This inspection was short notice which meant the provider and staff did not know we were coming until shortly before we visited the service. This inspection took place on the 15 & 29 January 2015. At the last inspection on 11th November 2013 the provider met all of the requirements we looked at.
At the time of our inspection the provider also acted in the role of the registered manager. The service provided care and support to predominantly children and young adults with a range of physical and / or learning disabilities across the London area.
From the telephone discussions we had with the relatives of children using the service we found that they were highly satisfied with the way the service worked with their children and they themselves as parents. They were confident about staff at the agency and felt able to discuss anything they wished to and staff were thought to be knowledgeable and skilled. Relatives felt that there was honesty in the way the service communicated with them. However, we found that the registered person had not provided sufficient support for staff by arranging suitable opportunities for staff supervision and appraisal.
Although overwhelmingly the service cared for children and young people under the age of 18 a small number of young adults were also catered for. The provider had not ensured that policies, procedures and information in relation to the Mental Capacity Act 2005 (MCA) were in place to ensure that people who could not make decisions for themselves were protected. The provider informed us that no one using the service would currently be subject to the MCA. It should be noted that the agency would not have responsibility for making applications under this legislation, but that applications must be made to the Court of Protection. Whether any applications had been made to the Court of Protection and If so, whether the provider was complying with any Court Order.
People who used the service, mostly children and young adults, had a variety of complex support needs and from the nine care plans that we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed, and the action needed to mitigate against risks was recorded. We found that risk assessments were updated regularly.
During our review of care plans we found that these were tailored to people’s unique and individual needs. Communication, methods of providing care and support with the appropriate guidance for each person’s needs were in place and regularly reviewed.
We looked at the training records of 14 support workers. We saw that in all cases, mandatory training had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff appraisals were not happening at least annually, and in some cases it had been two or more years since staff had their performance appraised. We were informed that the service was aware that this was the case and that improvements were necessary, and for staff to have a development plan arising from an appraisal system.
We found that staff respected people’s privacy and dignity and worked in ways that demonstrated this. From the conversations we had with people, and records we looked at, which showed us that people’s preferences had been recorded and that staff worked well to ensure these preferences were respected, whether they be children or adults.
Records which we viewed showed that people were able to complain and felt confident to do so if needed. People could therefore feel confident that any concerns they had would be listened to.
People who used the service and relatives told us that they provided their views about the quality of the service to the registered manager or other staff. However, the service accepted that they were not doing this with staff, other health and social care professionals and stakeholders. We found that the registered person had not taking steps to regularly assess, monitor and improve the quality of the service.
We recommended that the service seeks advice and guidance from a reputable sources about risk assessments, ensure that staff have an increased awareness of the policies, procedures and information in relation to the Mental Capacity Act 2005 (MCA).
There were two breaches of regulations. You can see what action we told the provider to take at the back of the full version of this report.