Your Life Your Home

Your Life Your Home is a domiciliary care agency. It provides personal care to people with a learning disability living in their own flats. People's care and housing are provided under separate contractual agreements. At the time of the inspection 17 people were being supported. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff provided effective support to identify people's aspirations and goals and assisted people to plan how these would be met. Staff focused on people's strengths and promoted what they could do. Staff enabled people to access health and social care support in the community.

People were protected from the risks of abuse, harm and discrimination. Staff were able to identify signs of abuse and knew how to report any concerns. People were supported to have their medicines as prescribed and were supported to be as independent as possible with their medicines.

Right Care:

Staff promoted equality and diversity in their support for people. People could communicate with staff as staff understood their individual communication. Staff received training, such as British Sign Language, to aid communication.

Staff provided care to people which was person-centred and promoted people's dignity, privacy and human rights. People’s care plans were written with them and available in easy-to-read formats. People's individual choices were recognised and respected. People were supported to keep in touch with people who were important to them.

People were supported by enough staff, who had been recruited safely. People were involved in the recruitment process.

Right Culture:

The service enabled people and those important to them to work with staff to develop the service. Feedback was requested from people, relatives or health care professionals.

Staff ensured the quality and safety of the service had been assessed to ensure people were safe.

Staff knew and understood people well. The registered manager worked hard to develop strong leadership. Quality monitoring systems had been developed and embedded. Morale within the staff team was high and staff felt valued.

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

Rating at last inspection and update

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Your Life Your Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Your Life Your Home is a domiciliary care agency. It provides personal care to people with a learning disability living in their own homes and flats. People's care and housing are provided under separate contractual agreements. At the time of the inspection 13 people were being supported. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People did not have individual environmental risk assessments to ensure they, and the staff supporting them were safe from harm. When people lived with health conditions, such as epilepsy, their home environment had not been risk assessed to ensure they remained as safe as possible.

Staff reported any maintenance concerns, where these had been identified, such as things needing repairing or redecorating, to the registered manager or maintenance staff and action was taken to complete the necessary work.

Staff knew who to contact in the case of an emergency, such as a problem with gas, electricity or water supplies.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered environmental risks. Based on our inspection of environmental risks we found:

Right support

• Model of care and setting did not always maximises people’s choice, control and independence

Risks within people’s individual homes had not been assessed and discussed with people to see what action was needed to keep them safe. This meant people were not always empowered to make day to day choices or supported to take control of their lives.

Right care

• Care was not always person-centred and did not always promote people’s dignity, privacy and human rights

Environmental risks were not assessed to identify and mitigate potential risks. This meant support was not always centred on the individual. Information was provided to people in a format they could understand.

Right culture

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

Systems and processes to assess and mitigate potential environmental risks were not in place.

People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice.

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

Rating at last inspection and update

The last rating at the inspection on 10 August 2021 was Requires Improvement. There were breaches of Regulations 12, 17 and 19 of the Health and Social Care Act. At the last inspection on 7 September 2021 the service was inspected but was not rated because we only looked at the breach of Regulation 12. At this inspection we identified a breach of Regulation 12 and a continued breach of Regulation 17. We will follow up on the breaches of Regulation in line with our re-inspection programme.

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of falls from a height. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

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

Your Life Your Home is a domiciliary care agency. It provides personal care to people with a learning disability living in their own homes and flats.

People's care and housing are provided under separate contractual agreements. At the time of the inspection 13 people were being supported. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided

People’s experience of using this service and what we found

People were protected from the risks relating to infection prevention and control. Staff had updated their training in relation to infection prevention control and were following this in practice.

