The focused inspection took place on 16 August 2018 and was unannounced.

Independent Living Alliance is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing in the community. Independent Living Alliance provides care and support to people with learning disabilities, physical disabilities, mental health conditions and acquired brain injury. At the time of the inspection 10 people were using the service.

There was a registered manager in post. 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 and how the service is run.

At the previous comprehensive inspection which took place in November 2016, the registered provider was rated as ‘Good’ in all five key areas (safe, effective, caring, responsive and well-led).

This focused inspection was carried out due to notifications of concern which CQC received in relation to clinical support people received, particularly in relation to nutrition and hydration risk management.

This focused inspection was carried out to ensure people received effective care and the registered provider was meeting all legal requirements. The team inspected the service against two of the five key questions we ask always ask: is the service effective and is it well-led?

No risks or concerns were identified in the remaining 'Key Questions' (safe, caring and responsive) through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these 'Key Questions' were included in calculating the overall rating in this inspection.

During this inspection we looked at the care people received in relation to clinical conditions they required support with. We did this in order to assess whether relevant risks had been appropriately assessed. People's health conditions were clearly recorded and staff followed specific care and treatment plans to support their overall health and well-being.

We reviewed clinical support processes that were in place to manage and mitigate risk. These included nutrition and hydration risk assessments, speech and language therapist (SALT) guidance, eating and drinking screening tools, dysphagia, (swallowing difficulties) eating and drinking training and competency assessments.

The day to day support needs of people receiving support from Independent Living Alliance were being met. Staff effectively liaised with healthcare professionals such as social workers, GP’s, dieticians, district nurses and SALT in order to provide effective high-quality care.

Staff received regular supervision and were supported with training, learning and development opportunities. Staff told us they felt supported and were able to develop the necessary skills and competencies to deliver effective care. Relatives also told us that staff were well equipped and trained to provide the care which was expected of them.

Consent to care was obtained in accordance with the principles of the Mental Capacity Act (MCA) 2005. The principles of the MCA were being followed and it was clear to see that people were involved in the decisions which were made in relation to the care they required.

Quality assurance systems were reviewed during the inspection. Audits, checks and tools were in place to assess, monitor and identify areas of improvement and development. Some of the feedback we received during the inspection and satisfaction surveys we reviewed indicated that further developments were required in the area of quality assurance.

The registered provider had a variety of different policies and procedures in place. These contained relevant and up to date information and were accessible to staff. Staff discuss

We carried out an announced inspection on 8 November 2016.

Independent Living Alliance Liverpool is a registered domiciliary care agency that provides personal care and support to people in their own homes. The organisation provides care to people with learning disabilities, physical disabilities, mental health conditions and acquired brain injury. At the time of the inspection 10 people were using the service. As part of the inspection we were invited to meet with two people living in specialised housing which catered for their health needs.

A registered manager was 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 people that we spoke with had no concerns about the safety of services and spoke positively about how safe they felt.

The provider had delivered an extensive training programme for staff and managers regarding adult safeguarding. The staff that we spoke with confirmed that they had attended the training and were able to explain the different types of abuse and what action they would take if they were concerned that abuse or neglect were taking place.

The care files that we saw showed clear evidence that risk had been assessed and reviewed regularly. Risk was reviewed by staff with the involvement of the person or their relative and maintained a focus on positive risk taking to support independence.

Staff were safely recruited following a process which included individual interviews and shadow shifts. People using the service were invited to be part of the recruitment process up to and including participation in interviews.

Staff were trained in the administration of medicines, but because the services were community-based, they were not always responsible for storage and administration. Some people who used the service were able to self-administer their medication, others required prompting. Self-administration had been risk assessed to ensure that it was safe.

Staff had been recruited and trained to ensure that they had the rights skills and experience to meet people’s needs. Staff were required to complete an induction programme which was aligned to the Care Certificate.

Staff were supported by the organisation through regular supervision and appraisal. We saw evidence of these processes during the inspection. Staff also had access to ‘team and practice development’ days where a range of issues were discussed and actions set to generate improvements.

The service operated in accordance with the principles of the Mental Capacity Act 2005. Staff understood their responsibilities in relation to the act.

People were supported to shop for food and prepare meals in accordance with their support plans. Some people were supported with menu planning to improve their nutrition or manage a health condition.

People’s day to day health needs were met by the services in collaboration with families and healthcare professionals. Staff supported people at healthcare appointments and used information to update support plans.

The houses that we visited had been built with the needs of the tenants in mind. They made good use of assistive technology to maximise people’s independence.

We had limited opportunities to observe staff providing support during the inspection. Where we did observe support we saw that staff demonstrated care, kindness and warmth in their interactions with people. People told us that they very were happy with the care and support provided.

We saw that staff knew the people that they supported well. When we spoke with them they described the person and their needs in detailed, positive terms. Staff told us that they enjoyed providing support to people and were able to explain how they involved people i

During our visit we found that people who used the service and their relatives were positive about the support they had received. Their comments included:

"I can go out when I want."

"My relative is well supported."

"I can make an informed decision."

People who used the service and their relatives told us that they felt able to raise any

concerns with the staff. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us that they had accessed supervision training and line management support to carry out their job roles.

The provider had clear systems in place to monitor the quality of the service provided. Clear processes were in place to ensure the maintenance of appropriate standards of cleanliness and hygiene.

People who used the service and their relatives told us they were happy with the service provided and the standard of support and care they received. Some comments made were:

"You couldn't get nicer than this".

"I feel very lucky to be living here".

"They really look after us".

Summary

We did not announce our inspection prior to our visit. We set out to answer our five questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. We reached our judgements through speaking with people who used the service and their relatives, speaking with staff and the manager of the service and reviewing records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people’s safety were appropriately managed.

Staff told us they felt appropriately trained and supported to meet the needs of the people they supported safely.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People were involved in regular reviews of their support.

Staff spoke about ‘supporting’ people and ‘encouraging’ people to use their independent living skills and to access the local community.

Is the service caring?

Staff told us they were clear about their roles and responsibilities in relation to promoting people’s independence and respecting their privacy and dignity.

Practices were in place to ensure people were involved in decisions about their care and support.

Is the service responsive?

The service worked well with other professionals to make sure people received their care in a joined up way. People were referred to health and social care professionals as appropriate to their needs.

People had detailed support plans which described their needs and how to meet these. Checks were carried out on a regular basis to make sure people received the care and support they needed.

Is the service well-led?

Systems were in place for checking on the quality of the service and making any required improvements. These systems were well developed and effective.

The service was managed in a way that ensured people’s health, safety and welfare were protected.

Staff reported feeling well supported and they had the opportunity to meet with their manager on a regular basis to review their work and discuss their development as workers.