Background to this inspection
Updated
31 August 2019
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
The inspection was carried out by one inspector.
Service and service type
This service provides care and support to people living in 11 supported living settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (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 CQC. 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.
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure the provider or registered manager would be in the office to support the inspection and we wanted to be sure there would be people at home to speak with us.
Inspection activity started on 30 July 2019 and ended on 31 July 2019. We visited the office location on 30 July 2019.
What we did before the inspection
Before the inspection, we looked at the information we held about the service. This information included statutory notifications the provider had sent to CQC. A notification is information about important events which the service is required to send us by law.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We also contacted local authority commissioners and asked them for their views about the service. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
During the inspection, we visited the registered office and spoke with the registered manager, the regional manager and two members of the senior management team. We also spoke with one person using the service, a team leader and a support worker who visited the office.
We visited six people in the supported living scheme and spoke with two service managers and three support workers during the visit. We also spoke with four people who used the service and with three relatives on the telephone about their experience of the service.
We looked at the support plans and associated records for five people who used the service. We looked at a range of records relating to how the service was managed; these included staff training, five medication records, induction and supervision records, quality assurance systems and policies and procedures. We also looked at the responses from the recent customer satisfaction survey and watched three brief videos involving the people using the service and staff.
Updated
31 August 2019
About the service
Affinity Supporting People Limited is a domiciliary care agency. It provides personal care to people living in their own homes and provides care and support to people living in 11 ‘supported living’ settings, so that they can live as independently as possible.
The service provides support to adults living with mental health needs, a learning disability or an autistic spectrum disorder.
At the time of the inspection, Affinity Supporting People Limited was providing a service to 98 people. Not everyone who used the service received personal care. The Care Quality Commission (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. 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 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.
The Secretary of State has asked CQC to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
People were provided with an excellent person-centred service which was very responsive to their needs, wishes and preferences. The overarching value of the service was, “Your Life, your way”. Throughout the inspection, we saw numerous ways of how this value was implemented and embedded into the ethos of the service to provide excellent outcomes for people.
Management and staff had an extremely positive impact on people's lives and went above and beyond to understand and respond to people's needs and preferences. They supported people's ability to express themselves and included their wishes and aspirations in support planning and activities. The service had taken a key role in the local community. Staff were actively involved in making contact with community resources and support networks to ensure people had access to a broad range of meaningful activities which improved their quality of life, developed their self-confidence and their self-esteem.
We saw excellent examples of where partnership working had improved people’s independence, safety and wellbeing, and met their needs and aspirations. 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. Detailed risk assessments followed best practice guidance and included positive risk taking to optimise people's opportunities to engage in activities.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
People continued to be safe and protected from the risk of abuse and avoidable harm. Staff were observed to be kind and caring. People were supported respectfully in ways that upheld their dignity. Excellent communication strategies ensured people had been supported to express their views.
The service was well led by a committed and skilled management team who led by example. They used effective checks and audits of care to provide high-quality, person-centred care. There was an ongoing plan of development for the service. The staff team were well trained and supported, and communication was good.
The provider followed their recruitment procedure which ensured all staff were safely employed. Induction training was thorough and the training for staff was kept up to date which meant they could provide effective care.
People's needs had been thoroughly assessed and their support plans included input from families and community-based professionals. People's health needs were identified, and they were supported to maintain regular appointments and screening. People were supported to eat and drink. Specialists were involved when required for people who were nutritionally at risk.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 15 November 2016).
Why we inspected
This was a planned inspection based on the previous rating.
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.