L'Arche Manchester - St Paul's Office

The last inspection of this service was in September 2016 where the provider was rated good in all areas. At this inspection we found the evidence continued to support the rating of good and the provider had improved to become outstanding in Caring and Responsive.

L'Arche provides personal care and support to people living in their own property under a tenancy agreement. People being supported are known as core members and staff are known as assistants and some assistants live in the properties. L'Arche aims to provide a holistic service where core members and assistants are seen as a community. L’Arche the organisation originated in France in1964 and supports people with learning disabilities all over the world and has 14 other communities within the UK. The service was supporting nine core members at the time of inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Core members and their families told us they felt safe while being supported by the service. Staff had received training in safeguarding vulnerable adults and could describe in detail, actions they would take if they had any concerns. Family members felt they could raise any concerns they had.

Staff were recruited safely. Robust pre-employment checks were in place to ensure the suitability of staff. Core members and their families were involved in the recruitment of staff and staff were matched to core members needs and preferences.

Medicines were managed safely, and staff received training and competency checks to assure the provider of their skills of administer medicines safely.

The provider ensured core members were supported safely in their property and had oversight of the safety checks in place in relation to fire, gas and electrical safety and water temperatures.

Core members had any risks they presented assessed and reviewed. Detailed strategies were in place to support staff and core members to reduce levels of distress. Families were involved in the risk assessment process and felt they had been supported to identify their own strategies to support their relative.

Staff members received a thorough induction to their job role. Their learning was checked in the form of tests at the end of the induction. Regular training was given to support staff in their role and further training was given specifically around the core members supported.

Regular supervision and appraisal took place. Core members were supported to be actively involved in the supervision process and fed back their comments via writing, pictures or drawings. Staff were supported to take breaks away from the service to rest and reflect.

Core members received a thorough assessment of their needs. Core members and their families were supported to access the service at their own pace. Family members told us the transition to the service was well managed with lots of open communication and planning to manage expectations and routines.

Support to manage health needs were clearly fed into care plans. From the onset of the service providing support, clear strategies were in place for how core members were supported to appointments and how involved the family wanted to be. Core members had health action plans in place, which clearly recorded outcomes of appointments and what needed to be done to keep core members healthy.

The provider worked in line with the Mental Capacity Act (MCA) 2005. Information from MCA referrals and authorisations could be found in care plans. Staff had received training in MCA and could describe what action was required to support core members to make decisions.

Core members were supported to eat and drink. Meals were a big part of the day for the service and everyone was included. Core members had choice and control over what they ate and were supported with specific diets as required. The service’s community kitchen had become a meeting point for core members, families and the community and people visited to eat together and talk to others.

The provider worked with landlords to ensure properties were suitable for core members with learning and physical disabilities to live in.

We observed exceptional kind and caring interactions between core members and the staff team. Core members were at ease with every staff member and staff looked for signs and facial expressions for how core members were feeling. Families told us the service was so valuable to them and praised every part of the service.

Staff members were aware of how hard it was for families to trust others to care for their relatives. Staff and family members told us that excellent relationships had been built to maintain open lines of communication and remain involved in their relative’s care.

Staff were able to explain how they managed signs of distress in core members and we observed them implementing such strategies to support calm core members.

Core members communicated in a variety of ways and staff were aware of this and used signs, verbal communication, pictures, symbols, facial expressions and gestures to respond. Staff could clearly describe what it meant if a core member behaved in a particular way and how they could help.

The family unit and friendships were at the heart of L'Arche life and staff were not just there to support core members but to nurture and promote confidence. Family members told us, they would be lost without L'Arche and they had impacted significantly on their relatives lives and themselves.

Core members were supported to represent themselves and others at national speaking groups. This was to ensure the voice of people with learning disabilities was heard.

Person centred care was embedded throughout the service and captured in care plans. Care plans heavily involved the core member, their families and professionals. They were easy to read, contained pictorial images and were regularly reviewed. Positive behaviour support fed into care plans and gave clear strategies to promote positive behaviour.

Person centred activities were encouraged and promoted. Core members were supported to attend a range of activities which included exercise and the opportunity to engage in activities in the local community. Where core members could not fully engage, staff members supported them to undertake an activity. Core members and their families were very complimentary of the support provided to undertake activities and short breaks away from the service. Spiritual wellness was at the heart of all activities and staff encourage people to actively participate and have choice and control over what they did.

