About the service:

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. At the time of our inspection there was one adult and one child using the service.

Not everyone using Live and Learn receives 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.

People’s experience of using this service:

• The provider had continued to make improvements since our last inspection in April and May 2017.

• Staff received better training and continued to receive supervision and support to help them with their work.

• The provider continued to improve the records they kept and the checks they did to make sure people received good, safe care. This included new policies and procedures to make sure staff were up to date with legal requirements.

• People continued to receive safe care by staff who knew the risks people faced. Staff supported people to be independent while keeping them safe.

• The provider reviewed and updated support plans for the person and child using the service. These were personalised and gave staff guidance on the support they required to have their needs, wishes and choices met.

• People and children continued to be protected from abuse. Staff received refresher training in safeguarding adults and children and were aware of the reporting procedures to follow if they witnessed or suspected abuse had occurred.

• People and children continued to participate in a variety of social and recreational activities that met their social and physical needs. They were encouraged to eat and drink sufficient amounts to maintain good health.

• Staff continued to support people and children with their medicine safely .

• The provider and staff worked with healthcare professionals to make sure people and children had the support they needed, when they needed it.

• Relatives told us they thought the staff were good. People and children received support from the same staff, this meant there was a continuity of care and staff knew people and children’s needs well.

• The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for this service after our inspection was “good”.

For more details please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

• At our last inspection the service was rated as “requires improvement”. Our last inspection report was published on 1 June 2017.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Follow up:

• We will continue to monitor this service to ensure people receive safe, compassionate and high-quality care. We will re-inspect in line with our schedule for those services rated as good. We will inspect sooner if we think there is a risk to people.

This inspection took place over two days on 24 April and 2 May 2017 and was announced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in May 2016. At that inspection we gave the service an overall rating of ‘requires improvement’ because the provider was in breach of the regulations. We found the provider did not have effective arrangements to manage risks. Staff had not received all the appropriate and up to date training they needed. The provider had not carried out their own reviews of people and children’s care and support needs. And, they did not have effective systems to assess and monitor the quality and safety of the service or ensured accurate, complete and up to date records were maintained. We asked the provider to take action to make improvements.

We carried out a focussed inspection in November 2016 to check the provider’s progress in meeting legal requirements. Although we found some improvement had been made the provider had not made all the changes needed. The provider told us unforeseen circumstances had impacted on their capacity to prioritise the improvements that were required but said these would be made by the end of December 2016.

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. At the time of this inspection there were two adults and one child using the service.

The service had a registered manager, who was also the provider, 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider had taken action to make the improvements needed to meet legal requirements. Measures were now in place to reduce identified risks to people and children. The provider assessed and reviewed risks to people and children due to their specific health care needs and those posed by the environment. They also ensured detailed plans were in place for staff to follow to reduce and minimise these.

Staff had received training and felt well supported in their roles by the provider. They were aware of their responsibilities in relation to The Mental Capacity Act 2005 (MCA). However staff were still not up to date with moving and handling procedures and any recent developments in this area to enable them to support people effectively. This training was scheduled for completion in May 2017. The provider had also reviewed and improved training provision. But it was too early at this inspection to assess the effectiveness of these new arrangements to check these were leading to improved outcomes for people and children using the service.

The provider had reviewed and updated support plans for each person and child using the service. These were personalised and set out for staff the support people and children required to have their needs, wishes and choices met. Relatives were actively encouraged to participate in planning and reviewing the care and support their family members needed. Where there were changes to people and children's needs, their support plans were updated and staff were immediately made aware so they knew how these should be met.

The provider had implemented a new computer based records management system. Information about people, children and staff was now stored in one place and was easily accessible when required. People and children’s care records were now up to date and accurate. Staff files contained details about the training and supervision they received and evidence of employment and criminal records checks. As these changes had only recently been made it was too early to assess the

We carried out a comprehensive inspection of this service on 17 May 2016 at which breaches of legal requirements were identified. We found the provider did not have effective arrangements to manage risks to people and staff to ensure they were sufficiently protected from the risk of injury and harm. They had not ensured staff had received all the appropriate and up to date training they needed to support people effectively. They had not carried out their own reviews of people’s care and support so that they were assured that these continued to meet their needs. And, they did not have effective systems in place to assess and monitor the quality and safety of the service or ensured records were maintained so that these were accurate, complete and up to date.

