LinkAbility is a small domiciliary service which provides support to people living in their own homes or with their families. The level and hours of support vary depending on the needs and wishes of people. Support may include helping people to maintaining their own tenancy, provide assistance with domestic tasks, food preparation, personal care and daily activities. The agency office is located in a business centre on the outskirts of Heywood town centre. There is off road parking opposite the building and disabled access is also available.

We gave the agency 48 hours’ notice of the inspection to ensure a senior member of staff would be available. At the time of the inspection the service was supporting 15 people in four supporting living projects and 13 people who lived in the wider community.

We last inspected LinkAbility in August 2014. We found that improvements were needed with regards to people’s care records to ensure information was accurate and complete. We also identified that events involving people who use the service had not always been reported to CQC as required by legislation. As requested, the provider to send us an action plan telling us how they intended to make the improvements needed. We reviewed these areas during this inspection and found that improvements had been made.

The service has a registered manager. However they were on leave at the time of the inspection. 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.

What people told us demonstrated that opportunities were made available to promote and encourage people to maintain their independence and develop positive relationships with others. People and their relatives told us they were happy with the support provided by staff, which was delivered in a dignified and respectful manner. Staff spoken with demonstrated a clear understanding and gave examples of how privacy and dignity was promoted and maintained.

Information about people was person centred and focused on their individual needs and wishes. Support plans and risk assessments were written in a sensitive manner and provided clear and accurate information to guide staff in the safe delivery of people’s care and support.

People told us they felt safe with the staff that supported them. Staff had completed training in how to safeguard people from abuse and knew the action they should take if they had any concerns.

People were clearly involved in making decisions about their support. Where people lacked the mental capacity to make certain decisions appropriate arrangements had been made to ensure their rights were protected. Staff had received training on the Mental Capacity Act 2005 and were aware of the importance of seeking people’s permission before carrying out tasks.

We found that safe systems were in place with regards to the recruitment of staff, management of medication and health and safety. These helped to protect people’s health and well-being.

Staff received induction, supervision and a programme of training to help ensure they were able to deliver safe and effective care. Staff spoken with confirmed they received regularly training and were equipped to support the needs of people they visited.

People were encouraged to have a balanced and nutritional diet. Where necessary staff provided support so that people’s health care needs were appropriately met.

Systems were in place to monitor and review the quality of service provided. There was a commitment from the management team and staff to continually improve the service so that outcomes for people were positive. Both staff and people who used the service were encouraged to be involved and make comment on the service provided and to id

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive to people’s needs?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, family members and the staff supporting them and looking at records. We also looked at the reports of monitoring visits undertaken by Rochdale Local Authority.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Linkability supports people in the community who live with family or independently in their own home. They also provide a 24 hour supported living service to people who share a house and are tenants renting the property.

We were told by the registered manager that 75 per cent of the staff team had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and that the remaining 25 per cent would receive training as soon as possible. We were told that meetings took place as and when necessary, which together with the training, ensured that any decisions made about the people's care and support were made in the best interests of the person.

Between January 2014 and the time of our inspection July 2014 there had been three incidents which had been reported to the Local Authority. We were satisfied that they had been dealt with satisfactorily and were now closed. However CQC had not been formally notified.This was discussed with the registered manager as it is a requirement that all significant events and incidents are reported to CQC.

Two of the people who used the service told us that they felt safe and were pleased with their support workers. The three family members we spoke with also told us that they had no concerns about the care their relatives received from the support workers and the service.

The service followed a recruitment procedure that included obtaining references from previous employers and making Disclosure and Barring Service (DBS) checks. These procedures ensured that as far as possible only suitable people were employed.

We looked at the systems for managing and administering medication in the home where three people had 24 hour support. We found that the medication was managed and administered safely.

Is the service effective?

The support workers received training in safeguarding adults, moving and handling and National Vocational Qualifications. This ensured that the care was provided by members of staff with up to date skills to support the people who use the service.

The support workers we spoke with told us that they thought there was enough staff to support people who used the service. The also told us that they had regular meetings with managers and were able to discuss their training needs and any concerns they had.

We saw in the house we visited that people had access to relevant aids and adaptations to support their health care needs.

Is the service caring?

