This inspection was announced and took place on the 12 and 13th June 2017.

Halton Adult Placement Service was previously inspected in January 2016 during which we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance, staffing and fit and proper persons employed. At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection.

Halton Adult Placement Service is part of Halton Borough Council (The Provider). The service is coordinated from an office located within the grounds of Runcorn Town Hall.

The service currently provides personal care and support for 52 adults with a diverse range of needs. This includes older people (some of whom are living with dementia) and people with learning and / or physical disabilities who live within the Halton district. 32 people were receiving the regulated activity of ‘personal care’. 24 people were in receipt of day care and eight people received respite care.

At the time of the inspection there was 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.

A divisional manager and the registered manager were present during the two days of the inspection. They engaged positively in the inspection process together with adult placement staff and carers.

The needs of people using the service had been assessed, planned for and kept under review. Risk assessments had been completed alongside each care plan where appropriate, to help staff to identify and control potential and actual risks. Care and support plans viewed were person centred and included key information on what was important to people and how best to support them.

Staff were supported through regular on-going training and supervision to develop the necessary skills and competence for their roles. People spoken with were complimentary of the adult placement service and how well they were supported by the staff. People confirmed they were treated with respect and dignity and told us that the staff understood their specific needs.

People received care and support from staff that had been through robust recruitment procedures to ensure they were of suitable character to work in an adult placement setting. This helped to make sure staff did not pose a risk to people using the service.

Systems had been established to ensure that the management team and staff knew how to respond promptly to suspicion or evidence of abuse and to complaints or concerns. This helped to safeguard the rights and wellbeing of people using the service and confirmed the service was responsive to information of concern.

Where people were not able to indicate what they wanted, staff knew them well enough to anticipate their needs. The requirements of the Mental Capacity Act 2005 were met and staff helped people to express themselves and to seek consent. People told us that they were given choices, allowed to take responsible risks and staff included them in decision making processes. A social worker had been assigned to the adult placement team to undertake mental capacity and best interest assessments subject to the needs of the people using the service. At the time of our inspection no applications had been made to the Court of Protection for a DoLS.

Staff spoken with confirmed they promoted healthy eating and monitored any changes in the wellbeing and needs of people they cared for on an on-going basis. Food safety, nutrition and hydration guidance had been developed for staff to reference. Procedures were also in place to liaise with family members and to arrange GP call outs and initiate referrals to he

We met six service users who were provided with support from the service. They told us they were ” happy” and had no problems. They told us they liked meeting up with other service users and got on well together.

They all told us they liked being with their carer. One person told us they had been out shopping to the local shop and another person told us they liked going swimming.

We spoke to a sample of seven relatives and representatives of service users supported by the adult placement scheme. They were all positive about the service provided and used comments such as “it’s excellent”; “really good”; couldn’t be without it” to describe the support provided.

They all told us they would tell someone if they were not happy with the service provided. Two people told us they had experienced various problems with the transport arriving at different times sometimes a lot later than expected which shortened the time for support to be provided. They told us they had reported these issues with the manager and office staff at the service.

One relative told us they were in regular contact with their carers and had “really good communication” with them and knew what support and care was provided to their relative.

Four relatives told us they had never met the carers who provided support for their relative and they had no contact details for them. They also told us they didn’t know what they did or what they ate when being supported and they advised they had not been included in a review of their adult placement.

Some people gave various suggestions when asked what could be improved with the service. They told us they would like to be in contact with the carers and would like to be involved in any type of review of their adult placement scheme and support provided. They also told us they would like to know what their relative did during their placement and what they had to eat. They advised this would help them especially when they were planning their relative’s meals when arriving home.

Some relatives told us they had the same carer providing support for their relative while some told us their relative went to different carers but they were unsure why.

We had also contacted the local authority contracts and monitoring team for Halton social services before we visited the service. However they advised that they did not review the Adult Placement Scheme.

This inspection was announced and took place on the 18 January 2016. A second day of the inspection took place on 19 January 2016 in order to gather additional information.

Halton Adult Placement Service was previously inspected in December 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

The Halton Adult Placement Service is part of Halton Borough Council (The Provider). The service is coordinated from an office located in the grounds of Runcorn Town Hall.

The service currently provides personal care and support for 62 adults with a range of needs. This includes older people (some of whom have dementia) and people with learning and / or physical disabilities who live within the Halton district.

The main use of the service is for day care however ten people receive respite care.

At the time of the inspection there was no registered manager at Halton Adult Placement 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.

A divisional manager and the manager of the service were present during the two days of the inspection and engaged positively in the inspection process.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that recruitment records were incomplete and did not provide sufficient assurance that people were being cared for by staff that were suitable to work with vulnerable people.

We found that carers had not completed all the necessary induction, core and specialised training relevant to their roles.

We found that the registered person had not established or operated effective systems or processes to assess, monitor and improve the quality and safety of the services provided (including the quality of the experience of service users receiving the service).

People who used the Halton Adult Placement Service or their representatives spoke highly of their experience. All the people we spoke with told us that they liked their carers, got on well with them and looked forward to time with their adult placement link carer.

Likewise, all the adult placement carers we spoke with and met showed a genuine interest and affection for the person or people they cared for and a commitment to providing a person centred service.

Systems had been established to respond to suspicion or evidence of abuse and to complaints or concerns.

Staff spoken with confirmed they promoted healthy eating and monitored any changes in the wellbeing and needs of people they cared for on an ongoing basis. Food safety, nutrition and hydration guidance had also been developed for adult placement carers to reference.

Procedures were also in place to liaise with family members and to arrange GP call outs and initiate referrals to health and social care professionals when necessary.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. We noted that the provider had developed corporate policies and procedures to provide guidance for staff on the MCA and Deprivation of Liberty Safeguards (DoLS).

Training records viewed did not include any details of training in the MCA. Furthermore, adult placement carers spoken with reported that they had not completed training in this protective legislation. We found no evidence that decisions were made on behalf of people that lacked capacity without reference to the MCA framework.