Shared Lives Derbyshire is a local authority operated service that supports adults with a learning disability or autistic spectrum disorder to live in the community, in the family home of their shared lives carer. Shared Lives schemes offer an alternative to both residential and more traditional care at home services for people who need personal care and support with their day to day lives. The Care Quality Commission (CQC) regulates the provision of personal care for people who use the service.

At the time of the inspection Shared Lives Derbyshire was involved in supporting people with a learning disability or autistic spectrum disorder who were settled in long-term placements or who took short respite care breaks. The provider is responsible for appointing, training, monitoring and supporting local carers who are self-employed and receive a payment for providing people with personal care, accommodation and other assistance.

This inspection took place on 6 February 2018 and was announced. The provider was given 48 hours’ notice of our intention to conduct the inspection, as we wished to ensure key staff would be available to contribute to the inspection. Telephone calls to shared lives carers were completed on 12 and 13 February 2018. On 23 March 2018 we visited four people at a day centre who lived in full time shared lives arrangements.

At our previous inspection in July 2017, we found one continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a warning notice in relation to the key question, ‘Does the governance framework ensure that responsibilities are clear and that quality performance, risks and regulatory requirements are understood and managed?’ At this inspection we found improvements had been made and the service now met this regulation.

Systems and processes were now in place to check on the quality and safety of services, including medicines administration, with carers trained in medicines administration and medicines administration records kept. Carers training was now monitored to ensure carers met the training requirements set by the provider. Policies specific to the governance of the shared lives scheme were now in place.

People made decisions in relation to their care and support and received support to enable them to be as involved as possible; where people needed support to make decisions their rights were protected under the Mental Capacity Act 2005; we found this had been followed for most people. Care plans were reviewed with people and their carers. People understood their care and support because carers worked with other professionals to ensure people received information in a way that they could understand.

The service is required to have 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. At the time of our inspection there was a registered manager in post. The registered manager understood their responsibilities for the management and governance of the service. The service was focussed on achieving good quality outcomes for people. The service was managed with an open and transparent culture where people were listened to and carers were valued.

The provider had systems in place to enable carers to recognise and respond to allegations or incidents of abuse or harm. Risk assessments were in place to identify day to day risks, as well as risks associated with people’s health conditions; actions were taken to reduce these known risks. Recruitment processes helped to ensure carers were suitable for their role. Processes were in place to match people to suitable carers and therefore carers had sufficient time to care for

This inspection took place over 18, 19 and 20 July 2017 and was announced. The provider was given 48 hours’ notice for the registered manager to make arrangements for us to visit the office, meet with people, talk with shared lives carers and review records. We visited the premises on 18 and 20 July and made phone calls to shared lives carers on 19 July. We visited some people who used the shared lives scheme at a day centre on 18 July.

The service provides personal care to people who live with shared lives carers in their homes either on a full time or short term basis. The service operates across Derbyshire. At the time of this inspection 44 people were cared for in full time arrangements and 31 people in short term care.

Not all shared lives carers who administered medicines had received training in medicines management and had received clear instructions to record any medicines administered to people.

Therefore evidence to show all people received their medicines as prescribed was not complete.

This meant not all people had complete and accurate records of their care; as a result, systems and processes to assess, monitor, improve, identify and reduce risks were not effective as records reviewed of people's care were incomplete. In addition, systems to ensure effective audits of MAR charts were not in place.

Policies and procedures concerned with ensuring the quality and safety of services were not fully adopted and embedded for the shared lives Derbyshire service.

Improvements had been made to ensure shared lives carers received training in other areas identified as required by the provider. Where training was still outstanding, this was identified and monitored to ensure steps were taken to complete the training.

The service is required to have 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. At the time of our inspection there was a registered manager in place.

People felt safe with their care and support. Risks were identified and actions to manage risks were in place, for example any risks associated with health conditions.

Recruitment checks were in place for the recruitment of shared lives carers. These checks helped the provider make safer recruitment decisions.

Processes were in place to manage any accidents and incidents should they arise.

The provider had a policy and procedure in place on the Mental Capacity Act 2005 to follow, should a person not have the capacity to consent to their care. Shared lives carers sought people’s consent before they provided care.

People had sufficient food and drink that met their preferences. Records showed any specific dietary needs, such as the need for a diabetic diet, were identified and met. Shared lives carers were aware of people’s healthcare needs and supported people to access other healthcare provision when required.

Shared lives carers felt supported by the registered manager and members of the shared lives team and had regular contact with them.

People felt cared for by their shared lives carers and felt included in planning their lives together.

Shared lives carers understood people's needs and how to meet these. In addition people's hobbies and interests were known and supported. People knew how to raise any worries or concerns, and had been able to do so. People received personalised and responsive care.

Shared lives carers respected people’s dignity and privacy and promoted their independence. The shared lives project manager promoted awareness of dignity in care and had become a dignity champion. People were involved in planning and reviewing their care and support.

The shared lives team promoted open and inclusive ways of worki

This inspection took place on 18 May 2016 and was announced. A second day of inspection took place on 23 May 2016 in order to visit people being cared for at their home.

Shared Lives Derbyshire recruits and monitors paid carers to provide support to adults with learning disabilities within carers’ own homes. At the time of this inspection 70 people received support from paid carers recruited by the scheme.

The registered manager had been in post for six weeks at the time of our 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.

We found checks help ensure people were safe were not always completed. Safeguarding and medicines management training for shared lives carers was not always up to date. Medicines recording practice did not always follow good practice guidance. Shared lives carers’ training and their skills and knowledge of the Mental Capacity Act (MCA) 2005 had not been consistently kept up to date.

The service did not ensure people had access to information about how to make a complaint or express a concern about the service. Nor did it have systems and processes that ensured the service reviewed all complaints and concerns raised by people using the service. Other systems and processes were not effectively operated to ensure the quality and safety of services and to ensure risks were identified and reduced.

People received support from sufficient numbers of shared lives’ carers. People received individual support and attention when living in households with more than one person being cared for. Shared lives carers were checked prior to accepting a care arrangement to ensure they were safe to care for people using the service. People were cared for within warm and caring relationships within family environments.

Shared lives carers’ demonstrated they understood how to support people maintain their independence and promote their dignity and privacy. People received responsive and personalised care and were involved in planning their support. People’s views were listened to and respected. People were supported with any dietary needs and received sufficient nutrition and hydration.

The service was viewed as approachable and the registered manager was leading a review of the development of the service with an open leadership style.