The provider, registered manager and staff understood the need to follow Government and Public Health England guidance about the use of personal protective equipment (PPE) and support bubbles, which had not previously been followed throughout the COVID-19 pandemic. Staff observed social distancing guidance and wore PPE appropriately. People were supported to stay safe and wear face masks when they went out.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 9 October 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

Your Life Your Home is a domiciliary care agency. It provides personal care to people with a learning disability living in their own homes and flats. People’s care and housing are provided under separate contractual agreements. At the time of the inspection 13 people were being supported.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not protected from the risks relating to infection prevention and control. Government and Public Health England guidance about the use of personal protective equipment and support bubbles had not been followed throughout the COVID-19 pandemic. Staff had not observed social distancing guidance. People had not been supported to follow national guidance and restrictions.

People were not supported by staff who had been recruited safely. Action to mitigate risks was not consistently robust.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they felt safe being supported by staff from Your Life Your Home. People were supported by a team of staff who knew them well and there were enough staff to provide care and support.

People received their medicines safely and as prescribed. People were supported to manage their own medicines when possible.

There was an open culture where people and staff were valued as individuals. Regular checks and audits were completed, and people’s care records were kept up to date.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Safe and Well-led key questions, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

People were empowered to make day to day choices. They were supported to take control of their care and support and enabled to be as independent as possible.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Support was centred on the individual and promoted people’s dignity, privacy and human rights. Staff were had the skills, experience and knowledge to support people living with learning disabilities and autism. Information was provided to people in a format they could understand.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The registered manager and staff had built positive relationships with people and demonstrated a genuine care for people. Staff spoke passionately about supporting people to increase their independence.

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

Rating at last inspection

The last rating for this service was Good (published June 2018).

Why we inspected

The inspection was prompted in part due to concerns raised regarding unsafe recruitment practices. Whilst reviewing information, additional concerns were raised regarding infection prevention and control. As a result, a decision was made for us to inspect and examine those risks. We undertook a focussed inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, recruitment practice and management oversight.

Please see the action we have told the provider to take at the end of this report.

Your Life Your Home is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger adults living with a learning disability. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection Your Life Your Home were providing the regulated activity of personal care to two people. Both people had a tenancy agreement and lived in their own flats. They received additional support from staff throughout the day.

The care service has 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 learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service is run by a registered manager. A registered manager is a person who has registered with 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.

People told us they felt safe whilst being supported by the staff. People were protected from the risks of abuse and discrimination. Risks associated with people’s care had been identified and there was guidance for staff on how to manage risks and keep people safe. People’s medicines were managed safely and they received them on time. Staff understood their responsibilities in regard to infection control and used protective equipment, such as gloves, when required.

Staff had been recruited safely. They were trained and skilled to provide people with care and support they needed and received regular supervision from the registered manager. There were sufficient staff to provide people with the care they needed when it was needed.

Accidents and incidents were reported in line with guidance and the registered manager reviewed them to check for any pattern to make sure the correct action was taken and that people were referred to other health professionals if needed.

People’s physical and mental health and social needs were assessed. People told us they received care and support from regular staff and that their needs were met.

People told us that staff supported them, when they wanted them to, to prepare meals and eat healthily. They were also supported with their healthcare needs and to access doctors and other healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice. Staff had an understanding of the Mental Capacity Act 2005 and how it impacted on the people they supported. People said the staff asked for their permission to enter their flats and to support them with personal care. People’s privacy and dignity were promoted and maintained.

People told us the staff were kind. Staff listened to people and knew them well. People were involved in making decisions about the level of care and support they needed. People received care that was responsive to their needs. Each person had a care plan, which they had access to, which reflected the support they needed and provided guidance for staff.

People told us they knew how to complain. An easy to read version of the complaints form was available for people to use. People said that staff would help them if they were unhappy about something. Staff supported people to go out in the local area and to enjoy activities of their choice.

People’s choices and preferences for their end of life care were discussed and recorded to make sure staff could follow their wishes.

The registered manager had experience of supporting people living with learning disabilities and oversight of the service. Feedback about the quality of the service was regularly obtained and checked to see if improvements could be made. Staff felt they could speak to the registered manager and the provider if they had a concern and that action would be taken. Audits were completed to assess the care being provided. The registered manager worked with health care professionals, such as local commissioners, care managers and multi-disciplinary teams.