We spoke with one person who used the service and contacted another person by email who was assisted by a senior support worker. They told us that they liked the support workers. One person told us; “I like going bowling and visiting café’s and parks”; they also said; “ I like them all (support workers), they are nice to me and treat me well”. Another person told us that they had a choice at meal times and could go to bed and get up when they wanted to. They also told us that they could talk to the registered manager or the senior support worker if they had any problems or were not happy.

We also asked the three family members we spoke with if they felt comfortable in bringing up any issues with the service that they may have concerns about. All said that they did feel able to and would do so. One person told us that there had been an incident which had been dealt with immediately by the registered manager to the person’s satisfaction.

We were told by the registered manager that people’s cultural requirements were supported and that recently the service had changed a person’s support times to accommodate Ramadan. We were also told that there were support workers available who could communicate in Hindu or Gujarati if English was not the person’s or the family’s first language.

We saw that people were treated with respect and that they were encouraged to be as independent as their capabilities would allow.

Is the service responsive to people’s needs?

From speaking with the registered manager and the support workers we found that there was a good understanding of people’s needs. Also some good work had been done by support workers with people using the service in producing personal profile’s of the person which included their likes and dislikes. These documents had pictures and simple text to help the person’s understanding of the information contained within the document.

However we had concerns that the information recorded in the care plans was not signed and dated which meant that people reading the care plan could not be sure of how up to date the care plan was. We were also concerned that some of the recording needed to be more precise so that the reader was not in doubt as to the care needs of the person. We discussed our concerns with the registered manager.

Is the service well led?

Linkability provides services to people with a learning and/or physical disability. The service had two branches; one located at head office in Chorley and one in Heywood. The Heywood branch also covered the Rochdale area.

The organisation is a registered charity and has a board of directors. Members of the board attend the quality sub group meetings which take place every two to three months.

The service had the Investors in People (IIP) Accreditation; silver award. IIP assess and accredit organisations on the management and quality of the service they provide to both people who use the service and those who work for the service.

There were procedures in place for auditing and monitoring finances and health and safety. Linkability had also organised inspections of the four tenancies by the Greater Manchester Fire and Rescue service with regard to the safety of the buildings. From these visits the service had implemented all the recommendations made by the service, completed fire risk assessments and produced evacuation plans. Other quality monitoring checks were completed by the senior support workers and the registered manager. These records were checked and used to improve the service.

Tenants meetings had been re-introduced after a year’s absence and the first meeting was due to take place at the end of August. One of the tenancies had started their own meetings to discuss items which related to their particular needs and requirements.

During our inspection we had the opportunity to speak with four people who used the service, three relatives and two staff. Overall people spoke positively about their experiences. People told us; “Yes I have a file, it tells staff what they need to know about me”, “I would tell the staff if I was not happy with the support I received” and “I like it here, I’m happy”.

We also looked at the individual care records for people. Records provided information for staff about people's needs and wishes and how they wished to be supported.

Suitable arrangements were in place to protect the rights of people who may lack the capacity to make decisions about their own treatment, care and support. The introduction of a new electronic care plan will enable people to take more of active role in planning their care and support.

Staff worked closely with other agencies so that people’s social, emotional and physical health care needs were effectively met.

Adequate numbers of staff were available to meet the needs of people. A recent restructure had taken place allowing for more flexibility when planning people’s support.

Systems to monitor and review the service provided so that people received a safe and efficient service which met their individual needs.

During our inspection visit we spent some time observing and talking with people who used the service and their support staff.

One of the people we spoke with who lived in a shared house, said that they [the tenants] “Knew which staff were on duty each day” and that “they [the staff] helped them with anything they needed to do”. Another person said they were “happy and settled”.

Whilst visiting another person we saw the different methods of communication used by staff to enable this person to maintain some control over their life and their independence. It was evident staff had a good understanding of this persons needs and the support they required.

Information was made available to people about what they could expect from the service and what they could do if they were not happy.

We found there were suitable arrangements in place for the recruitment and selection of staff ensuring they were suitable for the position available.

Staff were provided with on-going training and development ensuring they had the knowledge and skills needed to support people effectively.

The staff spoken with told us they felt supported. They told us, “It’s a good agency to work for”, “There’s an open door policy” and “The manager is very approachable, he does his best to sort things out if there’s a problem”.

Two of the staff members spoken with felt that communication between them, people receiving support and the management team could be improved.