This inspection took place on 17 and 20 April 2018 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The service was last inspected on 16 March 2017, where we found the provider to be in breach of two regulations in relation to staff training and supervision, and notification of other incidents. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Effective and Well-led to at least good. However, the provider did not submit an action plan. At the inspection on 17 and 20 April 2018, we found that the provider had made some improvements but they were not sufficient.

Hackney Shared Lives Scheme is a local authority operated service that supports adults with a learning disability or mental health needs. People using this service receive care and support by individuals, couples and families who have been approved and trained for that role, and are called shared lives carer. People using the service live with the shared lives carers in their homes. At the time of our inspection Hackney Shared Lives Scheme supported 19 people with a learning disability or mental health needs who were settled in long-term placements. A total of 15 shared lives carers had been appointed and some carers had been approved to care for more than one person.

The service did not have a registered manager. The manager had applied to become the registered manager of the service. 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.

Shared lives carers were suitably vetted before they were matched with people. There were appropriate criminal checks in place for the main shared lives carers but the provider was not able to provide copies of support carers’ criminal checks as per their policy. Not all shared lives carers had carried out yearly safeguarding training. However, most shared lives carers knew the provider’s safeguarding reporting procedures. We have made a recommendation about staff training for safeguarding. The provider had not ensured that all shared lives carers completed six core trainings per year as per their policy. Shared lives carers did not receive regular supervision and felt they were not well supported.

People’s care plans were not always comprehensive and were not always reviewed and updated yearly. Shared lives carers and people were not always provided with the updated care plans. The provider did not have processes in place to enable staff to discuss and record people’s end of life care wishes. We have made a recommendation in relation to end of life care planning.

There was lack of oversight of the service due to a shortage of office staff. The provider did not maintain contemporaneous records of people’s care, staff personnel, training, and management of the service. The provider did not always review people and shared lives carers’ views and feedback to continually improve the service.

People using the service had been living with their shared lives carers for a number of years and felt safe with them. The provider had identified, assessed and mitigated risks associated to people’s health, care and mobility needs. People received appropriate support with their medicines management needs. Shared lives carers maintained medicines administration charts when they administered or prompted medicines. There were appropriate health and safety checks in place to ensure people lived in a safe environment.

People’s individual needs were assessed at the time of referral and told us their care, nutrition and hydration needs

This inspection took place on 16 March 2017 and was announced. The provider was given 48 hours’ notice because the location provides a shared lives care service and we needed to be sure that someone would be in. At our previous inspection on 14 January 2016 we found the provider was meeting regulations in relation to the outcomes we inspected.

Hackney Adult Placement Scheme is a Shared Lives service, formerly known as Adult Placements. This means adults who may have learning disabilities or mental health needs receive care and support provided by individuals, couples and families who have been approved and trained for that role. The service is run and managed by the London Borough of Hackney. At the time of our inspection, there were approximately 32 adults using the service, supported by 22 shared lives carers.

A new manager had recently started at the service and they were in the process of applying to become the registered manager of the service. 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.

People using the service told us they liked their living arrangements and they were happy. They were able to lead independent lives with the appropriate level of support and encouragement from their shared lives carers. They were involved in making decisions related to their care, including having a choice about the placement and giving their opinions about the type of placement they would like.

Shared lives carers told us they enjoyed their roles and they were able to forge lasting and meaningful relationships with people. Many had been shared lives cares for a number of years and were aware of the expectations of the role and how to support people in an appropriate manner.

People received support in relation to their food, general health and medicines. This was at a level suitable for their needs, some people were more independent than others but the level of support required was identified during the assessment process and subsequent reviews.

Shared lives carers were recruited in a safe manner, the provider followed guidance from shared lives plus in this regard. Shared lives carers were not always supported to update their training. We found significant gaps in the training records that we saw. Formal supervisions did not always take place either.

A thorough assessment process was in place which included identifying people’s needs, finding a suitable shared lives carer and carrying out risk assessments. People using the service and shared lives carers were given an opportunity to meet and spend time together before coming to an agreement. The wishes of both people using the service and shared lives carers were considered during this process.

Support plans were easy to read and contained person centred information which allowed people to be supported in a manner of their choosing.

Shared lives carers told us there was not much communication from the provider apart from one shared lives coordinator. Vacancies at management level meant that some aspects of service provision such as training and placement reviews had not been fully completed. The provider did not submit statutory notifications to the CQC in a timely manner.