We undertook this focused inspection on 3 November 2016. We checked the provider had made the improvements needed to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Live and Learn on our website at www.cqc.org.uk

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. Most people using the service have had their care funded by their local authority. At the time of this inspection there were three people, mainly young adults, using the service.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider had not yet made all the improvements needed to meet legal requirements. The provider told us, since our last inspection, due to unforeseen circumstances they had had to step in and provide direct care and support to people for a significant period of time to ensure they received the care and support they required. The provider said as a result, this had impacted on their ability to prioritise the actions required to make the improvements needed.

The provider told us they had taken some action to make improvements. They had made arrangements to attend training in moving and handling procedures and the Mental Capacity Act 2005 to update their knowledge and skills in these areas. They were also working with an external company to help them identify specific training staff required so that appropriate courses could be arranged for them to attend. The external company was also supporting them to implement new service policies and procedures that would guide staff in how to care for and support people appropriately.

The provider told us the improvements that still needed to be made. These included ensuring information about managing identified risks to people was current and easily accessible, people's care and support plans were current and reviewed regularly to check for any changes to their needs, quality spot checks undertaken on staff were recorded and other records relating to the management of service, such as staff training information was current. The provider said these improvements would be made by the end of December 2016. We will visit the provider after this date to check these improvements had been made.

This inspection took place on 17 May 2016 and was announced. At the last inspection in September 2015 we found the service was meeting the regulations we looked at.

Live and Learn is a small domiciliary care service based in the London Borough of Sutton. The service specialises in providing personal care to children and young adults with a learning disability. Most people using the service have had their care funded by their local authority. At the time of this inspection there were ten people, mainly young adults, using the service.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found the provider in breach of their legal requirement with regard safe care and treatment. The provider had not done all that they should to identify and manage risks to people and staff to ensure they were sufficiently protected from the risk of injury and harm.

We found the provider in breach of their legal requirement with regard staffing. The provider had not ensured staff had received all the appropriate and up to date training they needed to support people effectively.

We found the provider in breach of their legal requirement with regard person centred care. The provider had not ensured that the service arranged their own regular reviews to ensure that the care and support provided to people continued to meet their needs.

We also found the provider in breach of their legal requirements with regard to good governance. The provider’s systems to assess and monitor the quality and safety of care that people experienced were ineffective. Records kept by the service had not been maintained in such a way as to ensure these were complete, accurate and up to date.

You can see what action we told the provider to take with regard these breaches at the back of the full version of the report.

People’s relatives and staff had mixed views about the management of the service. Relatives said they preferred to deal with staff providing care to their family member rather than contacting the provider’s main office where management and administration staff were based. A relative described the main office as ‘chaotic’ and said the office was short staffed. A staff member however told us they felt well supported by the registered manager in terms of dealing with any issues or concerns they had and their own personal development. The registered manager confirmed there had been changes in current staffing arrangements in the main office and they planned to take on all the current administration and management duties themselves.

People’s relatives said staff had the skills and experience to support people with their care. Although staff said they were well supported, the provider had not followed their own policy for ensuring staff received regular formal supervision. The registered manager acknowledged current arrangements were not enough to assure themselves of staff’s on-going competency and ability to carry out their roles effectively. They said these would be reviewed and amended.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. The provider could not be fully assured that all staff were aware of their legal responsibility to act within the principles and codes of conduct associated with the MCA, when obtaining consent from people they supported. This was because they had not ensured staff received training on the MCA. The registered manager agreed to undertake training in the MCA after the inspection. However staff sought people’s consent before providing care and support wherever possible. Outcomes from best interests meetings held by car

We carried out a comprehensive announced inspection of this service on 22 September 2014 and found there was a breach of legal requirements. After this inspection, we told the provider what action we required them to take meet legal requirements. The provider needed to ensure 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 about how the service is run.

We undertook this focused inspection on 8 September 2015 to check the provider was meeting the regulations they were previously breaching and found there was a registered manager in place. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Live & Learn on our website at www.cqc.org.uk

Live & Learn is a domiciliary care agency that provides personal care to people in their own home. It specialises in providing care to younger adults with learning and/or a physical disability. It offers support to approximately ten people with much of its work coming from Surrey County Council.

