About the service: Independence Homes Domiciliary Care Agency (Independence Homes) provides support for adults with epilepsy and other neurological conditions. Some people may also have physical and learning disabilities or mental health needs. At the time of this inspection, the service was providing support within the regulated activity of personal care to 91 people across nine ‘supported living’ settings. Support ranged from a few hours per day to 24-hour care. CQC does not regulate the premises used for supported living; this inspection only looked at people’s personal care and support.

People’s experience of using this service:

Whilst there were no significant concerns raised about the services provided at eight of the supported living settings, the people living at Woodland Court were not receiving appropriate care and support. Ongoing failure to address the issues at Woodland Court have therefore impacted on the service as a whole.

The lack of skilled and experienced staff deployed at Woodland Court placed people at risk of harm. Staff were unable to meet people’s complex needs and this had a significant impact on people’s physical and emotional well-being.

People and their representatives were angry that their views were not being listened to and their experience was further impacted by the low staff morale. Relationships with other health and social care professionals had broken down as practitioners expressed frustration at the lack of coordination of people’s care.

Despite receiving continuous feedback about the decline of quality at Woodland Court, the provider had failed to have effective oversight and monitoring of the service.

Rating at last inspection: Outstanding (Published September 2017). The rating has therefore dropped since the last inspection.

Why we inspected: This inspection was carried out in response to multiple concerns that we had received regarding the service being provided at Woodland Court. These concerns were raised by a range of stakeholders and indicated significant issues about the way Woodland Court was being staffed and managed.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will be seeking an action plan from the provider and continuing to monitor the service.

Independence Homes Domiciliary Care Agency (Independence Homes) provides support for adults with epilepsy and other neurological conditions. Some people may also have physical and learning disabilities or mental health needs. At the time of this inspection, the service was providing support within the regulated activity of personal care to 57 people across seven locations. A further new supported living complex opened in August 2017, but was not in operation at the time of our inspection. Support ranged from a few hours per day to 24 hour care.

The inspection took place over three days. The service was given 36 hours’ notice of the inspection in order to arrange visits to three locations and make staff available to speak with. This also enabled us to obtain contact lists of family members and advocates to faciliate real-time feedback.

The service had a registered manager. 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.

Independence Homes provided a bespoke service to a high standard. People living with epilepsy benefitted from the provision of services delivered by highly trained staff. Staff had an excellent understanding of people’s needs and how to support them safely and effectively. Staff knew the importance of respecting people’s choices and advocated on their behalf.

Strong leadership across the service fostered a culture of high support and high challenge. The provider was focussed on continual development and evolution in line with industry best practice.

Staff were highly motivated and proud to work for the organisation and were committed to the future of the service and making it the best it could be.

There were good recruitment procedures in place that helped ensure that people received their support from staff of suitable character. Staff enjoyed their work and felt well supported in their roles. They had access to a wide range of training which equipped them to deliver their roles effectively. Staff were proud to work for Independence Homes and felt valued and empowered to deliver high quality care.

Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly. Learning was shared from within and outside the organisation and community contacts were well established. National best practice legislation and local policies were referenced to set and measure standards of care.

The service celebrated its successes as a way of motivating staff, but was never complacent and always striving to continually improve. People were regularly asked to provide feedback on the service. Where people made suggestions or raised issues, they were listened to and resulted in change.

The service had excellent systems in place to ensure that staff worked effectively together as a team to meet people’s holistic needs. The medical team provided a bespoke service that bridged the gap between support staff and the health profession. Medicines were managed safely and where possible, people were supported to become independent in this area.

The service had good systems in place to ensure that people’s needs were properly assessed at the start and kept under ongoing review. Risks to the health, safety and well-being of people were addressed in an enabling and proportionate way to ensure that people were kept safe without being restricted from living their life as they wanted.

People received a personalised service that was planned proactively in partnership with them and which was responsive to their individual needs. People had control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to

Independence Homes Domiciliary Care Agency provides support for adults with epilepsy and people who have both physical and learning disabilities. They provide care to people who live in nine houses and require substantial support from domiciliary care workers. This support ranges from a few hours per day to 24 hour care.

The inspection took place on the 7 October 2015 and was unannounced due to concerns that we had received.

The service had a registered manager. 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 registered manager and provider is the same person for Independence Homes Domiciliary Care Agency. On the day of our inspection we were supported by the Operations Director and two Senior Operations Managers and told by them that the registered manager had little involvement in the day to day running of the service. We were told the registered manager was also the provider and their main involvement was supporting the development of clinical best practice in the care of people with epilepsy.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. However managers at the individual locations did not always report incidents to the local authority or CQC in a timely manner.

The operations team made sure there were enough staff to meet people’s needs. However when the provider employed new staff at the service they had not always followed safe recruitment practices. The Operations Director sent us information to show how this had been rectified.

Assessments were undertaken to identify people’s support needs and care plans were developed outlining how these needs were to be met. We found that people had person centred care plans that were detailed and enabled staff to provide the individual care people needed.

Some people told us they were involved in the care plans and were consulted about their care to ensure wishes and preferences were met. Other people and relatives said they had not been involved in care planning.

Staff worked with both internal and external healthcare professionals to obtain specialist advice about people’s care and treatment for seizures. The internal staff are coordinated by the registered manager who is a neurologist to provide governance in the management of seizures in epilepsy. However we received feedback from some external professionals to say that they were not always provided with information in a timely manner.

The provider had arrangements in place for the safe administration of medicines. We were told by staff that people were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access to health care services when needed.

We could not find evidence that the service considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had not always been assessed. People did not have choice to receive care from a different provider at the accommodation they lived at. DOLs applications had not always been submitted for those people who needed permanent support and to live at the address for their own safety.

People are supported to shop for, cook and prepare food and drink of their choice within their ability.

There were clear lines of accountability. The service had leadership and direction from the operation management team. However people and relatives were not aware of who the registered manager was and they were not visible on a day to day basis within the service settings.

Staff felt fully supported by operations management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered to undertake additional training and development courses to increase their understanding of the needs of people using the service.

Feedback was sought by the operational management via surveys which were sent to people and their relatives. Survey results were positive and any issues identified acted upon.

People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.