Expect Limited

Updated 6 June 2019

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

The inspection was prompted in part by some recent concerns which we were made aware of by the local authority. We attended the service earlier than scheduled to ensure that people were not exposed to unnecessary risks.

Inspection team:

The inspection team consisted of four social care inspectors.

Service and service type:

This service is registered as domiciliary care agency which provides care in supported living settings. People were living in supported living houses. Senior support workers managed the everyday running of the supported living houses and the registered manager had oversight of the service. It provides personal care to people living in their own houses and flats in the community as well as specialist housing. It provides a service to older adults and younger disabled adults. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks relating to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced.

The inspection took place on 30 April 2019. We also visited a number a people in their homes, with permission on this date.

What we did:

Prior to the inspection we reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about. We also sought feedback from the local authority. We had not requested a Provider Information Return for this service. A PIR is key information providers are required to send us about their service, what they do well, and improvements they plan to make.

During the inspection we visited people across five houses and spent time talking to them, the staff and reviewing documentation.

We also spoke with five staff, both registered managers, the training manager, and the compliance and complaints service manager. We looked at 10 care records across the homes we visited, including records relating to the administration of medicines, audits and other records associated with the management of the service and three staff recruitment files.

Updated 6 June 2019

About the service:

Expect Limited provides personal care and support to people in their own homes in the Sefton area of Merseyside.

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:

There was not always clear guidance for staff to follow with regards to consuming food and drink whilst supporting people in their homes. We have made a recommendation about this. Some information in care files was not always easy to find and differed in their presentation. The registered manager explained there was a new system in place which would re format people’s care plans, so they were clearer. Recent audits had been used to evidence the need for this change. Audits took place across all areas of service provision, and detailed action plans were drawn up as a result of the findings.

People told us they felt safe receiving care from Expect. Our observations showed that people’s homes were secure, clean, and kept to a nice standard. Staff were deployed in suitable numbers, and staff had time to spend with people and were not rushed. Medication needs were assessed, and medication was only given by staff who were trained to do so. Staff were recruited safely, and incident and accidents were analysed for patterns and trends. Risks to people were assessed safely.

Staff had the correct skills to support people and their training was up to date and recorded in a training matrix. Staff were required to engage in supervision and had an annual appraisal. People were supported to eat and drink in accordance with their needs. Decisions and consent to care and treatment were sought in line with the Mental Capacity Act 2005.

We received positive comments about the staff in relation to the support they provided. Everyone said staff were kind and caring. Staff were able to describe how they ensured people’s dignity was respected. People were involved in their care plans.

We observed, heard and read examples of how people’s routines and choices were listened to and respected. There was a complaints procedure in place.

Rating at last inspection: rated good, report published November 2017.

Why we inspected: This inspection brought forward following some concerns we received which may put people at risk of harm.

Follow up: ongoing monitoring.