Affinity Trust - Domiciliary Care Agency - Midlands, is a domiciliary care agency. It provides personal care to people living in their own houses or flats. This service also provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. 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.

This inspection started on 8 January 2019 and ended on 10 January 2019. At the time of the inspection the service supported 111 people using the service.

At our last inspection of 1 June 2016, we rated the service as ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People felt safe and were supported by staff who understood how to protect people from abuse. Risks related to people’s care and support needs had been continuously assessed, monitored and their support reviewed to keep maintain their safety.

People were supported with their medicines in a safe way. People were supported with their health care needs when required. People were supported with their dietary needs. Staff worked with other professionals to meet people’s care and health needs.

Staff had been recruited appropriately and had received the essential training and support for their role to provide effective care. There were sufficient numbers of staff available who worked flexibly to support people.

People continued to be involved and made decisions about all aspects of their care. People were encouraged to take positive risks. They 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 were involved in the development and review of their support plans. These were produced in formats so that people could easily understand their care. Support plans were personalised and took account of their individual preferences, choice of lifestyle and cultural needs. Staff had clear information and guidance to support people in meeting their needs.

People were cared for by staff who were kind and caring. Staff respected people's privacy and dignity. People were involved in the review of their support plan. People’s independence was promoted by staff. People pursued their interests and hobbies and maintained relationships with family and friends.

The service had a registered manager. There was an open and transparent approach by the registered manager and the management team. People using the service and staff confirmed the management team were supportive. Concerns were acted upon promptly and any lessons learned were shared with the staff team to improve the quality of care provided.

Quality assurance processes were in place to monitor the quality of care delivered. People using the service, their relatives, health and social care professionals and staff had opportunities to give feedback and influence the development of the service.

This inspection took place on 11 April 2016 and was announced. We returned on 12 and 13 April 2016 to complete the inspection.

Affinity Trust – Domiciliary Care Agency – Midlands is a domiciliary care service providing care and support to people living in their own homes. The office is based in Beaumont Leys, Leicester and supports people is their homes across locations in Leicester, Leicestershire, Staffordshire and Sandwell. At the time of this inspection there were 88 people using the service who resided within their own home. People’s packages of care varied dependent upon their needs. In some instances people were supported over a period of 24 hours.

The service has two registered manager in post. 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.

The inspection was facilitated by the registered managers and the supported living managers at the six locations we visited.

People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff were trained and understood their responsibility in protecting people from the risk of harm.

Risks were assessed and took account of people’s communication needs. Support plans developed involved the people and where appropriate their relatives and health care professionals to ensure staff had clear information to help keep people safe.

Staff were recruited in accordance with the provider’s recruitment procedures. The provider took account of the needs of people they supported to ensure there were sufficient numbers of staff to promote their safety and wellbeing.

People were supported by knowledgeable staff that had a good understanding of people’s needs. Staff received ongoing support and training to provide person centred care to keep people safe and provide support if their behaviours became challenging. People were supported by staff to take positive risks to promote their independence, rights and choice of lifestyle.

Staff were further supported through regular supervision and an annual appraisal to ensure they had the knowledge and skills to support people. Staff group supervisions were used to share information as to good practice and used as a learning opportunity to develop staff.

People were supported by trained staff to take their medicines. People’s capacity to make informed decisions about their medicines had been assessed and where appropriate best interest decisions had been made. This helped to ensure people’s health needs were met when they were unable to make an informed decision.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles. This included staff seeking consent from people before supporting them. The registered manager sought advice and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

People’s support plans had clear guidance and information for staff to ensure they provided personalised and tailored care and support that promoted people’s wellbeing and independence. Regular reviews of people’s needs and support plans ensured care provided was effective and appropriate when people’s needs changed.

People were supported by staff with their nutritional needs and health. Support plans reflected the support people needed to maintain a healthy diet and manage food tolerances, which included meal planning, grocery shopping and preparing meals.

Records showed staff supported people with their health needs and where required liaised with health care professionals to ensure they had access to appropriate medical care.

People found staff were caring

We attended the services’ main office to look at records and we talked to the management staff. We visited a site where Affinity Trust were providing care and support to a group of people living in rented accommodation and we telephoned the relatives of three people who were using the service to gather their views of the service being provided.

People told us that they were happy with the service they received. One person told us:”They [the staff] are very good to me, I like them all.”

Relatives spoken with told us how satisfied they were with the service. One person told us: “I cannot tell you how satisfied we are, the care staff couldn’t be more helpful.” Another explained: “We are confident that she has the comfort, care and consideration that she deserves.”

People were supported to be as independent as possible and were enabled to take part in activities that they enjoyed. One person explained: “They have been excellent, he gets out far more now than he used to, to discos and the pub. He goes swimming as well now; he can do what ever he wants.”

We observed the staff going about their work in an unhurried manner and providing care and support at a pace that suited each individual person.

We visited a site where Affinity Trust provides care to a group of people living in rented accommodation. They were having lunch after a busy morning of individual activities including food shopping, a bike ride, and a visit to a café in a local park. A staff member told us, “If they want to go out we take them – it’s their choice what they want to do each day.”

We met one person who showed us their flat which they were proud of. They were given a drink of fruit juice which they declined. They asked for coke instead and the staff member brought it for them. They then sat down to watch a favourite television programme. They appeared at home, calm and relaxed, and in control of their life.

Another person was sitting in a communal area with staff who were helping then choose what they wanted to do that afternoon. Staff communicated well with this person, ensuring they were involved in decision-making. A staff member told us, “Because we have enough staff we can offer individual one-to-one care and activities. The people here are all different and they want to do different things. We facilitate that.”

The people who use the service appeared safe in the care of Affinity Trust staff. Relationships of trust and mutual respect had been built up. Staff were aware of people’s vulnerabilities and how best to protect them. They used their interpersonal skills and knowledge to minimise risk to people in their homes and in the wider community. They gave us examples of situations they needed to avoid or manage to prevent the safety of the people they cared for being compromised.

The people who use the service were involved in recruiting their staff team and took an interest in who was working for them. One person we met kept a large-print copy of the staff rota on the wall so they could see who was on duty each day.

The staff we met were experienced and worked with people in a positive and empowering way, offering them choice where possible. They were warm and caring in their approach and the people who use the service responded positively. The people who use the service liked the staff and enjoyed having a laugh and a joke with them.

We visited the registered office at Beaumont Leys and three of the supported living sites that Affinity Trust Domiciliary Care Agency Midlands provided support to. We spoke with some of the staff employed and with two of the people who received support.

Staff understood people's individual communication needs. They knew what approach to take to assist each person to be involved in making decisions about their daily routines.

The people we spoke with who used the service told us that they were satisfied with the support they received. One said, "It is all ok.” Another told us that they got on well with the staff who supported them. This person said, “They (staff) are kind to me. They take me out, take me shopping. I like it.”

Arrangements for the administration and management of medicines were reliable. Staff participated in medication training and their competency was checked on a regular basis to ensure that they had appropriate skills and knowledge in relation to administering medicines.

Staff had regular one to one meetings with their line managers to discuss any issues relating to their work. They also had an annual performance review. Staff we spoke with felt they received the support they needed to help them carry out their roles.

The provider carried out regular audits to check that the service was operating effectively. People who used the service were asked for their views and comments about the service they received.