with their breathing.

People’s care records did not always contain personalised information relating to their preferences, life histories or preferred daily routines. This meant that information was not always available to enable staff to work in a way that was in line with people’s preferences.

The processes in place within the organisation were not always person-centred. People and their relatives commented that they did not find the service responsive when they tried to contact them to raise issues. They told us their phone calls were not always returned, or they felt unclear who they needed to speak to about their concerns. One person’s relative told us they had been made to feel like a “nuisance”, whilst others told us of unprofessional conduct in some of the contact they had with the organisation.

Some staff we spoke to told us that managers were not always available in the event of an emergency. The registered provider had an ‘on call’ system in place where staff could contact a member of the management team for support where an emergency occurred out of hours. However staff told us managers did not always respond when they used this. This placed people and staff at risk of harm.

Staff were not always clear about who their line manager was. In some examples this had resulted in disruptions to the care teams supporting people. The discussions we had with both people and staff showed that the organisation did not always ensure a smooth transition into the service for new packages of care. This had resulted in low staff morale amongst those staff who were supporting newer packages of care, and lower satisfaction amongst people and their relatives who had more recently started being supported by the organisation. Comments from people who had been using the service for longer periods of time showed that they had initially experienced similar issues.

Audit systems were in place, however these had not been robust enough to identify and address the issues identified by the local authority safeguarding team, or the issues identified as part of the inspection process. The registered provider had commissioned an external quality monitoring service to support with identifying areas that required improving, and had taken action in response to the report that had been produced.

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

People received their medication as prescribed. Staff had been assessed to ensure they were competent to do this. However we observed that protocols for PRN (‘as required’) medicines did not always provide all the information required. These provide details to staff on when and how much medication to administer. We raised this with the registered provider for them to address.

People told us that staff were “excellent” and that they were good at providing the care and support required. The comments from people and their relatives highlighted that there was a stark contrast between the quality of the care being provided by staff, and the interactions they had had with the registered provider.

We observed positive interactions between people and staff where people appeared relaxed and at ease in the presence of staff. Staff offered people choice and control over their care needs and promoted their independence where able. This showed that positive relationships had developed, which upheld people’s dignity and human rights.

Staff had received the training needed to carry out their role effectively. There was an induction process in place which included a period of shadowing experienced members of staff. The induction also included the standards required by the Care Certificate. This is a national set of standards that all care staff are required to meet.

Recruitment processes were safe. New members of staff had been required to provide two references, one of which was from a previous employer. This had also been subject to a check by the disclosure and baring service to ensure they were not barred from working with vulnerable people.