Below is a summary of what we found. The summary is based on speaking with two people who used the service or their relatives. We also spoke with two care workers, and the manager. We looked at two sets of information about people who used the service and care workers records. There were ten people using the service when we inspected.

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

We considered our inspection findings to answer five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

The provider's staff recruitment and selection process was adequate. Care workers had completed training in keeping vulnerable people safe. Assessments were carried out by staff to make sure that people’s needs were identified so care plans could be developed about how to meet them.

Is the service caring?

People we spoke with were positive about the care provided by care workers. Comments included, “They (care worker) are very calm and placid, just what my child needs”. Another parent said, “She (care worker) was part of our family”.

People were involved in making decisions about how they wanted to be cared for. They told us that care staff respected their privacy and dignity, and that they were involved in making choices about their care.

Is the service responsive?

People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. We found that care workers monitored people’s conditions and where necessary sought the advice and assistance of other community based health professionals such as GPs and district nurses.

Is the service effective?

People received care from care workers that were well informed and trained to meet their needs.

Is the service well-led?

The agency did not have a registered manager as required by legislation. We have asked the provider to tell us what they are going to do to meet the requirements of the law. We will make sure that appropriate action is taken by the provider by completing a follow up inspection in the near future.

Live and Learn provide a service to children and young people who have a physical and/or learning disability. They provide support in the home, including overnight stays, or by taking children and young people out. The agency works with Surrey Social Services and was working with 10 families at the time of our inspection; of these 10 families, four were children under the age of 18 and the rest were young adults.

On the day of our inspection, the manager/owner was unable to be present. The inspector was therefore assisted by an experienced care worker who was in day to day charge of the service whilst the manager was off sick.

We contacted two sets of parents of children who used the service. This was because the children themselves were not able to communicate verbally over the telephone to us to express their views. We also spoke to two members of staff who provided the direct care to the families.

This inspection was carried out as part of the 2012/13 inspection programme. It was also to follow up on two compliance actions which had been made at the previous inspection in February 2013.

Live and Learn provide a service to children and young people who have a physical and/or learning disability. They provide support in the home, including overnight stays, or by taking children out. The agency works with Surrey Social Services and was working with 12 families at the time of our inspection.

We contacted three sets of parents of children who used the service. This is because the children themselves were not able to communicate verbally over the telephone to us to express their views. We also spoke to three members of staff who provided the direct care to the families.

This service was a small independent agency who had worked with families for some years. The manager was also the owner, and often worked with individual families; there was a small, permanent staff team. This meant that there was continuity and consistency with each child having a main worker who did the majority of the visits.

Parents were positive about the support provided by the staff and the level of consistency that they had. One comment we received was, “she (the member of staff) is an absolute God-send” and from another parent, “she (child) always enjoys going out with them”.

There were significant areas that the service could improve on, namely staff training and written documentation relating to the children themselves.

Live and Learn provide a service to children and young people who have a physical and/or learning difficulty. They can provide support in the home, including overnights, or by taking children out. The agency has a contract with Surrey Social Services and currently are working with 17 families.

The agency is a small independent concern who have worked with families for some years, often over 10 years.

The manager is also the owner, and often does the work with individual families, there is also a small staff team. This means that there is continuity and consistency with each child having a main worker who does the majority of the visits. There is then a secondary worker who covers holidays, sickness and other emergencies. This gives consistency to the families.

Parents were positive about the support provided by the workers and the level of consistency that they had. One comment we received was, ‘kids enjoy going out with the workers.' However, their view of the agency was rather different with comments such as the 'agency are reasonable without being over the moon’. Another parent said, 'I find it difficult to communicate with them, they never respond to phone calls or emails.'

There are significant areas that this service could improve on, namely training and supervision of staff. Whilst there was very patchy evidence of either taking place on a regular basis, the manager stated that records had just not been updated. The Commission is requiring the agency to provide improvement plans for both these areas, outlining exactly what training and supervision has been given for each member of staff and what is planned for the future.

The manager remains unregistered with the Commission; this is in direct breach of regulation 5 of the Health and Social Care Act. The manager has stated that she will become registered.