Archived: Aspirations Northwest Adults

There was a new manager in post who had yet to apply for the position of 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 responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run’.

Aspirations Northwest Adults is a domiciliary care service providing 24 hour care, mostly within a supported living setting. The service supports people with complex mental health needs or learning disabilities.

People were administered their medicines by staff who were trained in the safe administration of medicines. We found however the medicine policy was unclear, there was a lack of information around the administration of ‘as required’ (PRN) medicines and staff competencies to administer medicines were not always checked.

We have made a recommendation around improving the safe management of medicines.

People said they felt safe when supported by the staff in their home.

The staff we spoke with could clearly describe how they would recognise abuse and the action they would take to ensure actual or potential abuse was reported. A safeguarding policy was in place for staff to refer to along with local authority guidelines for reporting an alleged incident.

Staff sought advice and support from external health professionals when needed to help assure people’s health and wellbeing.

Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect people from unnecessary harm.

People had a plan of care/support plan which recorded their needs, wishes, preferences and medical history. The support plans identified the level of support people needed to maintain their health and wellbeing. Healthy eating was promoted by the staff and nutritional support given as required.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). A number of documents showed people’s consent, or relatives’ consent (if legally empowered to do so) to evidence their inclusion in the planning of care.

People were supported by sufficient numbers of staff to provide care and support in accordance with individual need.

Recruitment procedures were robust to ensure staff were suitable to work with vulnerable people. Staff files reviewed showed all relevant recruitment checks had been undertaken prior to staff starting work at the service.

Sufficient numbers of staff were available to support people in their own home. This was confirmed by talking with staff, looking at staff rotas and talking with people who used the service and their relatives.

Staff told us they were supported through induction, on-going training, supervision and appraisal. Formal supervision meetings had not been held recently for a number of staff. Following the inspection the acting manager confirmed these were being undertaken. A training plan was in place to evidence staff learning and development.

We visited some people in their own home. We saw staff speak in a gentle and caring manner. Staff took time to listen and to respond in a way that people engaged with understood. Our observations showed staff had a good understanding of the people they supported. Staff told us how they respected people’s day to day choices and they were aware of promoting good standards of dignity and respect in their work.

Maintenance and safety checks for fire safety were undertaken in people’s own home.

A process was in place for managing complaints. People we spoke with knew how to raise a concern or make a complaint. The complaints procedure along with a number of other policies were available in an easy read format to help people’s understanding.

We received positive feedback about the management of the service from people who used the service, relatives and staff.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the service. This included the provision of questionnaires and meetings. The acting manager informed us questionnaires were due to be sent shortly, as it was acknowledged this type of feedback had not been sought for some time.

Quality assurance systems and processes were in place. These were not as robust as they could be in light of our findings and also the findings from a recent service report which identified actions required in a number of areas.

We have made a recommendation around improving the current auditing systems and processes to assure the service provision.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff and from looking at records held at the service central office and one of the service locations.

Is the service safe?

We found care plans and risk assessments in place and these reflected people's preferences, interests, aspirations and diverse needs. Not all care documents seen gave clear instructions to care regarding the care provision and how to identify changes in a person's condition that may need emergency assessment and treatment. Records we saw showed evidence of involving people in planning their care and establishing consent.

The staff we spoke to were aware of the Mental Capacity Act [2005]. The Mental Capacity Act [2005] protects people who lack capacity to make a decision for themselves because of permanent or temporary problems such as mental illness, brain injury or learning disability. If a person lacks the capacity to make a decision for themselves, staff can make a decision in their best interests.

Is the service effective?

We found that staff members were generally aware of the needs and wishes of people living at the service and support was delivered in a way that met those needs. Relatives of people who use the service told us this was the case. People who used the services of the agency were involved with their plan of care and their agreement sought where possible. Staff had access to a training programme and supervision to help them undertake their job role safely and effectively.

Is the service caring?

Staff told us how they promoted people's independence and respected people's rights to privacy and dignity. One person we spoke with said, "All the staff are nice." We observed staff interacting positively with people and taking time to engage with different activities that people wanted to take part in. We observed staff providing support and found they were warm, polite and respectful in their approach.

Is the service responsive?

We saw records which confirmed that the provider had an effective system in place to take account of comments or complaints relating to the service. Staff worked closely with external health care professionals to help monitor people's health, welfare and safety. People who used the services of the agency had access to medical support at the appropriate time.

Is the service well-led?

We found that the provider had a system in place to help monitor the agency and improve the care provision for people who used the services of the agency. This included a number of audits [checks] on how the service was operating. Shortfalls had been addressed and lessons learnt discussed with the staff.

We visited one shared house and one individual flat. We spoke with two people living there and asked them about the care that staff provided to them. They told us that staff were helpful and respectful and supported them well. We observed staff communicating with people. We saw that they were able to communicate effectively together. We observed people being treated with respect and dignity.

Person centred care records were in place in the person's home and in the office, providing up to date information about people.

Staff supported people to shop for and to prepare meals in the way they wanted, at the times they wanted.

Recruitment and selection was carried out thoroughly. This meant that the correct checks were made on staff and they had the skills needed to support people.

Systems were in place for monitoring the quality of the service people received. They were regular checked and changes made if needed.

People knew how to complain if they were unhappy with the support they received. They told us that they were well supported by the staff team.

One person who used the services said 'I like living here, I like all my support staff they are good. I can talk to them all.'

Another person told us 'The care staff always show dignity and respect privacy as they look after me, they knock on my door.' 'I am involved in the planning of my care.'

We observed care files, these were well organised and had a person centred approach. The service maintained a contact record of all telephone calls or written correspondence with family members, representatives and other professionals.

We made general observations within the home of the wellbeing of people and observed staff had a positive rapport with the people living at the home.

The service had robust quality audit and monitoring systems in place to support the care delivery monitoring.

Staff told us they had a handover of medication and money each morning. There was a handover book in place for each of the people who lived in the home. There was also a communication book for staff notes from each shift.