Archived: Living Ambitions (Chester)

Updated 8 September 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.

This inspection took place on 8 August and was announced. The provider was given 48 hours’ notice prior to the inspection visit. Prior notice was provided because the location provides a domiciliary care service and we needed to be sure that staff would be available on the day.

The inspection team consisted of one adult social care inspector.

Before the inspection visit we reviewed the information which was held on Living Ambitions. This included notifications we had received from the registered provider such as incidents which had occurred in relation to the people who were being supported. A notification is information about important events which the service is required to send to us by law.

A Provider Information Return (PIR) was received prior to the inspection. This is the form that asks the registered provider to give some key information in relation to the service, what the service does well and what improvements need to be made. We also contacted commissioners and the local authority prior to the inspection. We used all of this information to formulate a ‘planning tool’ and to identify key areas we needed to focus on during the inspection.

During the inspection we spoke with the registered manager, three members of staff, three relatives and one person who was receiving support.

We also spent time reviewing specific records and documents, including five care records of people who received support, five staff personnel files, staff training records, medication administration records and audits, complaints, accidents and incidents and other records relating to the management of the service.

Updated 8 September 2018

This inspection took place on 8 August 2018 and was announced.

Living Ambitions is a domiciliary care agency. This service provides care and support to people living in their own homes and supports them to live as independently as possible. Living Ambitions provides a service to young and older adults. At the time of the inspection the registered provider was providing support to five people.

A registered manager was in post at the time of the inspection. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. This was the first inspection since the registered provider had registered with CQC in March 2017.

The registered provider had a variety of different systems and processes in place to assess and monitor the quality and safety of the care people received. This meant that people were receiving safe, effective, compassionate and high-quality care. Such systems included regular care plan and medication audits, care plan reviews, medication competency assessments and quality questionnaires.

Care files contained individual care plans and risk assessments. Information we checked was up to date, relevant and regularly reviewed. Staff were familiar with the individual needs and risks of the people they support. We received positive feedback about the level of safe care people received.

Medication management systems were safely and effectively managed. Each person had robust medication records in place. Records contained the level of support each person required and the level of risk that needed to be monitored. Staff received the relevant medication training and regularly had their competency assessed to ensure they were complying with safe administration policies and processes.

We found that the area of ‘recruitment’ was safely managed. This meant that all staff who were working for the registered provider had sufficient references and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed are suitable to work within a health and social care setting. This enabled the registered manager to assess level of suitability for working with vulnerable adults.

All accidents and incidents were appropriately recorded and analysed on a monthly basis. The registered manager explained that there was very little activity in relation to accident/incidents but staff were aware of the reporting procedures.

People were protected from avoidable harm and risk of abuse. Staff were familiar wit safeguarding procedures and knew what ‘whistleblowing’ meant. Staff had completed the necessary safeguarding training and there were up to date safeguarding and whistleblowing policies in place.

The registered provider had suitable infection prevention control procedures in place. Staff were provided with the relevant personal protective equipment (PPE) and were encouraged to comply with infection control procedures. There was an infection control policy in place for people to consult if they needed further guidance and support.

We checked if the registered provider was complying with the principles of the Mental Capacity Act, 2005. People’s capacity had been assessed and where appropriate the relevant deprivation of liberty safeguards (DoLS) had been authorised. ‘Consent’ to care had been obtained by people who has the capacity to make decisions and records indicated that people and relatives (where legally able to do so) were involved in relevant decisions which needed to be made.

Staff were supported with training, learning and development opportunities. Staff told us that they were fully supported by the registered provider and had developed the correct skills and competencies to provide the level of support that was expected. Staff received regular supervisions and annual appraisals were also taking place.

The day- to- day support needs of people who received support was effectively managed. Appropriate referrals were taking place to external healthcare professionals (when needed) and the relevant guidance and advice which was provided was routinely followed. Support was provided by a range of different healthcare professionals such as GPs, dieticians, speech and language therapists (SALT), district nurses and physiotherapists.

People were supported with their nutrition and hydration support needs. People were supported with a ‘choice’ of food and drink but also encouraged to have healthy, balanced diets. Where needed, staff ensured they followed the relevant guidance that was provided by SALT and dietetics departments.

People received dignified and respectful care. We received positive feedback about the level of care that was provided and how staff always ensured that care was delivered to a high standard. Staff explained the different levels of tailored care that people received and relatives also told us that the care was ‘excellent.’

Confidential information was protected and securely stored in line with General Data Protection Regulation (GDPR). People’s sensitive and private information was stored at the registered address and was not unnecessarily shared with others.

People and relatives received a guide around what to expect from the service from the outset. This contained essential information about the expected level of care and support people would receive.

Care plans were person-centred and provided detailed information in relation to a person’s wishes, choices and preferences. We received positive information about the level of responsive care people received. Staff were familiar with the likes, dislikes, preference and wishes of each people they supported and explained that they were able to develop positive relationships.

People were supported to actively participate in hobbies and activities they were interested in. Staff supported people to access to the local community as well as other activities that kept them stimulated, motivated and occupied.

The registered provider had a complaints policy in place. People and relatives knew how to make a complaint and told us that they would feel confident making a complaint if they needed to.

The registered provider had a range of different policies and procedures in place. Policies we reviewed included safeguarding, equality and diversity, whistleblowing, supervision, serious incidents, infection prevention and medication administration policies. Policies and procedures were all up-to-date and were available to staff as and when they needed to access them.

The registered manager was aware of their regulatory responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures. The necessary notifications were submitted to CQC in timely manner.