LDN London Domiciliary Care Service

At the time of the inspection the service was supporting 101 people in the City of Westminster, the Royal Borough of Kensington and Chelsea and Camden. Not everyone using Westminster Society Domiciliary Care Services for Adults receives a 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.

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.

There were registered managers in post at the time of our inspection. 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. The service had six registered managers and one nominated individual who were responsible for all services under this registration.

The service was exceptionally caring. People using the service and their relatives spoke extremely positively about the caring and compassionate nature of the staff and felt that staff went above and beyond their expectations of care to meet their needs.

Staff ensured that people's emotional needs were supported at sensitive moments in their life and had worked closely with them, their relatives and health care professionals, especially when managing bereavement.

People were supported to have access to advocates if the provider felt they needed support to have their voice heard. Staff had also supported people when they were unable to or found it difficult to express their

choices and wishes.

People using the service and their relatives were confident they would be listened to and felt the management team were approachable and felt comfortable getting in touch. The provider gave people the opportunity to discuss the issues they faced and supported them to have their voices heard in the wider community.

People were supported to follow their interests and maintain relationships with relatives and friends that mattered to them. The provider had been creative in overcoming barriers to providing support to people and created opportunities for people to carry out a wide range of activities and events with friends with a shared interest. There was evidence that cultural requirements were considered and positive work had been done to raise staff awareness for people who identified as LGBT+ (Lesbian, Gay, Bisexual, Transgender and other ways that people can define themselves, for example Q (Questioning) and I (Intersex)).

Care was personalised to meet people's individual needs and the provider ensured people were fully involved in discussions about how they wanted their care and support. An initial needs assessment was completed from which care plans and risk assessments were developed.

The management team understood the legal requirements of the Mental Capacity Act 2005 (MCA) and staff took the necessary action if they had concerns about people's capacity. We observed that staff respected people's decisions and gained their consent before they offered support.

People's nutritional needs were recorded in their care plans and staff were aware of the level of support required, with further guidance available for people who needed extra support. People were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, psychiatrists and the community learning disability team.

Risks to people were identified during an initial assessment with detailed guidance and control measures in place to ensure their freedom was respected and staff supported them safely. Advice and guidance was sought from health and social care professionals to support staff to manage a range of complex behaviours that challenged the service

New staff received a comprehensive induction training programme to support them in meeting people's needs effectively. They shadowed more experienced staff in supported living services before they started to work independently with people. Staff received regular supervision and told us they felt supported by their staff teams and line managers.

People using the service and their relatives told us they felt safe using the service and staff had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with.

People who required support with their medicines received them safely and all staff had completed training in the safe administration of medicines, which included observations and competency assessments. Appropriate checks were in place to minimise errors and action was taken if errors were reported.

Staff spoke positively about the culture of the service and felt valued as part of the organisation. People and staff were fully involved in the development of the service and staff had opportunities to progress within the organisation.

There was a range of effective quality assurance systems in place to monitor the quality of the service provided, identify any concerns and understand the experiences of people who used the service. The management team were open to feedback to help make improvements within the service.

The five questions we ask about services and what we found