Core members and their families could be supported at the end of their life. The service had links with primary care support and GP services. An easy read booklet had been developed to help core members understand what happens at the end of life and the service remembered people who has passed away by talking to core members and sharing positive stories.

Core members and their families felt they could raise any concerns they had and were aware of how to raise concerns. Staff members told us families were not afraid of asking questions and said that open lines of communication had enabled them to have good relationships with core members and their families.

Staff felt well supported by the registered manager and enjoyed working for the provider. The registered manager was visible across the service and led by example. The provider employed a dedicated training and human resources co-ordinator to ensure staff were recruited and monitored appropriately and trained to the best of their ability.

Practices to promote leadership and management had begun to be embedded into the service. The staff felt this was a huge positive and looked forward to seeing the service grow.

The provider had developed a national formation programme to encourage staff to think why core members displayed distress behaviours. This involved encouraging staff to think about the way they responded to distressed behaviour and changing the way they speak or respond.

The provider had received many compliments thanking them for their support and care of core members. Feedback was requested from core members and their families at annual reviews and staff were asked for feedback anonymously and findings were used to improve the service.

The registered manager completed a number of audits to monitor and improve the service. Any actions were taken in a timely manner.

L’Arche Manchester is a service which offers support to people living in a shared house under their own tenancy. The support staff live on the premises and the aim of the service is to enable people to live as independently as possible and to reach their full potential.

The service had a registered manager who had been in post since 2013. 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.

People appeared safe with the care and support they received from staff at L’Arche Manchester. Family members felt their relatives were safe and staff knew how to keep people safe and were aware of how and to whom they could report any safeguarding concerns.

Staff sought consent from people before providing care or support. The ability of people to make decisions was always assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were always taken in the best interests of people when necessary.

Risk assessments were personalised and kept up to date. Care plans were written with the person and/or their families. They had been supported to be involved in identifying their support needs and the care plans were in a picture format to ensure people understood what they were about.

People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the needs of the people and had received appropriate training in order for them to meet people’s needs. The recruitment process was robust and all required checks were in place prior to staff commencing work. People who were supported by L’Arche Manchester were involved in the recruitment process which showed the service was taking their view into consideration.

Medicines were administered, stored and disposed of safely and in line with the required legal requirements and guidelines. There were appropriate guidance and protocols for staff when people needed ‘as required’ medicine. Information about the medicines was available in picture format in order to explain to people what they were for. All staff had undertaken training in order to administer medicines safely and they had all been competency assessed. One staff member had undertaken train the trainer training in order to complete the competency checks on staff.

Staff were observed as being kind and caring, and treated people with dignity and respect. There was an open, trusting relationship between the people and staff. Staff knew people well and this showed in the way they interacted with each other. People were supported with writing their end of life care plans and the service had supported people to understand the death of one of their housemates.

We saw people were supported to attend activities both in the community and within their own home. People had the choice about whether they joined in or not and were fully supported by staff.

We saw people and their relatives had been asked for feedback about the service they received. There was a record of what actions had been taken to address any identified concerns. Staff worked well as a team; we saw them communicating with each other in a respectful and calm manner. There was an open and transparent culture which was promoted amongst the staff team.

Everyone knew who the registered manager was and felt the service was well-led. All staff said they felt supported and felt they could raise any concerns with the registered manager and they would be acted upon.

We viewed the policies and procedures and saw they were being followed. Quality assurance checks were being completed and when incidents had occurred action had been taken to try to prevent a re-occurrence.

The home was two houses converted into one and each resident or 'core member' as they were referred to by L'Arche had their own tenancy agreement. Some care staff also lived in the home under a separate tenancy license agreement. Live in staff provided the core members with 24/7 care and support.

At the time of our visit there were two core members who lived in the home although one was on holiday with family. The remaining core member was unwilling to engage in any form of communication with us.

We spoke with the parent of a core member who told us: 'It's excellent'. And: '[Name] is really happy there'.

We observed the interaction between the core member and staff and saw that this person was always asked and consent obtained prior to any care or assistance being provided.

We also visited the main office for L'Arche Manchester to view records and speak to staff who lived in this building and who provided additional support to the core members.

We saw that care plans were person centred and contained a range of risk assessments and information. All of which was repeated in easy read format.

We found that staff had received training in the safeguarding of vulnerable adults and that L'Arche had systems in place to monitor the quality of the service provided.