Archived: Merton Integrated Learning Disabilities Service

Merton Team for People with Learning Disabilities is an integrated health and social care team consisting of staff from a number of disciplines including community nurses, social workers, occupational therapists, psychologists, physiotherapists and speech and language therapists. The team specialises in providing health care, support and advice to adults with a learning disability living in the London Borough of Merton. The team also retains a responsibility for people who are placed by them in out of borough residential care placements. At the time of our inspection approximately 500 people with a learning disability and their carers were using the service.

The service was required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run. Following a reorganisation of the service, a new manager was appointed in June 2016. They confirmed they were in the process of submitting their application to CQC to become the registered manager for the service.

Staff were trained and supported to protect people from abuse or risk of harm from discrimination. They worked with other professionals when they had concerns about people to ensure they were sufficiently protected. They provided advice and support to healthcare professionals to ensure people were not discriminated against because of their learning disability.

Staff prioritised people’s safety and welfare when planning the support they required. Staff worked together to assess how people’s specific needs could put them at risk. They developed plans for people and their carers to follow to manage identified risks to prevent injury or harm to people. Staff regularly reviewed these plans to check these continued to prioritise people’s safety and welfare. More frequent reviews were undertaken on people who were deemed as at high risk to check that intended outcomes to reduce risks to them were being achieved.

The provider ensured staff were suitable and fit to work at the service by carrying out employment and criminal records checks before they could start work. Staff received appropriate training to help them meet people’s needs. They were supported with their continuous professional development and kept up to date with best practice in their professional disciplines.

People and their carers were involved in planning their care, support and treatment. Staff carried out assessments to determine what support people needed and used a range of screening tools to do this. They developed health care and support plans that set out how people’s identified needs should be met. These reflected people’s personal goals and objectives for how care, treatment and support should improve the quality of their lives. There was clear information for staff about people’s life histories, likes and dislikes and what was important to them when being supported by the service. Staff reviewed progress against people’s goals and objectives and made changes to the support planned, when this was needed.

Staff supported people and their carers to manage people’s health conditions and to access the services they needed to promote and maintain their physical and mental health. People were supported to attend appointments at a range of healthcare services. Where people needed additional specialist support with their healthcare needs, staff helped them to access this. Staff had good links with local hospitals, GP practices and residential care homes and supported them to improve health outcomes for people using this service.

People and their carers spoke positively about the staff that supported them and said they were kind, caring and professional. Staff supported people to communicate their needs and wishes to all involved in the provision of their care, treatment and support. They worked with people to design communication systems specific to their needs so they could inform their carers and other health care professionals how they wished to receive support. Staff ensured the needs of people in hospital were well communicated to all staff involved in their treatment and care. Information about people in their health care and support plans were available in easy to read pictorial formats which people could understand.

Support was designed to enable people to learn or regain the skills they needed for independent living. Staff worked with people and their carers to build the confidence they needed to travel independently in the community. They encouraged people and their carers, when planning support, to identify activities and interests they wanted to pursue and then helped people to take these up. They helped to reduce risks to people’s physical and mental health from social isolation.

People and their carers were satisfied with the support they received from the service. They were comfortable raising any issues and concerns they had with staff. They knew what to do if they wished to make a complaint about the service. Information was provided to them in a pictorial, easy to understand format which explained how they could make a complaint. The provider had arrangements in place to deal with people's complaints appropriately.

The provider had clearly stated aims about what people and their carers should expect from the service to support their physical and mental health and wellbeing. Senior staff ensured staff’s individual work priorities and objectives reflected the service’s aims. They reviewed through supervision and team meetings how these were being achieved. Staff were clear about how their roles supported people to experience good outcomes in relation to their physical and mental health and wellbeing.

Senior staff demonstrated clear leadership and management of the service. They monitored the performance of the team through performance indicators. They also monitored complaints and used this to measure quality and inform learning. They promoted an open and inclusive culture in which people, their carers and staff could express their views about the quality of support people experienced. Staff felt well supported by senior managers and were confident that they would act on their suggestions and make improvements when needed.

Staff worked with a wide range of health and social care services and providers to provide advice, guidance, and training to support them in meeting people’s needs. Staff also supported commissioners to help design and shape services for people with a learning disability in the local community. They provided advice and support that would enable commissioners to take account of the specific needs of people.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 2005. All staff were required to have knowledge and oversight of the MCA and DoLS and had received relevant training in these areas.

People we spoke with said that the team helped them with their health and care needs. Comments included "the staff who support me always discuss my health needs with me", "the nurse has helped me to manage my medicines" and the staff take me to hospital and dental appointments."

The service had effective links and relationships with other social and health care providers such as hospitals, GPs, residential and other community services.

There were effective systems in place to ensure that people who used the service were safeguarded from possible abuse. Staff received regular training and guidance in safeguarding vulnerable adults.

We found that staff received a wide range of training and development and they were supervised and monitored in their practice. Annual appraisals were carried out their professional development reviewed. People we spoke with thought the staff appeared knowledgeable and they had the right skills to offer appropriate support.

The provider had effective systems in place to monitor the quality of the care and support that people who used the service received. We saw that a range of audits had been carried to improve health outcomes for people who used the service.