The inspection took place on 19 and 27 April 2018 and was announced.

Independent Living Solutions provides specialist care and support packages to people living in their own homes. They work with people who have an identified need such as spinal cord injury, brain injury or cerebral palsy. They provide a case management and rehabilitation service to children and adults.

Not everyone using Independent Living Solutions receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.

People and their relatives told us the staff were caring, there were good support teams in place and people were treated with respect and dignity.

People were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received appropriate training and were able to recognise any safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

Where risks to people had been identified, risk assessments were in place and guidance for staff on how to minimise those risks.

Consent to assist people was gained prior to any action or activity undertaken. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and were able to apply this in their work with people.

Deprivation of Liberty Safeguards (DoLS) applications (court orders) had been made to the Supervisory Body appropriately, however not all documents were in place regarding health and welfare decisions for people who lacked capacity to make these decisions. We have made a recommendation about best practice regarding the Mental Capacity Act.

Care plans detailed people’s preferences, choices and independent abilities. Care plans were person centred and people and their relatives had been actively involved in developing their support plans.

Staff spoke positively about the support they received from the management team (team leaders, case managers and the registered manager). All staff received regular one to one supervision with their case manager.

Relatives, professionals and staff told us the service was responsive and well managed. The service sought people’s, their relatives and staff views and opinions and acted upon them.

Independent Living Solutions provides specialist care support packages to people living in their own home. They work with people who have an identified need such as, spinal cord injury, brain injury or cerebral palsy. They provide a case management and rehabilitation service to children and adults. At the previous inspection conducted in 2013 all standards inspected were met.

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 questionnaire feedback received from staff and community professionals employed/used by the agency indicated that people were not always safe from abuse. However, people responding to questionnaires told us they were safe when staff were present. The person we visited responded in a positive manner to the staff on duty. The members of staff we asked knew that where there was alleged abuse the expectations was to report abuse to the lead safeguarding agencies.

The registered manager said staff attended training relevant to their role, staff told us the quality of the training provided needed improving. Safeguarding of vulnerable adults from abuse training was set as mandatory training by the provider for all staff to attend. The email dated 4 January 2017 updated professional mentors that annual webinar safeguarding training instead of three yearly training was to be completed by case managers. New staff had an induction when they started work for the agency. New staff were provided with material that followed the care certificate course for example, booklets and all areas were covered over one day. The registered manager said case managers “went through” the training material with new staff.

The registered manager said mental capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications were made by other professionals such as court of protection officers. However, the supervisory body was not contacted by the registered manager to inform them that the care regime deprived the person of their liberty. For example, where bed sides were used.

While quality assurance systems were in place and clinical audits strategies were identified as an area for improving, action plans were not in place on how the delivery of care was to be assessed and on how it was to improve. Staff and community professionals employed/used by the agency told us through questionnaires that the quality of training needed improving.

Care management plans were in place and were detailed for some people. Care plans included the aspects of care the person was able to manage for themselves. The care plans that we saw in one person’s home was not updated when they moved house including when there was a change of staff. For another person the care plan was not fully person centred. The documented language seen in contact notes used by a member of staff about one person lacked insight into their cognitive impairment.

The company employed provide the funds to provide personal care will determine the staffing levels needed for the care package. Members of staff we spoke with said the staffing levels were appropriate to meet the needs of the person they delivered personal care for.

Medicine systems were safe. Medicine Administration Records (MAR) were used to record the medicines administered. Medicines were stored safely and systems were in place to monitor medicine management.

People and relatives said the staff were caring and kind. The staff we spoke with told us the manner in which the person was enabled to make decisions. We observed members of staff interact well with the person. These staff knew the person’s preferences and sat at the person’s level when they interacted. Community professiona

In order to understand people’s experiences of care, we spoke with 14 people who used the service. We sent 61 questionnaires to people. Each person was sent an additional questionnaire to give to a relative, friend or advocate for completing, if they wanted to. A total of eleven questionnaires were returned to us. Seven questionnaires were from people who used the service and four were from relatives, friends or advocates.

People said they were happy with the service they received. They were fully involved in the assessment process and the delivery of their support. People were treated with dignity and respect and felt safe with the support they received. Detailed, comprehensive, person centred assessments and support plans were in place.

People and their relatives were fully involved in the process of recruiting new staff. This procedure was robust and specifically designed to meet the needs of each individual person. Records demonstrated the recruitment processes were clear, ordered and well maintained.

People and their relatives were encouraged to give their views about the service. They knew how to raise a concern or a formal complaint. People felt they would be listened to and their concerns would be properly addressed. The agency’s complaint procedure was clear, well written and easy to follow. A record of concerns, complaints and compliments was maintained.

As part of this inspection, shortly after our visit we contacted two relatives and two members of staff.

We spoke with one family who were receiving a support package through Independent Living Solutions (ILS). They told us that the company had been “excellent in involving the family and explained the various care options available to them. The staff ensure that I am in total control of my child’s care and support, and I have plenty of opportunities to express my views regarding the care or treatment received.”

Another person said “we have been involved in the recruitment process for new staff. From writing a job description tailored to our families needs, to being part of the second interview within our home. New staff have been introduced gradually and have worked alongside experienced staff until we have felt confident that the new staff know us, which I value. The staff are well trained and are more than aware of the importance of privacy and dignity, they are polite and respectful.”

Everyone we spoke with was confident that if they had any concerns, they would speak to any of the staff and it would be dealt with promptly and effectively.

We were not able to talk directly with people who used services, but spoke with relatives. We spoke with one family who were receiving a support package through Independent Living Solutions. They told us that the company had been excellent in involving the family and explaining the various care options available to them. Another family told us that any written and verbal information given to them was clear and set out in a way they could understand.

The operations manager explained some of the care packages which the company provided. For example, for families with children, this could mean respite care in a hospice or with a local family. Another example, could be the provision of several nursing teams, day and night which provided around the clock care for children with complex needs.

The family of a person using the service told us, “our care manager is so dedicated to our relative, they trust them and so do the family”. Another family said, “we definitely feel safe with our carers, they are really lovely and we are so lucky”.

Families told us that if they had any concerns about the safety of their child they would talk to their case manager. The case manager confirmed that they would always advocate on behalf of their client.