Your Choice

Updated 18 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The comprehensive inspection took place on 4 September 2018 and was announced.

As the service was small, one inspector carried out the inspection. We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service for younger adults who are often out during the day. Therefore, we needed to be sure that they would be in.

Before visiting the service, we looked at previous inspection reports and information sent to the Care Quality Commission (CQC) through notifications. Notifications are information we receive when a significant event happens, like a death or a serious injury.

We also looked at information sent to us by the manager through the Provider Information Return (PIR). The PIR contains information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed three people's care plans. We reviewed people’s care and support plans, activity plans and risk assessments. We also looked at; staff rotas, training records, recruitment files, medicine administration records, complaints and accident logs. We asked the provider to send us some documentation via email after the inspection. These were received following the inspection.

We spoke to five members of staff and four relatives on the days following the inspection. Views were also sought from health professionals; however, we did not receive feedback.

We also visited two people in their own homes where we spoke with one person and observed interactions between people, personal assistants and the provider.

Updated 18 October 2018

The inspection took place on 4 September 2018 and was announced.

We announced the inspection because Your Choice only provided care to a small number of people. By announcing our inspection, we could ensure that the provider was available and that we could visit people receiving support from the service.

Your Choice is a domiciliary care agency which provides personal care to three people with learning disabilities and complex health needs in their own homes. At the time of the inspection the agency provided personal care for three people. Not everyone using Your Choice received 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. Your Choice also provided other services to people not regulated by the CQC, for example; shopping, befriending and domestic assistance.

The majority of the people who used the agency lived with their relatives. The agency provided 14 personal assistants to support people. The support provided to people varied according to their needs and other arrangements, supported ranged from 24 hours a day to an hour every other day. The service provided to people and their families were flexible, therefore family were often provided with regular and ad hoc respite depending on their needs and preferences.

On the previous inspection in September 2017, we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that the systems and processes were in operation to assess, monitor and improve the quality and safety of the service were consistently applied.

At this inspection, we found that the provider was no longer in breach of Regulation 17. Your Choice had made improvement to become good. When areas for improvement were identified, they were immediately addressed by speaking to people and their families and by seeking official guidance..

The agency was registered to one person who is the provider and therefore the agency does not require a registered manager. The provider was the registered person. 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 registered provider had overall responsibility for the agency.

The care service has 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.

People were given the care and support they required. Interactions were kind and friendly, people smiled and looked relaxed in the company of personal assistants. The team of personal assistants shared the same values, to enable people to live a full and fulfilling life, relatives confirmed this ethos was embraced by all. Personal assistant's Risks to people were assessed and mitigated against and personal assistants had been trained and understood how to support people in a way that protected them from harm and abuse. The provider followed infection prevention and control guidance.

The provider completed checks on personal assistant's before they started work to ensure they were safe to work with people. People received care from personal assistant's that had the skills and knowledge to meet their needs. New personal assistants went through an induction period which was tailored to the needs of the people they would care for. Existing personal assistants attended regular face to face and online training which they found helpful and informative. The provider had systems in place to address any unsafe staff practices which included disciplinary action or retraining if needed.

People were supported by enough personal assistant's to safely assist them. Personal assistants were flexible so people and their families changing needs could be easily met. When needed, people received help with their medicines from personal assistants who were trained to safely support them. The senior personal assistants undertook regular checks to ensure people received their medicines as directed.

People were given person-centred care that promoted their independence and enabled them to live as full a life as possible. Personal assistants knew people well and understood how to support and care for them. The small teams were vigilant of changes to peoples physical and emotional health and responded to changes appropriately. People and their representatives determined what care the person should receive and the team worked alongside them and health professionals when people's needs and preferences changed. The provider regularly sought feedback from people and their families and relatives told us that if they had any issues, these were rectified immediately.

People were supported to have maximum choice and control of their lives and personal assistants supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Personal assistants encouraged people to be as independent as possible. People could do what they wanted, when they wanted and personal assistants respected their wishes at all times. People were treated with dignity and their spiritual, social and cultural needs were discussed and respected.

Incidents and accidents were recorded and teams reviewed these with people, their families and health professionals. If and when shortfalls were identified, these were investigated and resolved appropriately.

The service worked closely with the learning disability team which improved their knowledge of best practice. The manager planned to develop the service by joining local networking forums where the latest and best practice was discussed. Your Choice also had good working relationships with local organisations, so people had access to a range of activities and opportunities within the area.

People's privacy was respected and confidential personal information was stored safely.