Hackney Shared Lives Scheme

Hackney Shared Lives Scheme is a service that recruits, trains and supports shared lives carers to provide care and support to children between 13 to 18 years, adults with a learning disability or autistic spectrum disorder, a mental health condition, people who misuse drugs and alcohol, and with an eating disorder. People using the service live with the shared lives carers in their homes.

At the time of the inspection, 19 people were receiving support by 15 shared lives carers.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence, inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe living with shared lives carers.

People’s needs were safely met by shared lives carers who knew how to safeguard them from the risk of harm, abuse and neglect.

People received effective, timely and consistent care that enabled them to live healthier lives.

People were involved in planning their care and their care plans were comprehensive and regularly

reviewed.

People and shared lives carers were encouraged to raise concerns and make complaints.

People were supported by sufficient and suitable staff and shared lives carers who received relevant and regular training, and supervision to provide effective care.

Staff and shared lives carers were knowledgeable about how to provide care without discrimination and told us they treated people like individuals and met their individualised needs.

People told us shared lives carers treated them with dignity and respected their privacy and encouraged their independence.

The provider had a stable team and management to provide continuous support to shared lives carers.

The provider had effective systems in place to ensure people's safety and quality of care.

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

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 5 June 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

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

Hackney Shared Lives Scheme is a local authority operated service that supports adults with a learning disability or mental health needs. People using this service receive care and support by individuals, couples and families who have been approved and trained for that role, and are called shared lives carer. People using the service live with the shared lives carers in their homes. At the time of our inspection Hackney Shared Lives Scheme supported 19 people with a learning disability or mental health needs who were settled in long-term placements. A total of 15 shared lives carers had been appointed and some carers had been approved to care for more than one person.

The service did not have a registered manager. The manager had applied to become the registered manager of the service. 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.

Shared lives carers were suitably vetted before they were matched with people. There were appropriate criminal checks in place for the main shared lives carers but the provider was not able to provide copies of support carers’ criminal checks as per their policy. Not all shared lives carers had carried out yearly safeguarding training. However, most shared lives carers knew the provider’s safeguarding reporting procedures. We have made a recommendation about staff training for safeguarding. The provider had not ensured that all shared lives carers completed six core trainings per year as per their policy. Shared lives carers did not receive regular supervision and felt they were not well supported.

People’s care plans were not always comprehensive and were not always reviewed and updated yearly. Shared lives carers and people were not always provided with the updated care plans. The provider did not have processes in place to enable staff to discuss and record people’s end of life care wishes. We have made a recommendation in relation to end of life care planning.

There was lack of oversight of the service due to a shortage of office staff. The provider did not maintain contemporaneous records of people’s care, staff personnel, training, and management of the service. The provider did not always review people and shared lives carers’ views and feedback to continually improve the service.

People using the service had been living with their shared lives carers for a number of years and felt safe with them. The provider had identified, assessed and mitigated risks associated to people’s health, care and mobility needs. People received appropriate support with their medicines management needs. Shared lives carers maintained medicines administration charts when they administered or prompted medicines. There were appropriate health and safety checks in place to ensure people lived in a safe environment.

People’s individual needs were assessed at the time of referral and told us their care, nutrition and hydration needs were met. Shared lives carers were aware of people’s dietary needs and encouraged people to maintain a balanced diet. People were supported by their shared lives carers where requested to access ongoing healthcare services. People told us they were given choices and supported in making decisions. Their care plans made reference to their capacity. Shared lives carers understood their responsibilities in acting in people’s best interests in line with legislation.

People told us they liked their living arrangements and found shared lives carers helpful and caring. Shared lives carers knew people’s cultural and religious needs and supported them where requested. People were supported to remain independent and told us their shared lives carers respected their privacy. People told us their shared lives carers knew their likes and dislikes. Shared lives carers and people knew how to raise concerns.

The management had introduced a forum to improve the communication and conducted regular staff meetings to keep staff informed on changes. The provider had recruitment plans in place for permanent staff and to increase the capacity in the office.

We found two breaches of the regulations in relation to staffing and notifications.

You can see what action we told the provider to take at the back of the full version of the report.

