Westminster Homecare Limited (Independent Living Network)

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.

'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people, and providers must have regard to it.

Not everyone who used the service received personal care. 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 experience of using this service and what we found

Based on our review of is the service safe, effective, caring, responsive and well-led questions, the service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care and right culture.

Some risks to people had not been documented and some quality assurance processes were not as effective as they could have been. This meant there was a risk of missing opportunities to make improvements and prevent any incidents reoccurring. No person had been harmed but this put people at risk of harm.

The regional director and deputy manager addressed these matters promptly, but until we highlighted these, actions had not been taken. Staff however were clear on how to safely support people with eating and drinking safely, and how time specific medicines had been correctly administered.

Right support

Staff complied with measures designed to reduce the risk of infections spreading, and focused on people's strengths and promoted what they could do, enabling the opportunity for people to lead fulfilling and meaningful lives. A person told us how careful staff were to always use the correct personal protective equipment (PPE), washing their hands and safely disposing of PPE.

Staff supported people with equipment to keep them safe by using an appropriate number of suitably skilled staff. A staff member said, "I see [person] being able to live at home with reasonable adjustments and the right equipment. It means a lot to them having more independence."

Staff received effective training in the use of restraint and were confident in their ability to deploy this training should it ever be needed. At the time of our inspection, where people needed restraint, such as with medicines, this was appropriately authorised, and only used in an emergency situation, as a last resort, and for the shortest time possible.

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.

Right Care

Staff focused on and promoted people's equality and diversity, supporting, and responding well to their individual needs. This changed people's lives for the better. A person said, “I feel safe when out [in the community], as staff are very good to me. I take all my [medicines] morning and night and staff watch me to make sure I haven't dropped any.” A relative told us how much more their family member could now do and how well staff understood their communications in ensuring the person was given equal opportunities.

People or their legal representative helped create and review their care plans when they chose to, and as such were a reflection of the support they needed and what people could do independently. Staff had training on how to recognise and report abuse and had the skills to help protect people from poor care and abuse, or the risk of this happening.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. All those we spoke with felt people were safe and had enough support to do this. People were supported to communicate in their preferred way including a few words and visual prompts.

People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. A relative told us the service always strove to improve the quality of people's lives and said, “[Staff] have transformed my [family member’s] life. Now they live in their own home. This has given them the confidence to keep growing with independence.”

Right Culture

People were supported by staff who understood best practice in relation to people's strengths, impairments, or sensitivities for people with a learning disability and/or autistic people may have. A relative told us the service had made a huge difference to their family member saying that although their family member needed a lot of support around their needs, staff were quick to make healthcare referrals for support when needed, meaning the person was eating more healthily.

Staff put people's wishes, needs and rights at the heart of everything they did. People, relatives, staff, and health professionals had a say in how the service was run. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Westminster Homecare Limited (Independent Living Network)

We have found evidence that the provider needs to make some improvements. Please see the safe and well-led section of this full report. The overall rating for the service has changed to requires improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This announced comprehensive inspection was undertaken by one inspector and an expert by experience and took place on 26 and 27 September 2017. At the previous inspection on 25 and 26 November 2015 the service was rated as ‘Good’. At this inspection we found the service remained 'Good'.

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.

Staff had retained the knowledge and skills from their safeguarding training to be able to protect people's rights whilst keeping them as safe from harm as possible. Staff knew the correct procedures to follow should they need to report and concerns they may have had about people's safety such as with medicines' administration.

Accidents and incidents such as those for people whose behaviours could challenge others and medicines administration were acted upon. A robust recruitment and staff selection process ensured that only staff who had been deemed suitable to work with people using the service were employed.

People were supported with the safe management and administration of their prescribed medicines by staff who had been deemed competent to do this.

Systems and processes remained in place to manage risks to people's safety and wellbeing. These were being followed to help ensure that any risk to people such as in their home, out in the community or using transport was managed as far as practicable.

A sufficient number of competent and skilled staff were able to meet people’s assessed needs. This helped ensure that people were given the help and support when they needed it and that this assistance was effective.

Staff continued to have received appropriate induction, training, support and development to carry out their role in a way which people benefited from.

People were enabled to access health care services and appointments by staff who made a difference to the quality of people's health. People were supported to eat and drink in a way which assisted with their nutritional needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care and support was provided with consideration, kindness, sensitivity and compassion by staff who respected people's right to privacy.

People were given and provided with various means and opportunities to comment on the quality of their care. People's suggestions and views were acted on promptly and this helped improve the quality of life that people lived.

People's interests, hobbies and pastimes were encouraged by skilled staff in an individual way such as enabling people to achieve ambitions that were previously not thought possible. As a result of staff interventions and respect for people’s independence, people led a more meaningful life.

The registered manager had created an inclusive atmosphere within the service and this had fostered an open and honest staff team culture. Staff were confident to report any care that was not up to the provider's standards.

Effective quality assurance systems and spot check/audit procedures were in place to drive improvements. Timely actions were then taken to improve the quality and standard of service that was provided.

Further information is in the detailed findings below.