We found two breaches of the regulations in relation to staffing and notifications. You can see what action we have told the provider to take at the back of the full version of this report.

This inspection took place on 14 January 2016 and was announced. The provider was given 48 hours’ notice because the location provides a shared lives care service and we needed to be sure that someone would be in. At our previous inspection on 16 October 2013 we found the provider was meeting regulations in relation to the outcomes we inspected.

Hackney Adult Placement Scheme is a Shared Lives service, formerly known as Adult Placements. This means adults who may have learning disabilities or mental health issues receive care and support provided by individuals, couples and families who have been approved and trained for that role. The service is run and managed by the London Borough of Hackney. At the time of our inspection, there were approximately 35 adults that had been placed with shared lives carers.

There was a registered manager at the service; however she was not managing the service at the time of our inspection. A care co-ordinator was currently managing the scheme. 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.

People using the service told us that the shared lives carers were kind and they liked living with them. They told us they supported them with their medicines, their food and their daily activities if needed. Carers completed medicine records when they administered medicines and told us they helped people to attend health appointments if needed.

Shared lives carers demonstrated empathy towards people that lived with them. They spoke about people as if they were their own family members and told us they did not discriminate against them and included them fully in their family life.

People told us they felt safe and there were procedures in place to help ensure this. Shared lives carers documented financial transactions and receipts were retained and checked by care coordinators. Carers were familiar with safeguarding procedures and the provider took appropriate steps when safeguarding concerns had been raised.

Thorough assessments took place before people came to live with a shared lives carer, these included identifying peoples’ support needs, risk assessments in relation to both people and also the living environment. Thereafter, placement monitoring reviews took place on a yearly basis which helped to ensure that the placement was appropriate and any identified risks were being managed.

Although robust recruitment procedures were in place which helped to ensure that people were placed with vetted carers, ongoing checks on carers were not always in line with the providers own policy. Shared lives carers told us they were happy with the amount of training and support they received.

Carers were aware of the importance of asking people for their consent to care. Support needs assessments and support plans were signed by people using the service, indicating their agreement to them.

Care records were person centred and documented the wishes of people using the service.

Although carers told us they felt well supported, we found that changes in the way the service was managed had meant that some audits to monitor the quality of service were not always taking place as frequently as before.

As part of our inspection we spoke with two people who used the service over the telephone. Both people told us that they were happy with the quality of care offered by their Shared Lives carers. People told us that they got on well with their carers. One person said, "everything is good. I like my carer." Another person said, "I am very happy."

We also spoke with five Shared Lives carers. They told us they felt were supported by the provider. Each carer was aware of the needs of people who used the service. One carer told us, "everything is going very well. So far so good." Another carer commented, "I feel I can speak freely." "Hackney Adult Placement Scheme are great."

At the time of our inspection there were 26 approved Shared Lives carers and the service was provided to 27 people.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was an effective complaints system available and people who used the service were aware of how to complain.

This was the second inspection of this service in the past 12 months. We did not speak to any people who use the service on this occasion, as the purpose of our visit was to to look at some additional outcomes in relation to the dignity and respect, and safeguarding people who use the service from abuse. We concentrated on the system the provider had in place to comply with the regulation. People who spoke with us during our previous inspection of the service told us they were treated with dignity and respect and that they were satisfied with the quality of care provided to them.

People’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

As part of our inspection we spoke with three people who used the service over the telephone. We carried out these reviews on 4 May 2012. Each person who spoke with us told us that they were happy with the quality of care offered by their Shared Lives Carers. In case of one person, they were aware of their move to a more independent setting. People told us that they were supported by their carers well and that carers ask for their opinions. One person said: ‘Yeah, they have been helpful. They are pleasant.’ Another person told us: ‘I find it good. Yeah, I like my carer. They ask what I like.’

During our inspection we also attended a Shared Lives carers’ training session, during which we had an opportunity to speak with 12 carers. All carers who spoke with us told us that they found Hackney Adult Placement Scheme very supportive. One person said that the Registered Manager and both Adult Placement Officers were ‘fantastic’ and ‘so accessible’. Carers felt that they received an excellent level of support. They also told us that the staff were very approachable and they liked the fact that they knew who to talk to if they had any issues to discuss.