Support for Living Domiciliary Care Agency

Updated 6 May 2021

The inspection

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

Inspection team

Visits to the supported living schemes were conducted by two inspectors and an inspection manager. A third inspector conducted the visit to the offices and reviewed records. The inspection was supported by an Expert by Experience who made phone calls to relatives and representatives of people who used the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in 25 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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

We gave a short period notice of the inspection because we wanted to visit the schemes where people lived, and we needed their consent to do this. We also needed to notify the provider of our intention to visit the office because they had mostly been working remotely since the start of the COVID-19 pandemic and we needed to make sure staff would be available to meet with us.

Inspection activity started on 13 April 2021. We visited eight of the supported living schemes on the 13 and 14 April 2021. We visited the office location on 15 April 2021.

What we did before the inspection

We looked at all the information we held about the provider. This included notifications of significant events and safeguarding alerts. We contacted some of the commissioners who organised and funded people's care and support. We received feedback from three.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We visited eight of the supported living settings and met the people who lived there and the staff who supported them. We also met a visitor at one scheme. At the schemes we spoke with people about their care, spoke with the staff and observed how staff interacted and cared for people. We also looked at how medicines were being managed, health and safety arrangements, infection control procedures and a selection of care and other records.

We visited the office location and met with the registered manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also met other senior managers who discussed work in different departments. We looked at the care records for seven people using the service and other records used by the provider to manage the service and monitor quality.

We spoke with the relatives and representatives of 22 people who used the service.

After the inspection

We continued to review records the provider sent us which included evidence of how they managed the service, policies, records of audits, meeting minutes and evidence of learning.

We arranged a meeting with the provider on 23 April 2021 to discuss our findings.

Updated 6 May 2021

About the service

Support for Living Domiciliary Care Agency provides personal care and support to people living in supported living accommodation in North West London. The service is part of Certitude, a London based, not for profit, social care provider for people with learning disabilities, autism, mental health needs or multiple needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of our inspection, 125 people were receiving support with personal care across 25 different supported living houses.

People’s experience of using this service and what we found

In some of the schemes we found improvements were needed to safety, infection control and medicines management. We discussed this with the provider, and they addressed these issues and developed an action plan to make improvements.

People experienced personalised care which met their needs and reflected their preferences. The provider was committed to reducing restrictive practices and staff understood this and worked with individual people to enable them to take risks and develop their independence. People's care was planned to meet their individual needs, with staff working alongside healthcare professionals to make sure people received the right support.

The staff were well trained, supported and knowledgeable. They demonstrated a good understanding of the people they were caring for and were able to use a variety of communication methods to allow people to make choices and have control over their lives. The staff were able to access the training and support they needed and felt valued.

The provider had effective systems for addressing concerns and making improvements to the service. They undertook quality checks and responded appropriately when things went wrong. People using the service, their families and staff felt managers were approachable, open, and listened to them.

There were local and provider level strategies to promote human rights and improve the quality of people's experiences. For example, the provider had improved the way they supported staff and people using the service with protected characteristics to feel included, safe and respected.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: People were supported to live within settings that met their individual needs. There was a robust assessment process which included involving people, their families and other stakeholders to make sure care was personalised and maximised people's choice while meeting their needs. People were supported to learn independent living skills and take risks to enhance their quality of life.

Right care: Care was provided in a person-centred way which promoted people's dignity and rights. Their lifestyle choices, religion, sexuality, culture and disabilities were respected and they were given the right care and support to live their lives to the full.

Right culture: There was a positive culture where staff were committed to caring for people. They knew people well and wanted to support them in a personalised way. They felt a sense of pride in people's achievements and happiness. The leadership created positives values and behaviours which were embedded and echoed throughout the service and in the day to day support of people being cared for.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The rating at the last inspection was outstanding (Published 5 April 2018). Whilst we found the service still had some outstanding qualities, we judged that these were not enough to rate the service outstanding in any key questions or overall. We also identified improvements were needed to ensure the safety of people using the service at all times. The provider addressed these concerns when we discussed them with the registered manager and nominated individual.

Why we inspected

The inspection was prompted in part by information about a number of incidents where people had been harmed. We carried out an inspection to assess whether standards of safety and quality were being met. Whilst we identified potential risk of harm in some areas, we were satisfied people were receiving a good service and the provider had responded appropriately to these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.