Hackney Adult Placement Scheme is a Shared Lives service, formerly known as Adult Placements. This means adults who may have learning disabilities or mental health needs receive care and support provided by individuals, couples and families who have been approved and trained for that role. The service is run and managed by the London Borough of Hackney. At the time of our inspection, there were approximately 32 adults using the service, supported by 22 shared lives carers.

A new manager had recently started at the service and they were in the process of applying to become the registered manager of the service. 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 using the service told us they liked their living arrangements and they were happy. They were able to lead independent lives with the appropriate level of support and encouragement from their shared lives carers. They were involved in making decisions related to their care, including having a choice about the placement and giving their opinions about the type of placement they would like.

Shared lives carers told us they enjoyed their roles and they were able to forge lasting and meaningful relationships with people. Many had been shared lives cares for a number of years and were aware of the expectations of the role and how to support people in an appropriate manner.

People received support in relation to their food, general health and medicines. This was at a level suitable for their needs, some people were more independent than others but the level of support required was identified during the assessment process and subsequent reviews.

Shared lives carers were recruited in a safe manner, the provider followed guidance from shared lives plus in this regard. Shared lives carers were not always supported to update their training. We found significant gaps in the training records that we saw. Formal supervisions did not always take place either.

A thorough assessment process was in place which included identifying people’s needs, finding a suitable shared lives carer and carrying out risk assessments. People using the service and shared lives carers were given an opportunity to meet and spend time together before coming to an agreement. The wishes of both people using the service and shared lives carers were considered during this process.

Support plans were easy to read and contained person centred information which allowed people to be supported in a manner of their choosing.

Shared lives carers told us there was not much communication from the provider apart from one shared lives coordinator. Vacancies at management level meant that some aspects of service provision such as training and placement reviews had not been fully completed. The provider did not submit statutory notifications to the CQC in a timely manner.

We found two breaches of the regulations in relation to staffing and notifications. You can see what action we have told the provider to take at the back of the full version of this report.

Hackney Adult Placement Scheme is a Shared Lives service, formerly known as Adult Placements. This means adults who may have learning disabilities or mental health issues receive care and support provided by individuals, couples and families who have been approved and trained for that role. The service is run and managed by the London Borough of Hackney. At the time of our inspection, there were approximately 35 adults that had been placed with shared lives carers.

There was a registered manager at the service; however she was not managing the service at the time of our inspection. A care co-ordinator was currently managing the scheme. 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 using the service told us that the shared lives carers were kind and they liked living with them. They told us they supported them with their medicines, their food and their daily activities if needed. Carers completed medicine records when they administered medicines and told us they helped people to attend health appointments if needed.

Shared lives carers demonstrated empathy towards people that lived with them. They spoke about people as if they were their own family members and told us they did not discriminate against them and included them fully in their family life.

People told us they felt safe and there were procedures in place to help ensure this. Shared lives carers documented financial transactions and receipts were retained and checked by care coordinators. Carers were familiar with safeguarding procedures and the provider took appropriate steps when safeguarding concerns had been raised.

Thorough assessments took place before people came to live with a shared lives carer, these included identifying peoples’ support needs, risk assessments in relation to both people and also the living environment. Thereafter, placement monitoring reviews took place on a yearly basis which helped to ensure that the placement was appropriate and any identified risks were being managed.

Although robust recruitment procedures were in place which helped to ensure that people were placed with vetted carers, ongoing checks on carers were not always in line with the providers own policy. Shared lives carers told us they were happy with the amount of training and support they received.

Carers were aware of the importance of asking people for their consent to care. Support needs assessments and support plans were signed by people using the service, indicating their agreement to them.

Care records were person centred and documented the wishes of people using the service.

Although carers told us they felt well supported, we found that changes in the way the service was managed had meant that some audits to monitor the quality of service were not always taking place as frequently as before.

We also spoke with five Shared Lives carers. They told us they felt were supported by the provider. Each carer was aware of the needs of people who used the service. One carer told us, "everything is going very well. So far so good." Another carer commented, "I feel I can speak freely." "Hackney Adult Placement Scheme are great."

At the time of our inspection there were 26 approved Shared Lives carers and the service was provided to 27 people.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available and people who used the service were aware of how to complain.

People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.