What life is like for people using this service:

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

People were protected from abuse. Staff understood their role and responsibilities for keeping people safe from harm. People told us they felt safe using the service and would tell someone if they felt unsafe. Medication was managed safely. There were safe processes in place to enable people to obtain and administer their own medication. People were supported to take risks as part of an independent lifestyle. People were protected from the risk of the spread of infection because staff followed good infection control practices. People’s needs were met by the right amount of staff who were suitably skilled and experienced.

Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People told us that staff provided them with all the right care and support. Staff were inducted into their roles and completed the training they needed. People were supported to shop for their own food and plan healthy meals of their choice. People received the support they needed with their healthcare. People consented to their care and support. Staff understood people’s rights to make decisions in line with the Mental Capacity Act 2005.

People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy, dignity and independence. Staff supported people to maintain and develop life skills and to achieve their goals and aspirations. Staff understood and supported people to maintain important relationships.

People were involved in the development and reviewing of their care plans. People’s strengths, level of independence, personal history, hobbies and interest were reflected in their care plans. People were supported to access the local community and work opportunities. People were provided with information about how to complain and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The service was well managed by a person who promoted a positive culture that was person centred and inclusive. People and staff described the registered manager as supportive and approachable. They told us they were fully engaged and involved in the running and development of the service. The systems for checking on the quality and safety of the service were effective and helped to make improvements to the service.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 16 June 2015)

About the service: Westwood Care and Support Care Limited provides care and support to people living in three ‘supported living’ settings, so that they can live in their own homes as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection the service was supporting 8 people with a learning disability.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was an announced inspection, carried out on 19 & 25 February 2016. We gave 48 hours’ notice of the inspection because the manager is often out of the office supporting staff or providing care. We needed to be sure that the registered manager or someone who could act on their behalf would be available to support our inspection.

Westwood Care and Support Limited is a domiciliary care agency, providing personal care and support to people living in their own homes. The service operates from an office based in the Halewood area of Knowsely, Liverpool.

The service has a manager who was registered with CQC in May 2011. 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 last inspection of Westwood Care and Support was carried out in November 2013 and we found that the service was meeting all the regulations that were assessed.

People felt safe when they used the service and they had no concerns about the way staff treated them. There were systems in place to protect people from abuse including training for staff and policies and procedures for staff to follow. Staff recognised the different types and indicators of abuse and were confident about reporting any concerns they had.

Staff knew how to deal with an emergency situation and they were confident about what to do should one arise. People who used the service and staff had information about who they could contact for advice, guidance or support at any time of the day or night.

Staff received the training and support they needed. New staff completed an induction programme and all staff received ongoing training relevant to their role, responsibilities and the needs of the people they supported.

The registered provider had a policy and procedure relating to medicine management. Staff responsible for administering medication completed the relevant training and had their competency checked regularly to ensure they were managing people’s medicines safely.

An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans were person centred and detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed with the involvement of the person and other significant people such as family members and relevant health and social care professionals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

People who used the service felt they were treated with kindness and they said their privacy and dignity was respected. People’s independence was promoted, they were supported to do as much as they could for themselves so that they did not lose their independence.

People’s wishes and preferences were accurately reflected in the care plans. Contact records were maintained detailing the support people received and they were an effective way for staff to communicate important information about people.

The culture of the service was positive and open. People who used the service and staff described the registered manager as being approachable and supportive. Systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and t

Staff demonstrated awareness of mental capacity and consent. They explained the way in which they communicated with each person who used the service and described how they were helped to make their choices. One staff member said “We are led by the service users’ needs and not the other way round”.

We spoke with two people who used the service, the relatives of two other people and five members of staff. Comments included:

“They help me to go out, support me with shopping, help me with my budget and help me keep contact with my family and friends”

“[My relative] can tell me and they can tell the staff if they were unhappy. If there was something they didn’t like they could let it be known. I am sure they are happy and safe and well looked after. They bring [my relative] home to me because it’s not so easy for me to get there”.

Before people started to use the service an assessment of their needs and abilities were undertaken. Care plans covered physical, emotional, mental health, social and behavioural needs. They provided clear instructions to staff about what was required to meet each person’s needs. We saw that care plans were reviewed regularly.

Risk assessments considered areas such as falls, moving and handling, difficult behaviours and nutrition and provided instruction to staff on what to do. For example, in the case of a person with heightened anxiety we saw instruction to staff about how to avoid triggers and how to diffuse the situation if it became necessary.

We reviewed the action taken by the provider following a recent safeguarding incident and looked at what had been done to protect the person in the future. We found that a thorough investigation had taken place and appropriate action had been taken. This meant the provider had systems in place to identify and deal with allegations of abuse and prevent the risk of further abuse happening in the future.

We looked at five staff files and saw that they contained notes of supervisions carried out during the year. We also saw that annual appraisals had taken place and were scheduled in for review in the following year. Staff spoken with said they felt well supported and appropriately trained to do their job effectively.

We found there were systems in place to assess and monitor the quality of the service provided. There were policies and procedures in place to support care delivery and provide staff with direction. However, we found there was no system in place to audit and report incidents or manage trends. We discussed this with the registered manager during the visit and they said they would introduce a system with immediate effect.

People who used the service told us they felt included in decisions about their care and support. There were systems in place to enable people to contribute their views about the running of the service. For example a regular meeting had been held for people to discuss issues about their support, people had regular reviews of their support and people had been given the opportunity to complete surveys about their experiences of the service.

People who used the service and their relatives gave us good feedback about the support people had received with their health and personal care. Each person had a care plan which described their strengths and needs, their individual choices and their future goals. Care plans had been reviewed on a regular basis to make sure they were up to date and people had set new goals as part of this.

People gave us good feedback about staff. People told us staff were “Very nice” and one person told us they felt staff were “Excellent”. We found that staff were supporting the aims and objectives of the service in encouraging people to make choices, use their skills, and participate within their local community

People who used the service and relatives told us they would feel confident to raise any concerns or complaints about the service but they had not had reason to do so. They also told us they felt confident the provider would address any issues they raised. The manager told us she had never received a complaint about the service.

We spoke to two people who used the service. We asked their views about how they are involved in making decisions about their support and how the service was run.

People told us they had information about the service which they kept in their home. Most of the people we spoke to said they didn’t really look at their care plan file.

One person told us they generally spoke to the staff or the manager who they saw nearly every day if they had any issues needing to be sorted out.

They all felt that the standard of support provided by the staff was very good.

People generally felt they always received the same staff to provide their support.

Some comments made included, for example:

“I’ve got no problems, I’m happy here and I’ve got everything I want”.

“I’m really looking forward to Christmas; I think we are going for a Christmas meal with the staff”.

”The staff keep me up to date with everything I have some files about the staff in the hall”.

"We have the same regular staff they are very good".